Background: Acne vulgaris is a multifaceted skin disorder, affecting more than 85% of young individuals worldwide. Pharmacological therapy is not always desirable because of the development of antibiotic resistance or the potential risk of adverse effects. Non‐pharmacological therapies can be viable alternatives for conventional therapies. However, sufficient evidence‐based support in the efficacy and safety of non‐pharmacological therapies is lacking. Objective: To assess the efficacy and safety of several non‐pharmacological therapies in the treatment of acne vulgaris. Methods: A systematic literature review, including a best‐evidence synthesis, was performed to identify literature. Three electronic databases were accessed and searched for studies published between January 2000 and May 2017. Results: Thirty‐three eligible studies were included in our systematic review. Three main types of non‐pharmacological therapies were identified laser‐ and light‐based therapies, chemical peels and fractional microneedling radiofrequency. The majority of the included studies demonstrated a significant reduction in acne lesions. However, only seven studies had a high methodologic quality. Based on these seven trials, a best‐evidence synthesis was conducted. Strong evidence was found for glycolic acid (10–40%). Moderate evidence was found for amino fruit acid (20–60%), intense pulsed light (400–700 and 870–1200 nm) and the diode laser (1450 nm). Initially, conflicting evidence was found for pulsed dye laser (585–595 nm). The most frequently reported side‐effects for non‐pharmacological therapies included erythema, tolerable pain, purpura, oedema and a few cases of hyperpigmentation, which were in most cases mild and transient. Conclusion: Circumstantial evidence was found for non‐pharmacological therapies in the treatment of acne vulgaris. However, the lack of high methodological quality among included studies prevented us to draw clear conclusions, regarding a stepwise approach. Nevertheless, our systematic review including a best‐evidence synthesis did create order and structure in resulting outcomes in which a first step towards future research is generated.
Acne vulgaris is considered one of the most common medical skin conditions globally, affecting approximately 85% of individuals worldwide. While acne is most prevalent among adolescents between 15 to 24 years old, it is not uncommon in adults either. Acne addresses a number of different challenges, causing a multidimensional disease burden. These challenges include clinical sequelae, such as post inflammatory hyperpigmentation (PIH) and the chance of developing lifelong disfiguring scars, psychological aspects such as deficits in health related quality of life, chronicity of acne, economic factors, and treatment-related issues, such as antimicrobial resistance. The multidimensionality of the disease burden stipulates the importance of an effective and timely treatment in a well organised care system. Within the Netherlands, acne care provision is managed by several types of professional care givers, each approaching acne care from different angles: (I) general practitioners (GPs) who serve as ‘gatekeepers’ of healthcare within primary care; (II) dermatologists providing specialist medical care within secondary care; (III) dermal therapists, a non-physician medical professional with a bachelor’s degree, exclusively operating within the Australian and Dutch primary and secondary health care; and (IV) beauticians, mainly working within the cosmetology or wellness domain. However, despite the large variety in acne care services, many patients experience a delay between the onset of acne and receiving an effective treatment, or a prolonged use of care, which raises the question whether acne related care resources are being used in the most effective and (cost)efficient way. It is therefore necessary to gain insights into the organization and quality of Dutch acne health care beyond conventional guidelines and protocols. Exploring areas of care that may need improvement allow Dutch acne healthcare services to develop and improve the quality of acne care services in harmony with patient needs.
Background: A highly promoted opportunity for optimizing healthcare services is to expand the role of nonphysician care providers by care reallocation. Reallocating care from physicians to non-physicians can play an important role in solving systemic healthcare problems such as care delays, hospital overcrowding, long waiting lists, high work pressure and expanding healthcare costs. Dermatological healthcare services, such as the acne care provision, are well suited for exploring the opportunities for care reallocation as many different types of care professionals are involved in the care process. In the Netherlands, acne care is mainly delivered by general practitioners and dermatologists. The Dutch healthcare system also recognizes non-physician care providers, among which dermal therapists and beauticians are the most common professions. However, the role and added value of non-physicians is still unclear. The present study aimed to explore the possibilities for reallocating care to nonphysicians and identify drivers for and barriers to reallocation. Methods: A mixed-method design was used collecting quantitative and qualitative data from representatives of the main 4 Dutch professions providing acne care: dermatologists, GP’s, Dermal therapists and beauticians. Results: A total of 560 questionnaires were completed and 24 semi-structured interviews were conducted. A broad spectrum of non-physician tasks and responsibilities were delineated. Interviewed physicians considered acne as a low-complexity skin condition which made them willing to explore the possibilities for reallocating. A majority of all interviewees saw a key role for non-physicians in counselling and supporting patients during treatment, which they considered an important role for increasing patients’ adherence to proposed treatment regimes, contributing to successful clinical outcome. Also, the amount of time non-physicians spend on patients was experienced as driver for reallocation. Legislation and regulations, uncertainties about the extent of scientific evidence and proper protocols use within the non-physician clinical practice were experienced as barriers influencing the possibilities for reallocation. Conclusions: Delineated roles and drivers demonstrate there is room and potential for reallocation between physicians and non-physicians within acne healthcare, when barriers are adequately addressed.
