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The RCT may have been too small to rule out differences, and concealment may have been difficult to achieve because of the side-effects of the peelings.27 The open non-randomised trial has major limitations that compromise the validity of the results. The design of the study is not the most appropriate to answer a clinical question referring to treatment effectiveness. Befor-after comparisons do not allow firm conclusions to be drawn, and comparisons with results of previous reports from different populations may be misleading.28

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