A common criticism of Cochrane skin reviews by dermatology trainees, is that they always end up with the same conclusion of "insufficient evidence" to inform current practice. Whilst this may be true for some reviews, a glance at those reviews on the Cochrane Database of Systematic Reviews shows that at least 50% of those relevant to a practising dermatologist make specific and clear recommendations for therapy.21 Even "null reviews" that do not find any good evidence to make specific treatment recommendations have their uses. Thus, a recent systematic review evaluating the evidence for antistreptococcal treatments for guttate psoriasis found no reliable evidence despite confident textbook recommendations in favour of such a treatment approach.11 Not only does this identify a major gap needing research, it also reassures doctors and their patients that they are not missing some important study. It empowers doctors to feel more confident in relying on other levels of evidence such as case series and empirical reasoning based on mechanism until better studies are done. It also empowers patients with guttate psoriasis by allowing them to challenge doctors who insist that they must take prolonged courses of antibiotics or who threaten to take out their tonsils (Figure 54.4).
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Do You Suffer From the Itching and Scaling of Psoriasis? Or the Chronic Agony of Psoriatic Arthritis? If so you are not ALONE! A whopping three percent of the world’s populations suffer from either condition! An incredible 56 million working hours are lost every year by psoriasis sufferers according to the National Psoriasis Foundation.