7. Sulphur compared to benzoyl peroxide.
| Sulphur compared to benzoyl peroxide for acne | ||||||
| Patient or population: participants with acne Settings: Wayne State University Health Service Intervention: topical sulphur Comparison: topical benzoyl peroxide | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Topical benzoyl peroxide | Topical sulphur | |||||
|
Participants' global self‐assessment of acne improvement Numerical point system defined by investigator, high = well (medium term: treatment duration from 5 to 8 weeks) |
The score (high = well) was 0.75 in sulphur group and 0.66 in benzoyl peroxide group. | 34 (1 study) | ⊕⊝⊝⊝ Very lowa | SDs were missing. | ||
|
Withdrawal for any reason (medium term: treatment duration from 5 to 8 weeks) |
125 per 1000 | 334 per 1000 (78 to 1000) | RR 2.67 (0.62 to 11.39) | 34 (1 study) | ⊕⊝⊝⊝ Very lowb | ‐ |
| Total number of participants who experienced at least one minor adverse event | See comment | See comment | See comment | See comment | See comment | Total number of participants who experienced at least one adverse event not reported. But the authors reported that five patients in the benzoyl peroxide group (5/16) versus zero in sulphur group (0/18) developed erythema and drying. |
| Quality of life | ‐ | ‐ | ‐ | ‐ | ‐ | Not measured |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio; SD: standard deviation. | ||||||
| GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate. | ||||||
aDowngraded by four levels to very low quality evidence. Two levels for risk of bias: only one study included with high risk of attrition bias and unclear risk of selection, performance, detection, and reporting bias. Two levels for imprecision: very small sample size. bDowngraded by three levels to very low quality evidence. One level for risk of bias: only one study included with high risk of attrition bias and unclear risk of selection, performance, detection, and reporting bias. Two levels for imprecision: wide CI and optimal sample size not met. *We choose a mean baseline risk from the studies included in meta‐analysis, calculated as number of participants in the control groups with event divided by total number of participants in control groups (study population) as assumed risk.