This page is an archive of past discussions. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page.

The Good article nomination for Acne/Archive 1 has failed, for the following reason(s):

Although some editors are doing a great job to keep this article factually accurate and spam-free, I would like to see the following points cleared out:

• the symptoms section contains some information I was lacking in the causes section.
• There should be a classifications section, explaining what other forms exist outside acne vulgaris, e.g. chloracne
• Some information on whiteheads and blackheads should be mentioned in this article
• The intro should mention puberty.
• I suggest a differtial diagnosis and epidemiology section.
• There are some minor errors: e.g. P. Acnes instead of Propionibacterium acnes, Development of acne vulgaris in latter years, etc.
• It's not mentioned why it has a predilection for certain areas.

To summarise, I think is not organised enough yet, and some important information is missing. All comments are welcome! Steven Fruitsmaak 19:49, 3 July 2006 (UTC)

When I visited this article the scars section was mostly deleted and I put it back up. Was this a bad move and should it be reverted? - ScotchMB 23:17, 3 July 2006 (UTC)

I think it's worse actually, that we need an expert on the subject banner here. Look at all the disagreement and controversy on it. The snare 01:28, 8 January 2007 (UTC)

I edited the section about milk and acne since it includes sorbet as a dairy product. One needs to only click on sorbet, or be a person with dairy allergies like myself, to know that sorbet is not a dairy product, and is not made with milk. Apparently changing this to reflect the most likely real dairy product, sherbet, is vandalism. Could someone who knows better explain how sorbet belongs in the section about milk and acne? Rachaella ( talk) 01:27, 22 October 2009 (UTC)

I responded on your talk page to the message you left me, but for further information new sections are normally added at the bottom of talk pages. -- UltraMagnus ^speak 12:00, 22 October 2009 (UTC)

Those pics are disgusting! Shouldn't we perhaps apply more "encyclopedia-ish" ones?

A lot of pictures regarding medical things are disgusting, pretty much any medical encyclopedia or text has multitudes of pictures, of burns, keloid scars, tumors, bloody wounds and open bone fractures, that's just the way it is. You have to get used to it if you want to study medicine. Not that wikipedia is a comprehensive medical guide that doctors cite on their term papers, but it's more educational and accurate to see what the injury looks like than a text description. The snare ( talk) 02:10, 29 September 2008 (UTC)

need a redirect for 'acne' lowercase, is that an admin thing? — Preceding unsigned comment added by DennisDaniels ( talk • contribs) 18:05, 23 October 2002 (UTC)

There's no such thing; the first character is always a capital one. acne and Acne both point to the same page. ACne, AcnE, etc. don't (but please don't make pages for these!). Jeronimo — Preceding undated comment added 18:07, 23 October 2002 (UTC)

no intent on creating new pages just trying to figure out why acne is on the 'most wanted list' ...scroll down near 4. — Preceding unsigned comment added by DennisDaniels ( talk • contribs) 18:14, 23 October 2002 (UTC)

Something to consider adding, though it's relatively new. Why stress is a factor, Substance P. Jamesday 03:34, 17 Dec 2003 (UTC)

Yes, stress should be mentioned, how stress causes increased oil secretion in some people causes acne.-- 203.166.57.11 00:05, 13 Apr 2004 (UTC)

Shall we go into detail about treatments and causes that are more controversial or only stick to what we know?-- 203.166.57.11 00:05, 13 Apr 2004 (UTC)

I think these picutres are fine just they way they are as they depict reality instead of artwork Aujlakam 00:26, 18 January 2006 (UTC)

There is an available online resource Acne Vulgaris: Clinical Pictures and Treatment Info for additional clinical images of Acne Vulgaris. I think it would be helpful to add to the external links b/c it shows acne on a variety of skin types, body locations, and ages. I work closely with this site though so I do not feel comfortable adding it to the external links. Burrillr 15:19, 29 May 2007 (UTC)

Nothing on popping zits?? -- CJWilly

---

Male hormones, secreted oil, and skin particles don't "cause" bacteria, so I have trouble with bacteria being labeled an effect of acne. In the absence of the bacteria, pimples don't appear. Also, in the case of benzoyl peroxide at least, treatment can't be considered finished (until the hormone/skin oil causes subside) and acne will reappear within days if treatment is stopped. Yath 17:08, 12 Apr 2004 (UTC)

I guess whoever originally wrote that sentence meant to say that the bacteria are not the 'root cause' of the problem, as they are themselves caused by blockages in the hair follicles of the skin: without the blockages caused by the build-up of sebum, etc., there would be no bacteria, and consequently no pimples. I agree with you, though, that the text was a bit misleading as it was written. I've had a go at a rewrite, which (hopefully) is a bit clearer.

