Comment

The withdrawal rate was high in the first RCT,21 which compromised the validity of the results. Both RCTs have small samples, which make it difficult to draw conclusions with confidence. The RCT done in black people22 may have had insufficient power to rule out an effect, as CIs for physician-assessed changes were broad. It is impossible to draw reliable conclusions on the effects of retinoids in Caucasian women. The trials done in Asian people17 and black people22 were small, so the finding of no differences does not rule out the possibility of a clinically important effect. Side-effects, however, were quite common in people receiving retinoids. It is unknown whether the use of sunscreens may have introduced any confounding.

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