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Clinical practice guidelines for treatment of acne vulgaris: a critical appraisal using the AGREE II instrument

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Abstract

A significant number of clinical practice guidelines (CPGs) about the treatment of acne vulgaris in adolescents and adults have been published worldwide. However, little is known about the quality of CPGs in this field. The aim of this study was to appraise the methodological quality of published acne vulgaris CPGs. We performed a systematic review of published CPGs on acne vulgaris therapy from July 2002 to July 2012. Three reviewers independently assessed each CPG using the AGREE II instrument. A standardized score was calculated for each of the six domains. Our search strategy identified 103 citations but just six met our inclusion criteria. Agreement among reviewers was very good: 0.981. The domains that scored better were: “scope and purpose” and “clarity and presentation”. Those that scored worse were “stakeholder involvement”, “rigor of development”, and “applicability”. The European and the Malaysian CPGs were the only recommended with no further modifications. In addition, the Mexican, Colombian and the United States guidelines were recommended with provisos, with lower scores regarding stakeholder involvement, rigor of development and applicability. Only two guidelines clearly reported outcome measures for evaluating efficacy or included quality of life outcomes. CPGs varied regarding the consideration of light/laser therapy or consideration of complementary/alternative medicines. None of them included cost considerations of drugs such as systemic isotretinoin. In conclusion, published acne vulgaris CPGs for acne therapy vary in quality with a clear need to improve their methodological rigor. This could be achieved with the adherence to current CPGs development standards.

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Acknowledgments

Dr. Gloria Sanclemente is a PhD Candidate of the Universitat Autònoma de Barcelona, Spain. This work was supported by the Group of Investigative Dermatology-GRID (University of Antioquia), Medellin, Colombia, which is an academic research group with no affiliation with any pharmaceutical company.

Conflict of interest

Dr. Gloria Sanclemente has received speaker fees and support for attending meetings from pharmaceutical companies that sell acne vulgaris products such as Galderma and Roche laboratories, and from other companies not involved with acne products such as Pfizer and Jannsen-Cilag.

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Authors and Affiliations

  1. Group of Investigative Dermatology (GRID), School of Medicine, University of Antioquia, Carrera 20 # 2 Sur 185, Cons 1002 Clinica El Rosario, El Tesoro, Medellín, Colombia

    Gloria Sanclemente

  2. Public Health Department, Universidad del Norte, Barranquilla, Colombia

    Jorge-Luis Acosta

  3. Pediatrics Department, School of Medicine, University of Antioquia, Medellín, Colombia

    Maria-Eulalia Tamayo

  4. Iberoamerican Cochrane Center, IIB- Sant Pau, CIBERESP, Universitat Autònoma de Barcelona, Barcelona, Spain

    Xavier Bonfill & Pablo Alonso-Coello

  5. PhD Program in Salud Pública y Metodología de la Investigación Biomédica of the Departament de Pediatria, d’Obstetrícia i Ginecologia i de Medicina Preventiva, Universitat Autònoma de Barcelona, Barcelona, Spain

    Gloria Sanclemente

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  1. Gloria Sanclemente
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Correspondence to Gloria Sanclemente.

Appendix [4, 15]

Appendix [4, 15]

Databases searched for CPGs in Acne Vulgaris.

  1. 1.

    National Guideline Clearinghouse (NGC) http://www.guideline.gov/.

  2. 2.

    Canadian Medical Association (CMA) http://www.cma.ca/.

  3. 3.

    Scottish Intercollegiate Guidelines Network (SIGN) http://www.sign.ac.uk.

  4. 4.

    New Zealand Guidelines Group (NZGG) http://www.nzgg.org.nz/.

  5. 5.

    TRIP database http://www.tripdatabase.com/.

  6. 6.

    MEDLINE http://www.pubmed.gov/.

  7. 7.

    NeLH National Electronic Library for Health https://www.evidence.nhs.uk/.

  8. 8.

    Handbook of United Kingdom and European clinical guidelines for primary and shared care http://www.eguidelines.co.uk/about_guidelines.php.

  9. 9.

    AEZQ/AQuMed German Agency for Quality in Medicine http://www.aezq.de/.

  10. 10.

    CISMeF Catalog and Index of French-language health resources http://www.chu-rouen.fr/cismef/cismefeng.html.

  11. 11.

    Francophones/Catalog and Index of French -language health resources http://www.chu-rouen.fr/cismef/cismefeng.html.

  12. 12.

    NICE National Institute for Clinical Excellence http://www.nice.org.uk/.

  13. 13.

    GPC de la American Academy of Pediatrics http://www.aap.org/en-us/professional-resources/practice-support/quality-improvement/Pages/Clinical-Practice-Guidelines.aspx.

  14. 14.

    GPC Universidad California http://compliance.uclahealth.org/body.cfm?id=23.

  15. 15.

    Guidelines International Network http://www.g-i-n.net.

  16. 16.

    Grading of Recommendations Assessment, Development and Evaluation http://www.gradeworkinggroup.org/.

  17. 17.

    ICSI Institute for Clinical Systems Improvement http://www.icsi.org.

  18. 18.

    South African Departament of Health http://www.doh.gov.za/.

  19. 19.

    AHRQ Agency for Healthcare Research and Quality http://www.ahrq.gov.

  20. 20.

    ACP American College of Physicians http://www.acponline.org.

  21. 21.

    Singapore Ministery of health Guidelines http://www.moh.gov.sg/content/moh_web/home/Publications/guidelines/cpg.html.

  22. 22.

    CINAHL Cumulative Index to Nursing & Allied Health Literature.

  23. 23.

    Cochrane Library Plus http://www.update-software.com/clibplus/clibpluslogon.htm.

  24. 24.

    WHOLIS Sistema de información de la Biblioteca de la OMS http://www.who.int/library/databases/wholis_tutorial/es/.

  25. 25.

    MEDCARIB Literatura del Caribe en Ciencias de la Salud http://liscuba.sld.cu/index.php?P=FullRecord&ID=1647.

  26. 26.

    ADOLEC Salud en adolescencia http://www.adolec.org.ni/php/index.php.

  27. 27.

    PAHO Catálogo de la Biblioteca Sede de la OPS http://www.paho.org/.

  28. 28.

    LILACS http://lilacs.bvsalud.org/.

  29. 29.

    European Academy of Dermatology and Venereology http://www.eadv.org/.

  30. 30.

    American Aacademy of Dermatology http://www.aad.org/.

  31. 31.

    British Association of Dermatology (BAD) http://www.bad.org.uk.

  32. 32.

    American Academy of Pediatrics http://www.aap.org.

  33. 33.

    Associazione Italiana Dermatologi Ambulatoriali http://www.aida.it/.

  34. 34.

    Australasian College of Dermatologists http://www.dermcoll.asn.au/.

  35. 35.

    Danish Society of Dermatology http://www.danderm-pdv.is.kkh.dk/.

  36. 36.

    Dermatology Foundation http://dermatologyfoundation.org/.

  37. 37.

    Internet Dermatology Society http://telemedicine.org/.

  38. 38.

    Pacific Dermatologic Association http://www.pacificderm.org/.

  39. 39.

    Société Française de Dermatologie http://www.sfdermato.org/.

  40. 40.

    Society for Investigative Dermatology http://www.sidnet.org/.

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Sanclemente, G., Acosta, JL., Tamayo, ME. et al. Clinical practice guidelines for treatment of acne vulgaris: a critical appraisal using the AGREE II instrument. Arch Dermatol Res 306, 269–277 (2014). https://doi.org/10.1007/s00403-013-1394-x

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