I also agree with what you say about about benzoyl peroxide treatment, and I've altered the text accordingly. R Lowry 21:01, 12 Apr 2004 (UTC)

I wrote some of those changes, the bacteria is the result of other things, but without it, no pimple, so it is a cause. Killing the infection gets rid of the pimple. I agree with changes to what I wrote.-- 203.166.57.11 00:05, 13 Apr 2004 (UTC)

I'm wondering whether it's the cause of things too- it wouldn't surprise me if the presence of the bacteria didn't damage the skin and thus cause the skin to make more sebum; the skin would be trying to protect itself from damage. But the bacteria eats the sebum and emits chemicals that cause even more damage, so it's a vicious circle.

-WolfKeeper

Why have you removed all of my comments in your last revision lowry?? Some of them were good. -- Komencanto 08:54, 13 Apr 2004 (UTC)

I'm not aware of having removed any text, other than from the sentence that we've been discussing here. I also can't see any record of any edits to this article by someone called Komencanto, so it's a bit difficult for me to know which comments you're referring to. Can you be more specific? R Lowry 18:14, 13 Apr 2004 (UTC)

Consumption of heat damaged foods. Proteins exposed to heat are altered in such a way that digestive enzymes are unable to break them down into constituent amino acids. These proteins are processed by lymph glands and excreeted through the skin. Due to the hydrophilic nature of protein, subcutaneous water pressure is increased which closes off sebum canals, trapping bacteria. A cyst is the result. - Boy does this sound like nonsence pseudoscience. Has anyone got a reference for this stuff???? (posted by anon)

I've removed the paragraph you've quoted above, as it seems the text was added some time ago by a user trying to hawk his "natural remedy" product. The only reference I can find with "heat damaged food" and acne mentioned are these alternative medicine-type commercial sites. Seems they're trying to twist the principles of the Maillard reaction to dupe unwary customers. If anyone can provide a credible cite, the removed text may of course be reinstated. -- Hadal 08:30, 3 Sep 2004 (UTC)

Anybody heard about acne being reduced by sun exposure? I think I heard and read quite a bit about that in my time. It seems sun rays change the sebum chemically as well as plainly heating it and it can flow outwards easier.

I've read (I can't remember the source, but it was scientific) that although sun exposure in the short-term reduces acne, by killing bacteria and heating the skin, long-term exposure weakens the skin's ability to fight bacteria. The skin is particularly helpless if sunburnt. For this reason, nearly all dermatologists strongly recommend that their patients, including acne-prone ones, wear sunscreen during extended sun exposure. -- LostLeviathan 05:46, 6 Dec 2004 (UTC)

It's a good news/bad news kind of deal.

The blue light in sunlight kills P.Acnes; this improves acne in the short-term.

However the UV light damages the skin, and then acne comes back worse than ever when P.Acnes recolonises.

I heard a claim that 90% of people had worse acne after sun exposure in the long term, but I have never tracked it back to the literature to check.

That's what the ClearLight/Dermalux lamps are about- they don't produce much if any UV light.

-WolfKeeper

The dermatologist I went to told me sunlight had no effect on it at all. The snare 04:33, 6 November 2006 (UTC)

Not all dermatologists are experts on phototherapies I guess. WolfKeeper 05:35, 6 November 2006 (UTC)

This section should be deleted. —Preceding unsigned comment added by Liquidblue8388 ( talk • contribs) 22:57, 27 October 2007 (UTC)

Okay, obviously the "sex/masturbation causes acne" myth needs to be addressed, but the current paragraph feels very uncertain. It states:

Sex. Rumours have had it that both celibacy and masturbation are causes for acne. This is not the case. It is notable however that masturbation and any other sexual activity affects hormone levels and thus bodily oil production.

