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  • Effects of cosmetic and other camouflage interventions on appearance-related and psychological outcomes among adults with visible differences in appearance: a systematic review

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Complementary medicine
Original research
Effects of cosmetic and other camouflage interventions on appearance-related and psychological outcomes among adults with visible differences in appearance: a systematic review
  1. Shadi Gholizadeh1,2,3,
  2. Danielle B Rice1,4,
  3. Andrea Carboni-Jiménez1,2,
  4. Linda Kwakkenbos5,
  5. Jill Boruff6,
  6. Ankur Krishnan1,
  7. Vanessa L Malcarne3,7,
  8. Brett D Thombs1,2,8,9,10,11
  9. Scleroderma Patient-centered Intervention Network (SPIN) Body Image Patient Advisory Team
    1. 1Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
    2. 2Department of Psychiatry, McGill University, Montreal, Québec, Canada
    3. 3Department of Psychology, San Diego State University, San Diego, California, USA
    4. 4Department of Psychology, McGill University, Montreal, Québec, Canada
    5. 5Department of Clinical Psychology, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
    6. 6Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Québec, Canada
    7. 7Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, California, USA
    8. 8Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada
    9. 9Department of Medicine, McGill University, Montréal, Québec, Canada
    10. 10Department of Educational and Counselling Psychology, McGill University, Montréal, Québec, Canada
    11. 11Biomedical Ethics Unit, McGill University, Montreal, Québec, Canada
    1. Correspondence to Dr Brett D Thombs; brett.thombs{at}mcgill.ca

    Abstract

    Objective Visible differences in appearance are associated with poor social and psychological outcomes. Effectiveness of non-surgical cosmetic and other camouflage interventions is poorly understood. The objective was to evaluate effects of cosmetic and other camouflage interventions on appearance-related outcomes, general psychological outcomes and adverse effects for adults with visible appearance differences.

    Design Systematic review.

    Data sources MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid) CINAHL and Cochrane Central databases searched from inception to 24 October 2020. Two reviewers independently reviewed titles and abstracts and full texts.

    Eligibility criteria Randomised controlled trials in any language on non-surgical cosmetic or other camouflage interventions that reported appearance-related outcomes, general psychological outcomes or adverse effects for adults with visible appearance differences.

    Data extraction and synthesis Two reviewers independently extracted data, assessed intervention reporting using the Template for Intervention Description and Replication checklist, and assessed risk of bias using the Cochrane risk of bias tool. Outcomes included appearance-related outcomes, general psychological outcomes (eg, depression, anxiety) and adverse effects.

    Results One head-to-head trial and five trials with waiting list or routine care comparators were included. All had unclear or high risk of bias in at least five of seven domains. Effect sizes could not be determined for most outcomes due to poor reporting. Between-group statistically significant differences were not reported for any appearance-related outcomes and for only 5 of 25 (20%) other psychological outcomes. Given heterogeneity of populations and interventions, poor reporting and high risk of bias, quantitative synthesis was not possible.

    Conclusions Conclusions about effectiveness of non-surgical cosmetic or other camouflage interventions could not be drawn. Well-designed and conducted trials are needed. Without such evidence, clinicians or other qualified individuals should engage with patients interested in cosmetic interventions in shared decision making, outlining potential benefits and harms, and the lack of evidence to inform decisions.

    PROSPERO registration number CRD42018103421.

    • complementary medicine
    • epidemiology
    • mental health
    http://creativecommons.org/licenses/by-nc/4.0/

    This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

    https://doi.org/10.1136/bmjopen-2020-046634

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      Footnotes

      • Collaborators SPIN Body Image Patient Advisory Team Members: Amy Gietzen, Scleroderma Foundation, Tri-State Chapter, Binghamton, New York, USA; Karen Gottesman, Scleroderma Foundation, Los Angeles, California, USA; Genevieve Guillot; Sclérodermie Québec, Montreal, Quebec, Canada; Nancy Lewis, Ontario, Canada; Joep Welling, NVLE Dutch patient organization for systemic autoimmune diseases, Utrecht, The Netherlands.

      • Contributors SG, DBR, AC-J and BDT were responsible for the study concept and design, drafted the study protocol, contributed to data extraction, contributed to drafting the manuscript and approved the final manuscript. JB designed and conducted the search strategies, contributed to drafting the manuscript and approved the final manuscript. VLM and LK were responsible for the study concept and design, drafted the study protocol, contributed to drafting the manuscript, and approved the final manuscript. BDT is the guarantor.

      • Funding The study was supported by funding from the Canadian Institutes for Health Research (CIHR; CMA – 151728). DBR was supported by a CIHR – Health Systems Impact Doctoral Fellowship. AC-J was supported by a CIHR Frederick Banting and Charles Best Canada Graduate Scholarship. BDT was supported by a Tier 1 Canada Research Chair.

      • Competing interests None declared.

      • Patient consent for publication Not required.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Data availability statement All data relevant to the study are included in the article or uploaded as online supplemental information. All data extracted and analysed for the present study are reported in the manuscript and its tables.

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.