Evidence was reviewed according to the hierarchy of evidence whereby systematic reviews of randomised controlled trials (RCTs) are accepted as the most robust evidence, followed by individual RCTs. The primary source of evidence was therefore a recent systematic review of all acne therapies, prepared for the Agency for Healthcare Research and Quality (AHRQ).14 This was supplemented by evidence located by searches in the following databases: Cochrane Library (Issue 1 2002), Cochrane Skin Group Specialist Trial Register, Medline (1966 to February 2002) and Embase (1980 to February 2002). An initial filter was applied to locate all acne trials [((study or trial) and acne).mp] and then more specific terms were applied within this set for individual interventions. No exclusions on the basis of language or study type were made.
The impact of detergent bases on the control of sebum has not been ascertained, although it has been hypothesised that removal of sebum may enhance the activity of topically applied antibacterials. There is also controversy as to whether exfoliation using abrasives clears blocked PSDs and speeds up lesion healing, or whether associated irritancy and drying may
aggravate inflamed skin. Antibacterial agents reduce surface bacteria, but there is little evidence to suggest that they penetrate the PSD.
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