My particular objection is to that last sentence, which contradicts the main sentence since it suggests that masturbating or not does have some effect on acne. Just for a start, are there any credible studies that show the effect masturbation has on hormone levels? If not, then that last sentence should be deleted. -- LostLeviathan 05:53, 6 Dec 2004 (UTC)

It seems obvious to me that sexual arousal, as well as stress/anger, raises androgen levels and thus stimulates bodily oil production. Karl Stas 10:03, 25 Feb 2005 (UTC)

But sexual arousal != sex/masturbation. It's a tad difficult to suggest avoiding sexual arousal, stress and anger. So whether or not physical/emotional responses can affect hormone levels hardly bears any relevance to the question as to whether there's a correlation between sex/masturbation/celibacy and acne. — Ashmodai ^{( talk · contribs)} 01:44, 16 November 2006 (UTC)

it has been widely accepted that these are not true due to lack of scientific study on the subject I understand what this is trying to say, but on the other hand I don't think that a lack of study is generally accepted as proof of anything. Perhaps someone should change it to "there is nothing in the scientific literature to confirm this." 72.240.220.81 03:24, 26 July 2007 (UTC)

sex has a massive therapeutic value in all senses, concerning the aids a young person to achieve emotional completion.it is clear that young people in some kinds of societies are very misled about it so it's hard to trust who is writing the comments regarding it here —Preceding unsigned comment added by Gt jaya ( talk • contribs) 18:01, 25 October 2007 (UTC)

I found a mention that acne was previously (before the 1970s) thought to be a sign of constipation and/or masturbation.-- Auric ( talk) 02:06, 8 October 2009 (UTC) ^[1]

The article currently says:

Chocolate, chips, sugar, milk and seafood among others have not been shown to affect acne. This means that the scientific studies done to date did not find a big difference between acne in two groups of people, one group eating the food in question and one group avoiding it.

Could someone cite a source for this? Everything I've read suggests that no serious scientific studies have been done on this subject. -- LostLeviathan 06:25, 11 Dec 2004 (UTC)

Re. acne and diet, I already can pinpoint the flaw of the study design. Perhaps the reason people who eat a bad diet have no significant different # of acne is because they can from a genetic basis. A better study design would be to have a prospective study on the effect of diet on the acne-prone people. This article makes much more sense: http://www.choiceusa.net/news_articleAcne&Diet11.03.htm. -- Skindr 14:15, 21 January 2006 (UTC)

(Skim) milk has been linked to acne [1]. Also, the absence of acne in non-westernized hunter-gatherer tribes, which cannot be explained by genetic factors, have led some researchers to speculate that a diet link to acne does exist. Dr. Alan C. Logan points to the low dietary omega-6–omega-3 ratio in these tribes, as well as to the absence of milk in their diet [2]. This contradicts Perricone, who claims that fatty acids (such as omega 3) actually reduce acne. Milk, fish and seafood also contain iodine, which can also cause acne. IMHO, the whole "misconceptions" section should be rewritten because it is over-simplified (see also my remarks on acne and hygiene, acne and sex). Karl Stas 13:11, 13 Mar 2005 (UTC)

There's been no double blind study link any dietary component to acne. That's the gold standard. Epidemiological studies are unreliable. For example, I have acne, and used to drink skimmed milk. But I did so, because I had acne and was trying to be 'healthier'. An epidemiological study of me would say that the acne was associated with skimmed milk (actually it made no detectable difference)! Epidemiological studies don't show which way any association flows. WolfKeeper 19:49, 1 October 2007 (UTC)

Re: Re. acne and diet, more mention should be made of the study linking hunter-gatherer populations with no incidences of acne and a different diet in comparison to what most Westerners with acne eat. Also, the theory of IGF-1 and acne that researcher Loren Cordain has proposed should be addressed, which would make up a decent basis for a diet-acne connection.

"One study [specify] suggested that chocolate, french fries, potato chips and sugar, among others, affect acne. A high GI (glycemic index) diet that causes sharp rises in blood sugar worsens acne" - chocolate and sugar aren't high GI —The preceding unsigned comment was added by 87.194.79.203 ( talk • contribs) 14:06, 19 June 2007 (UTC)

Sugar is the ultimate in high gycaemia, glycaemia is glucose is sugar. David Ruben ^Talk 21:12, 19 June 2007 (UTC)

Um, as a matter of fact, last time I looked at tables based on the research data, bread and rice was almost 50% higher than sugar; and the highest glycemic index of all was actually a complex carbohydrate: maltodextrin. It seems to me you are confusing sucrose (table sugar) with glucose; they are very different sugars, indeed there are a lot of different sugars and some of them have very low glycemic index indeed. WolfKeeper 03:38, 20 June 2007 (UTC)

You are confusing energy content with GI rating, which leads me to beleive you missed high school science, anyway GI is the rate at which your body turns eaten food into stored/burned energy. Simpler carbohydrates such as glucose and fructose are converted fast and have a high GI, Starches are bonded glucose molecules in chains which take considerably longer to digest because multiple different ensymes are involved in digesting it (glucose isnt diggested by enzymes) and these have low GIs. Fists ( talk) 09:06, 1 March 2008 (UTC) Edit:sucrose is glucose and fructose in a disaccaride, more complex than either of its parts and less complicated than starches found in grains. table sugar has a moderate GI but the sugars talked about generally in "high sugar products" are the simple sugars, genrally glucose not table sugar.