LINK
Acne Vulgaris is een veelvoorkomende huidaandoening die naar schatting 85-90% van de wereldbevolking in de leeftijdscategorie 15-24 jaar treft. Alhoewel acne veelal wordt beschouwd als een cosmetisch probleem, kan de ziekte een grote impact hebben op de kwaliteit van leven. Dit vraagt om een gerichte aanpak in acnezorg. Er zijn veel verschillende behandelingen mogelijk om acneklachten te verminderen. Echter blijkt uit onderzoek dat mensen met acne gemiddeld pas na 3,7 jaar een effectieve behandeling vinden, met de kans op levenslange acnelittekens.Doel Het primaire doel van het ACTE-onderzoek is het verkrijgen van inzicht in de meest doelmatige en doeltreffende zorg rondom mensen met acne. Daarbij wordt in het bijzonder gekeken naar de toegevoegde waarde van geïntegreerde ketenzorg en/of zorgpaden. Wat we hiermee willen bereiken? - (Snellere) afname van acne - Betere kwaliteit van leven van mensen met acne - Het vergroten van de patiënttevredenheid met betrekking tot acnezorg - Zinnige en zuinige zorg/de juiste zorg op de juiste plaats Resultaten Er lijken aanwijzingen te zijn dat veel niet-medicamenteuze behandelingen, zoals peelings en licht- en lasertherapieën effect hebben op het verminderen van acne. Eerste resultaten Looptijd 01 december 2015 - 01 september 2020 Aanpak In het ACTE-onderzoek staan de volgende vraagstellingen centraal: • Wat is de effectiviteit van niet-medicamenteuze behandelinterventies in de behandeling van acne vulgaris? (literatuuronderzoek) • Hoe is de Nederlandse acnezorg georganiseerd en wat zijn belemmerende en bevorderende factoren voor het optimaliseren van de doeltreffendheid en doelmatigheid van acnezorg, volgens acne zorgprofessionals? (kwalitatief onderzoek) • Welke zorg(paden) doorlopen mensen met acne en welke zorg(paden) dragen bij aan het verhogen van de doelmatigheid en doeltreffendheid van acnezorg, volgens mensen met acne? (survey-onderzoek).
Acne Vulgaris is een veelvoorkomende huidaandoening die naar schatting 85-90% van de wereldbevolking in de leeftijdscategorie 15-24 jaar treft. Alhoewel acne veelal wordt beschouwd als een cosmetisch probleem, kan de ziekte een grote impact hebben op de kwaliteit van leven. Dit vraagt om een gerichte aanpak in acnezorg. Er zijn veel verschillende behandelingen mogelijk om acneklachten te verminderen. Echter blijkt uit onderzoek dat mensen met acne gemiddeld pas na 3,7 jaar een effectieve behandeling vinden, met de kans op levenslange acnelittekens.Doel Het primaire doel van het ACTE-onderzoek is het verkrijgen van inzicht in de meest doelmatige en doeltreffende zorg rondom mensen met acne. Daarbij wordt in het bijzonder gekeken naar de toegevoegde waarde van geïntegreerde ketenzorg en/of zorgpaden. Wat we hiermee willen bereiken? - (Snellere) afname van acne - Betere kwaliteit van leven van mensen met acne - Het vergroten van de patiënttevredenheid met betrekking tot acnezorg - Zinnige en zuinige zorg/de juiste zorg op de juiste plaats Resultaten Er lijken aanwijzingen te zijn dat veel niet-medicamenteuze behandelingen, zoals peelings en licht- en lasertherapieën effect hebben op het verminderen van acne. Eerste resultaten Looptijd 01 december 2015 - 01 september 2020 Aanpak In het ACTE-onderzoek staan de volgende vraagstellingen centraal: • Wat is de effectiviteit van niet-medicamenteuze behandelinterventies in de behandeling van acne vulgaris? (literatuuronderzoek) • Hoe is de Nederlandse acnezorg georganiseerd en wat zijn belemmerende en bevorderende factoren voor het optimaliseren van de doeltreffendheid en doelmatigheid van acnezorg, volgens acne zorgprofessionals? (kwalitatief onderzoek) • Welke zorg(paden) doorlopen mensen met acne en welke zorg(paden) dragen bij aan het verhogen van de doelmatigheid en doeltreffendheid van acnezorg, volgens mensen met acne? (survey-onderzoek).
