Table.
GRADE Evaluation of interventions for Wrinkles.
| Important outcomes | Adverse effects, Quality of life, Wrinkle improvement | ||||||||
| Studies (Participants) | Outcome | Comparison | Type of evidence | Quality | Consistency | Directness | Effect size | GRADE | Comment |
| What are the effects of treatments for skin wrinkles? | |||||||||
| 2 (912) | Wrinkle improvement | Tazarotene versus placebo/vehicle cream | 4 | –1 | –1 | 0 | 0 | Low | Quality point deducted for incomplete reporting of results; consistency point deducted for inconsistent effect with different doses |
| 2 (291) | Wrinkle improvement | Tazarotene versus tretinoin | 4 | –2 | –1 | 0 | 0 | Very low | Quality points deducted for uncertainty about randomisation and allocation concealment, and inconsistent assessment of results; consistency point deducted for conflicting results |
| 13 (1480) | Wrinkle improvement | Tretinoin versus vehicle cream | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for uncertainty about randomisation and allocation concealment, inconsistent assessment of results, and short-term follow-up in some RCTs; consistency point deducted for conflicting results, but added for dose response |
| 2 (1099) | Wrinkle improvement | Isotretinoin versus vehicle cream | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for poor follow-up, no intention-to-treat analysis, and incomplete reporting of results |
| 2 (149) | Wrinkle improvement | Glycolic acid versus vehicle cream | 4 | –2 | 0 | –1 | 0 | Very low | Quality points deducted for sparse data, and incomplete reporting of results; directness point deducted for uncertainty about clinical significance of the outcome; consistency point deducted for conflicting results, but added for possible dose response |
| 1 (74) | Wrinkle improvement | Lactic acid versus vehicle cream | 4 | –2 | 0 | –1 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results; directness point deducted for uncertainty about clinical significance of the outcome |
| 3 (55) | Wrinkle improvement | Carbon dioxide laser versus dermabrasion | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and incomplete reporting of results |
| 2 (44) | Wrinkle improvement | Carbon dioxide laser versus chemical peel (including alpha and beta hydroxyl acids) | 4 | –3 | –1 | 0 | 0 | Very low | Quality points deducted for sparse data, inadequate blinding, and incomplete reporting of results; consistency point deducted for contradictory results |
| 4 (83) | Wrinkle improvement | Carbon dioxide laser versus erbium:YAG laser | 4 | –3 | –1 | –1 | 0 | Very low | Quality points deducted for sparse data, incomplete blinding, and incomplete reporting of results; consistency point deducted for conflicting results; directness point deducted for different outcomes assessed |
| 1 (20) | Wrinkle improvement | Carbon dioxide laser versus carbon dioxide laser plus variable pulse erbium:YAG laser | 4 | –3 | 0 | 0 | 0 | Very low | Quality point deducted for sparse data, incomplete blinding, and incomplete reporting of results |
| 19 (3195) | Wrinkle improvement | Botulinum toxin injection versus placebo | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for weak methods (possible bias, and pharmaceutical involvement in publications) |
We initially allocate 4 points to evidence from RCTs, and 2 points to evidence from observational studies. To attain the final GRADE score for a given comparison, points are deducted or added from this initial score based on preset criteria relating to the categories of quality, directness, consistency, and effect size. Quality: based on issues affecting methodological rigour (e.g., incomplete reporting of results, quasi-randomisation, sparse data [<200 people in the analysis]). Consistency: based on similarity of results across studies. Directness: based on generalisability of population or outcomes. Effect size: based on magnitude of effect as measured by statistics such as relative risk, odds ratio, or hazard ratio.