I'm fairly sure that something in the product Ovaltine (malt chocolate milk drink) causes my acne to flare greatly, Im not suggesting we put this in as it is "original research" but just putting it out there for people doing research and such. Fists ( talk) 08:55, 1 March 2008 (UTC)

Does Ovaltine contain egg powder?

There may be no general rule which foods cause acne and which don't. It looks like it depends on the individual's metabolism. E.g. I get acne from chicken meat and eggs, including cakes and biscuits, anything which contains egg or chicken meat.

It took me decades to establish this, because the acne appears between 5 and 7 days after consuming such products. The more of these products I consume, the more acne I get. Why there is such a delay is kind of baffling, but science ought to take delay factors into account, which also happen in migraines from diesel fumes and some such like. I eat chocolate regularly and in medium quatities, dark chocolate which still contain 50% sugar. 121.209.48.117 ( talk) 04:36, 9 December 2008 (UTC) (layperson)

What about the body's pH and acne. I recently saw a video by an doctor (can't really recall the doctor's name) and he was trying to use the theory of the body's pH in the acne and diet issue. He stated that once the body fall out of the pH range of 6 to 6.8 the body's health decreaes. As a result, acne can be one of the many deseases that can occur. Are there any veiws on this? Aradom18 ( talk) 21:07, 20 April 2009 (UTC)

I would consider this bullshit. How can eating eggs and chicken meat change the pH so that acne occurs in 5 to 7 days time? 121.209.51.139 ( talk) 01:45, 14 May 2009 (UTC)

Again, a "myth" in the article that I have some objection to. I've commented it out; the text read:

Acne is not caused by dirt... It is useful to clean your skin, but doing so will not prevent acne. Anything beyond very mild cleaning will make your skin worse because you'll damage it.

The last part is true; it is possible to clean excessively, irritating the skin and possibly increasing acne. But, how can it be claimed that cleaning your skin will not prevent acne? Can you name a dermatologist who does not recommend that acne patients wash their face on a regular basis? Furthermore, many things that the skin can be exposed to do cause acne. I'm not sure about "dirt" in the strict sense, but if your face is visibly dirty, I'd say the odds are good that something on it is comedogenic. Cleansing also can help reduce the cell build-up that clogs pores. Perhaps a better myth would be "It is impossible to clean your skin too much"? -- LostLeviathan 06:40, 11 Dec 2004 (UTC)

Acne goes on about 2 mm below the surface of the skin within the tiny pores. It's essentially impossible to clean out the pores with any kind of cleanser. You cannot clean out or unclog the pores by washing- the pores are way too small.

-WolfKeeper

Washing with a cleanser helps to remove the dead skin cells and keep the pores open. Karl Stas

At best, this is a small effect though. The real problems aren't at the surface, which is the only place cleansers can actually do anything. -WolfKeeper

If the sebum can get out and the pore doesn't get clogged, it will not get inflamed either.

I repeat, the blockage is often deeper in the pore than you can wash. I would argue that if it goes away with washing, then you don't actually have acne, you just weren't washing correctly.

For the same reason, salicylic acid is often prescribed to treat mild acne: it has a keratolytic effect, i.e. it helps to remove dead skin cells and prevent clogging of pores.

It's also antinflammatory, but salicylic acid is generally not very effective either.

But I do agree with you cleansers can't cure or prevent anything but the mildest forms of acne. They have no effect on the root causes of acne: sebum overproduction and the presence of P.acnes.

The root cause of acne is unknown in fact. And incorrect shedding in the pore is currently being fingered as a cofactor. And washing may well make that worse.

However, they are useful as a complement to other treatments.

Sometimes. Only sometimes. Washing is way overemphasised. Acne is *not* caused by dirt. And washing increases sebum production, worsens existing lesions and can excessively dry the skin. It also increases the chances of sunlight damage, which is known to worsen acne.

Some cleansers may also make acne marks fade faster. Karl Stas 22:02, 24 Feb 2005 (UTC)

All I know is that for me, washing has little to no positive effect, and usually seems to make things worse. I almost *never* wash my face with a cleanser. It gets wet when I have a shower (once a day, but not even every day), or when I swim. That's it. YMMV.

