Too many placebo-controlled randomised trials are conducted in dermatology even when alternative therapies exist. As a consequence, a large number of similar molecules used for the same clinical indication can be found in some areas, for example topical steroids. Many regulatory agencies still consider placebo controls as the "gold standard".24 There is a need to establish criteria for the use of placebo in dermatology. The criteria should be developed with the active and informed participation of the public and should be considered by ethics committees and regulatory agencies. "Pragmatic" randomised trials conducted under conditions close to clinical practice and contrasting alternative therapeutic regimens are urgently needed to guide clinical decisions.
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