Hunt 1992.

Study characteristics
Methods	Aim of study: to compare the efficacy and skin tolerance of a topical alpha hydroxy acid preparation gluconolactone 14% in solution, with its vehicle alone (placebo) and 5% BPO lotion in treatment of mild to moderate acne Design: parallel Unit of allocation: patients Allocation: randomisation; no details Blinding: blinding for participants, investigators and assessors Duration of trial (from recruitment to last follow‐up): not described Dropouts: 15 dropouts with reasons; 4 discontinued due to irritation of the skin
Participants	Population description: mild to moderate acne Setting: not described Randomised number: 150 Age: 20.1 (13 to 36) years Sex: 76/74 Severity of illness: mild to moderate
Interventions	Name of treatment group: alpha‐hydroxy acid group. n = 50 Description: alpha hydroxy acid preparation gluconolactone 14% in aqueous solution (formulation developed by Narhex Australia Pty Ltd) Treatment period: not described Timing: not described Name of control group 1: placebo group. n = 50 Description: the vehicle of treatment group Treatment period: not described Timing: not described Name of control group 2: BPO group. n = 50 Description: 5% BPO water‐based lotion Treatment period: not described Timing: not described
Outcomes	Primary outcomes Participants' global self‐assessment of acne improvement (e.g. measured by a 4‐point scale: excellent, good, fair, and poor). Authors did not report this outcome. Withdrawal for any reason (15 withdrawals during 12 weeks' study) Secondary outcomes Change in lesion counts (total or inflamed and non‐inflamed separately). From baseline to week 12, percentage reduction of lesion counts. Physicians' global evaluation of acne improvement. Authors did not report this outcome. Minor adverse events (assessed as total number of participants who experienced at least one minor adverse event) Skin reactions were graded using a 4‐point scale (0‐nil, 1‐mild, 2‐moderate to 3‐severe). Reported number of participants who experienced minor adverse events. Quality of life. Authors did not report this outcome.
Notes	Funding: Narhex Australia Pty Ltd
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "the patients were randomised into three treatment groups..." Comment: but no details of random methods were described
Allocation concealment (selection bias)	Unclear risk	Although "identical numbered packages" were used here, no more details for enough concealment were described.
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Quote: "All treatments were supplied in 100 ml aliquots, pre‐packed in identical numbered packages...both doctor and patients were blinded". Comment: blinding probably sufficient
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Quote: "...and patients were instructed not to describe to the assessing doctor any characteristics of the product such as colour, smell or consistency" Comment: blinding probably sufficient
Incomplete outcome data (attrition bias) All outcomes	Low risk	A total of 15 (10%) dropouts with reasons; number of missing data not considered enough to introduce bias significantly
Selective reporting (reporting bias)	Unclear risk	Insufficient data regarding "adverse events"
Other bias	High risk	Suspicious baseline imbalance in total lesion counts among groups (76.8 ± 7.5 in gluconolactone group; 94.7 ± 11.1 in placebo group; 76.5 ± 7.0 in BPO group); the use of a Student's t‐test with no posthoc analysis to compare the means of lesions of three treatment groups