I've uncommented this myth. It genuinely *is* a myth. People with the most superficial acne may have the impression that it is caused by insufficient washing, but anyone with worse acne than that, knows that it truly isn't caused by lack of washing. -WolfKeeper

I never said that acne was caused by dirt. What I'm saying is that when a pore gets clogged, a comedone is formed, which may then get inflamed by the P.acnes bacteria. Contrary to what you say, the mechanisms underlying acne are fairly well understood. Androgens cause sebum overproduction. As a result, dead skin cells remain "glued" to the skin and start clogging the pores. A comedo (blackhead) or papule (small bump) is formed, which then gets inflamed by the P.acnes bacteria, naturally present on the skin.

There is some truth in you assertion that excessive washing stimulates sebum production and may overdry the skin. I concede that soaps and cleansers can also irritate the sebaceous glands, actually worsening acne. But this does not mean that acne patients should avoid washing their skin. I wash my skin twice a day with a mild, non-comedogenic cleanser containing a small percentage of salicylic and citric acid, to good effect. I would certainly recommend washing twice a day with lukewarm water.

I'm not convinced that skin oil actually protects against UV light, as you seem to imply. Karl Stas 09:57, 25 Feb 2005 (UTC)

It doesn't directly. Washing removes the top layer of dead skin for a day or so, this normally protects the skin from the sun (SPF2-3 IRC). Hence washing increases any sunlight damage that may occur. And other common acne medications do a pretty thorough job of this too- Benzoyl peroxide for example- the FDA ended up adding a safety notice about this, after it had been on the market for years.

I'm really confused now. When you say the hair follicle are blocked, do you mean inside it, kind of like say a golf ball in a garden hose, if it was stuck at one of the ends it could be pulled out, but not if it was furthur down?

It seems to me the main problem is the blocked hair follicle. I was on acne medication once- minocin, which was to kill the bacteria in blocked pores (which I did not follow religiously, but it eventually went away), but what good would that do if the follicle is blocked and the same thing could start again. Unless, however, that the sebum would eventually build up pressure and push the blockage out. That it's the bacteria that cause pustules and red spots, and that's only if they are in the follicle before it gets blocked. The snare 19:55, 9 October 2006 (UTC)

Benzoyl peroxide and the topical retinoids may be the best compromise between cost effectiveness and genuine effectiveness and negative side effects in many cases.

I would like to see a source for this recommendation — it seems questionable to me. Benzoyl peroxide has a peeling effect, and tends to dry the skin somewhat. Topical retinoids can also cause dryness, redness, and skin irritation. Using two such products in combination may, conceivably, make the problem of acne even worse by over-drying the skin.

The patient information leaflet for Retin-A recommends (and this is a direct quote) not using "skin peeling agents or toiletries which have a strong drying effect on your skin" in conjunction with the product.

So -- is this a reputable recommendation, or is it just something that someone posted here without thinking about the possible consequences for other people? R Lowry 06:25, 3 Apr 2005 (UTC)

Well, no one came along to defend that sentence, so I'll assume it wasn't defensible and remove it from the article. R Lowry 01:25, 8 Apr 2005 (UTC)

I wouldn't say it was indefensible. Benzoyl peroxide, azelaic acid [www.bodyskin.blogspot.com]at least, is relatively cheap and effective in most cases of mild acne. Also, its side effects are less severe than Roaccutane: it bleaches textiles and may cause dry skin, shedding or redness. Retinoids like Adapalene are more expensive and nobody seems to know exactly how they are supposed to work. Adapalene didn't work for me, but had no serious side effects either. Roaccutane (isotretinoin) is no doubt the most effective acne treatment, but it has rather severe side effects and it's expensive. It is therefor recommended only as a "last resort" treatment. - Karl Stas 07:42, 8 Apr 2005 (UTC)

What you need are references. Frencheigh 07:41, 24 May 2005 (UTC)

---

Poll:

¿What is the fastest known way to remove a pimple? A week should be enough time. ¿How about we close the poll on 2005-06-01T00:00:00 ( GMT/ UTC)?

Is fastest known way to remove a pimple popping it?

