Journal of Clinical and Aesthetic Dermatology

JUN 2017

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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55 JCAD journal of clinical and aesthetic dermatology June 2017 • volume 10 • Number 6 r E v I E w table 3: levels of evidence. Evidence and recommendations are based on modified guidelines by oxford center of Evidence based medicine lEvEls oF EvidEncE t ypEs oF studiEs rEcommEndation 1a • Systematic review of randomized controlled trials (RCTs) with homogeneity • ≥2 high-quality RCTs (homogenous, consistent results) • ≥2 high-quality prospective right/left comparison trials (PRLCs) (homogenous consistent results) A: Strong, consistent level 1 studies 1b • Individual high-quality RCT • Individual high-quality RCT 2a • PRLC with control being "no treatment" • Multiple low-quality RCTs and/or PRLCs with concordant results B: Moderate, consistent level 2 studies 2b • Low-quality RCT • Low-quality PRLC • ≥3 placebo-controlled, open-label trials (OLTs) with concordant results 2c • Placebo-controlled OLT 3a • OLT with control being "no treatment" C: Weak, consistent level 3 studies 3b • ≥3 case series (homogeneity, consistent results) • OLT with no controls, patients <10 3c • Retrospective uncontrolled observational study 4a • Individual case series • OLT with no controls, patients <10 D: Very weak, consistent level 4 studies 4b • Case reports (cumulative patient number ≥3) with homogenous patients, treatment results 5 • Expert opinion without explicit critical appraisal • Based on physiology, bench research or "first principles" Inconclusive, no recommendations made Q U A L I T Y O F S T U D Y C R I T E R I A High-quality randomized controlled trial (rct) • Placebo controlled • Double blinded (investigator blinded) • Lack of significant unaccounted drop out subjects • Free of selected reporting • Matched treatment and control groups • +/- follow up low-quality rct • Lack of high quality controls • Or lack of 2 or more of above criteria • Or inadequacy/obscurity in 3 or more of above criteria [Table continued on next page]

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