For mild-to-moderate acne, retinoid + benzoyl peroxide beats benzoyl peroxide alone in the biggest live acne meta-analysis

Asked:

“most cited acne otc treatment meta-analysis results”

The highest-citation-count comprehensive acne-treatment meta-analysis located is Mavranezouli et al., British Journal of Dermatology 2022 (DOI 10.1111/bjd.21739): 179 randomized trials, about 35,000 observations, 49 treatment classes. It carries 98 citations on Researcher and 87 in Scopus; counts differ by index, so no universal “most cited” rank exists. This page summarizes its placebo-adjusted results from 21 source-level records across the journal, PubMed/PMC, UCL, Bristol and other scholarly hosts.

Placebo-adjusted reduction in total lesion count, mild-to-moderate acne (percentage points, 95% credible interval)

Bars show the point estimate; the thin line spans the 95% credible interval. Amber marks the professional chemical-peel category — limited, uncertain evidence, and not equivalent to an over-the-counter salicylic-acid product. Blue marks topical classes with OTC-relevant ingredients (OTC status varies by jurisdiction).

Scope, citations, tolerability, interpretation

Scope

179 randomized controlled trials, roughly 35,000 observations, 49 treatment classes, stratified by acne severity, published 2022.

Citations

98 on Researcher and 87 in Scopus, retrieved 2026-09-25. Counts are index-specific snapshots; this is the highest-count relevant meta-analysis located, not a definitive record.

Tolerability

Benzoyl peroxide and topical retinoids showed more discontinuation due to side effects than placebo in mild-to-moderate acne, but no detected difference in all-cause discontinuation for any class.

Interpretation

The paper pools drug classes and includes prescription treatments. The practical OTC takeaway: a retinoid + BPO combination has stronger evidence than BPO alone; the peel estimate does not support ordinary salicylic-acid cleansers.

Findings

Topical retinoid + BPO gave a 26.16-point greater lesion-count reduction than placebo (CrI 16.75–35.36), the strongest topical pharmacologic class for mild-to-moderate acne — academic.oup.com

BPO alone gave 15.60 points greater reduction than placebo (CrI 6.02–25.11), ranking below the topical combinations — pmc.ncbi.nlm.nih.gov

Chemical peels including salicylic or mandelic acid gave 39.70 points (CrI 12.54–66.78), but as a pooled professional-peel category with limited evidence — discovery.ucl.ac.uk

A later 2023 NMA of 221 RCTs (about 65,600 observations) likewise ranked oral isotretinoin first, followed by triple therapies with a retinoid, BPO and an antibiotic — medbeats.skyscape.com

Source records

Host	Record type	Link

Source: 21 source-level records about one paper (Mavranezouli et al., BJD 2022, DOI 10.1111/bjd.21739), including one comparator 2023 NMA record, retrieved 2026-09-25. Numbers are placebo-adjusted percentage-point reductions in total lesion count for mild-to-moderate acne with 95% credible intervals; citation counts are index-specific snapshots. Per-severity and per-sex rankings from the paper were cut for space.

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