Yes:

1. — Ŭalabio 06:53, 2005 May 24 (UTC)

No: (you must name a faster way with your vote):

Comments:

1. This poll is misguided. popping a pimple doesn't remove it and isn't a treatment for acne anyway. It leaves an irritated, infected lesion, increases scarring and doesn't clear up the acne. In addition, there is the danger that the pus will get forced under the skin or deeper into the pore, worsening the infection. Here in the UK, dermatologists still recommend against popping pimples (I talked to my mother, who is a dermatologist, about this once) and they're usually not paid for treating patients. On the contrary, they'd rather not pay for the treatment. I think this poll is missing the point. Popping pimples may be the fastest way of relieving immediate pain from a pimple, but it does not 'remove' it and does nothing to prevent others. -- Mike C | talk 09:15, 24 May 2005 (UTC)

Perhaps what he meant to say is, "What is the fastest way to get rid of a whitehead?" I'd like to know this as well. Popping obviously gets rid of it immediately, and over-the-counter treatments like Clearasil claim 3 days. I think it's really the whiteheads and shininess that bother people the most, not necessarily just the red spots. Oh, and I wouldn't recommend this as a great way to treat acne, but I'm currently receiving chemotherapy for Hodgkin's Disease, and by golly my acne cleared right up! :) I just hope it stays that way after I'm done with the chemo... -- Birdhombre 17:49, 14 Jun 2005 (UTC)

As far the fastest way to get rid of a pimple, aren't there hand held acne vaccums you can use to suck out the sebum from the pore? Though would this cause any scarring? When you get a pustule of acne, it's already inflammed as you normally can't see a sebaceous gland within the hair follicle because it is so small, and when you can see the pustule it has been inflammed. There's this that claims to restore acne in seconds (but according to this web site, it says minutes)

http://www.asseenontv.com/prod-pages/igia-ultra-clear.html The snare ( talk) 02:19, 29 September 2008 (UTC)

---

I'm adding an external link to site which has 70 - 80 pages of very valuable acne information..

the correct way to get rid of fluid under the skin which has been segregated into a pocket is by lancing if it serves no more function and it is unable to evacuate itself.read it up on the Internet-lancing-acne —Preceding unsigned comment added by Gt jaya ( talk • contribs) 17:59, 25 October 2007 (UTC)

I added a link with information on Levulan Photodynamic Therapy to the article. I have had this treatment myself and it is extremely effective. Elaborating in this detail on the acne page seems out of place, so the link is useful.

These links were moved here from the main page:

• www.mer ck.com/mrkshared/mmanual/section10/chapter116/116a.jsp The Merck Manual of Diagnosis and Therapy: Acne
• www.ac ne.org/ Acne.org - Home of "the regimen" - A succinctly outlined plan to help clear skin of Acne. Support forum and chat available.
• clinic.acnewiza rd.com/moreacne.html What is acne? Very visual description of various acne scars and people most likely to get it)
• www.beauty-cosm etic-guide.com/acne.htm Acne Cure and Help
• www.beauty-fitne ss-guide.com/skin-diseases/acne.htm Acne vulgaris Treatment and Prevention
• www.wasau na.com/levulan.html Levulan Blue Light Therapy

If you believe that any of these are apprpriate according to Wikipedia:External links please discuss here prior to adding them back.
brenneman ^{(t) (c)} 08:42, 19 July 2005 (UTC)

At least the Merck manual has detailed and objective information not already contained in the article. The "What is acne?" page has good photographs of different types of acne lesions. The other links have little value, but the same is true for some of the links that you have kept in the article. - Karl Stas 10:50, 19 July 2005 (UTC)

• Please, take them out then! I'd looked at the Merck manual link and removed it, but it you believe that it adds to the article, I have no objections to it going back on the main page. I feel the "what is Acne?" page is too close to advertising, but I'm always open to discussion. brenneman ^{(t) (c)} 13:26, 21 July 2005 (UTC)

• Also moved here: Acne in the movie world.
  brenneman ^{(t) (c)} 15:13, 12 August 2005 (UTC)

I think you're going a bit overboard here. Acne in the movie world adds to the article, and I don't really see how that info could be sucked into the wikipedia- seems to me to be a legitimate link. WolfKeeper

I also strongly disagree with removal of acne.org. It's a not-for-profit website, a .org site, and it contains voluminous descriptions and excellent videos of how to apply benzoyl peroxide (it really isn't very easy to apply it successfully, and I haven't seen this much detail anywhere else); plus in-depth discussions of other treatments and the forums are very, very good. Whilst ideally you would copy info into the wikipedia I don't really see how/why you would want to copy this particular info into the wikipedia, it's too detailed, but adding a link helps out the readers of the wiki. And not in a 'helps readers to buy product' sense, which is clearly not what we are about. On balance I think this link should be in the article. WolfKeeper

Can we copy the existing links here and thrash them out? Following that, then any new links we remove from the main page to here for discussion? - brenneman ^{(t) (c)} 03:29, 2 October 2005 (UTC)

I have moved this link here which was recently added. If anyone thinks it should be included in the article then please include it.

• Acne Resources Helpful overview of acne articles and current research

-- Clawed 01:28, 18 October 2005 (UTC)

There is a new ingredient on the market called Praventin, which supports a clear complexion from the inside Praventin ™ is a bioactive protein complex rich in Lactoferrin, and derived from whey. It is patent pending for an application in supporting a clear complexion by enhancing the body’s natural defenses. In a recent consumer study with teenagers it was demonstrated that oral supplementation with Praventin™ promoted a clear complexion, as assessed in table 1. Oral supplementation with Praventin™ resulted in a considerable improvement in skin condition. In table 2 a median decrease of 71% in blemishes after one month and 95% after two months is reported. Improvements were observed regardless of gender, age, or baseline appearance. Two weeks of Praventin™ use resulted in a clearer complexion, as illustrated in figures 1 and 2. The 44 teenagers were asked a set of questions about how they believed Praventin™ had supported skin health. • 76% saw visible differences in their complexion, among them were fewer blemishes, a reduction in redness, and less oiliness, consistent with a healthier complexion. • 83% stated they would like to continue taking Praventin™. The subjects reported no adverse side effects. As demonstrated in the study, Praventin™ can be used to support a clear complexion benefiting the physical and emotional well-being of young adults.

Recent anonymous edits overstate the role of dairy products. As far as I know, there is only one study suggesting a link between skim milk consumption and acne. Karl Stas 17:42, 4 September 2005 (UTC)

I also have reservations about the following passage added by the same anonymous user: "The most likely mechanism of plugging is a failure of terminal differentiation, the same process whereby leaves undergo a metabolic process that separates them from their twig or stem. Failure of this process may be linked to the anoxia produced by increased pressure in the lumen of the duct. This pressure in turn is produced by the hormone-induced overproduction of the duct lining cells. There is a very tight wrap around the duct preventing over-expansion, so internal pressures are thought to build up as a result. There is to date only circumstantial evidence to support this explanation but there is no conclusive proof of this theory." No reference is given. The language is very academic, I suspect a copyvio. Karl Stas 21:16, 4 September 2005 (UTC)

I removed the following because this is an encyclopedia and not a how-to guide.

. However, if you must pop a pimple make sure that the yellow pus is above the skin level. To do it safely without leaving any scar tissue, clean the area around the acne with a liquid antiseptic to minimize the risk of contamination. Then take a needle and sterilize it with alcohol and run it briefly through a flame to make sure the remaining microbes are dead. Next, take the sterilized needle and gently prick the top of the pimple's surface carefully enough not to poke it too far. Finally, use a clean piece of gauze, hold it over the pricked pimple, and apply gentle pressure on the sides of the pimple to extract the infected pus. If the pus does not come out with minimal pressure, then STOP immediately! Do not forget to apply an antibiotic ointment on the acne after doing this.

-- Clawed 22:25, 9 September 2005 (UTC)

I have mentioned lancing twice in this article and some idiot has deleted it...if you want references just look on the Internet there are thousands of them

if someone with acne doesn't know how to poke the bastards with the needle,all he will do is end up bruising his skin by using very blunt pressing movements with his fingers, and when the skin is bruised it is weakened and the infection spreads all around

Therefore the idiot who deleted lancing twice should really be given the condition for a while so he can figure it out —Preceding unsigned comment added by Gt jaya ( talk • contribs) 18:06, 25 October 2007 (UTC)

Put it back up ... it's been a while ;) 67.165.246.147 ( talk) 05:34, 16 January 2010 (UTC)

On one hand the article says:

Anything beyond very gentle cleansing can actually worsen existing lesions and even encourage new ones by damaging or overdrying skin.

But on the other hand:

Exfoliating the skin. This can be done either mechanically, using an abrasive cloth or a liquid scrub...

What gives? Are we to scrub rougly? Or not to scrub at all?

-- Vitalyb 11:28, 12 October 2005 (UTC)

I think that the Exfoliating part is done after the acne is controlled by other means. —Preceding unsigned comment added by 201.253.206.200 ( talk) 22:09, 21 February 2008 (UTC)

Exfoliation removes the "roof" of pimples so that the trapped sebum can come out. This method is recommended instead of popping pimples. And microdermabrasion is different from scrubs. Microdermabrasion uses particles that are much smaller than the particles found in scrubs. So microdermabrasions don't scratch the surface of the skin (unlike scrubs). Therefore exfoliating using microdermabrasion is much better. Check out this site for more details http://www.facialskincarefacts.org Aradom18 ( talk) 21:39, 20 April 2009 (UTC)

I have removed the following text:

However, this does not prove that such foods aggrovate already present acne. Foods high in sugars and fats can increase sebum production, and other foods can affect hormone production.

Spicy foods and such like can affect the intestines and the proper disposal of toxins, causing a buildup of toxins in the blood, which can aggrovate acne. Diet then, it seems, is not sufficient in causing Acne but does aggrovate the condition in someone who already has acne, or is genetically predisposed to it. To say diet does not affect Acne at all is ignorant.

Foods with a low glycemic index like wholemeals reduce sugar rushes in the body and keep sebum production in balance (it is necessary for some sebum to be produced to keep the skin moisturised). Foods that aid in digestion like fruits and vegetables maintain the balance in the gut, helping the breakdown and removal of toxins and prevent them from entering the blood. They also contain vitamins and minerals that aid in the proper functioning of the bodies tissues and organs. Herbs like milk thistle, red clover, burdock and dandelion help to detoxify the liver. It has been sugested that acne ultimately arises from improper liver functions which are not able to maintain sugar levels in the blood and to remove toxins efficiently. Toxins build up in the blood and sebum is overproduced. These two factors combine to produce Acne.

The possible role of high-glycemic foods is already mentioned in the article. The uncorroborated claim that a "buildup of toxins in the blood" can aggravate acne seems dubious. Karl Stas 16:35, 16 October 2005 (UTC)

I have read otherwise, that toxins in your body do affect acne. Please check this information. - Jessica Walkuski

Can you be less specific? WolfKeeper 01:03, 8 July 2007 (UTC)

I strongly agree with the text that was removed. As a teenager, I suffered from such a horrible acne that people recommended a stay at the Dead Sea to me. I think that if someone photographed me then, I would be now in every medical book, Section "Dermatic horrors". I had to change my T-shirts every morning, because they were full of large blood spots. Nothing worked against it too effectively, or had such side effects that it was unusable. My mother then used to visit a natural healer, who claimed that this heavy acne might be caused by the malfunction of liver. He invited me to visit him, but I refused, because I thought it was rubbish. After about one year, I saw that I had nothing to lose and I agreed. After an "energetic procedure", during which he allegedly removed a "bad energy" from my liver (which I clearly felt), he recommended to use a tea of horsetail (equisetum) and common agrimony. I took it with skepticism, but guess what happened: After mere 10 days, the horrible acne completely disappeared from the whole body. It was like a miracle. Since then I don't understimate the ability of healers anymore. And I also see that the causes of acne are poorly scientifically researched. I talked about it with several dermatologists, but all but one refused to even try the tea therapy...saying that it was rubbish.

You can take my case as an anecdote, but a very persuasive one. I have no doubts that heavy acne has a lot to do with toxins in the blood. Note please that both these herbs contain a lot of ethereal oils and silicilic acid, and are used to support the function of kidneys and liver. I don't know, if acne is directly caused by sugars, but personally I observed a clear connection with the consumption of hot dogs and pork meat (i.e. animal fatty foods) in me. Hopefully this info will help to convince those, who still wonder, in what a direction the research should be led. 82.100.61.114 ( talk) 17:41, 29 October 2008 (UTC)

Why is this article been tagged for cleanup. Can someone please list what sections of this article need to be improved. Otherwise I think the tag should be removed as I don't see any real problems with this article.-- Clawed 09:39, 15 December 2005 (UTC)

I think this article should be moved to Acne Vulgaris; since it doesn't describe Acne rosacea for example. Anyone disagree? (I was planning a redirect or disambiguation from Acne). WolfKeeper 08:47, 16 December 2005 (UTC)

I don't know about anyone else, but i'm i the only one who seems to have noticed that Acne.org is a COMMERCIAL LINK.....here is a direct quote from the site "Drugstore.com gives me 10% of every order made from this page. Please bookmark this page for future orders. Currently the bandwidth charges for acne.org are around $1000 per month". Now if this seems to be ok with everyone, why not other commercial sites or a site with some guy with excellent marterail but has a few google adds on it.

Come on people...........Acne.org is a commerical site for the purposes of making profit, So why in the world is it added to external link section everywhere??????

I guess we have to look at whether it adds to the information in the article or not. The information on precisely how to use benzoyl peroxide correctly- I've personally seen this nowhere else. And I don't find it to be heavily commercial. The guy 'Dan' who runs it does make money from the site and from a dirt-cheap benzoyl peroxide he sells. But he's not pushing it down people's throats to my estimation, and he also links to other guys products that he makes no money on. If you type 'acne' into google -that's the first link; and I don't have a sense that they've paid to be there, that should tell you something. Still, the guy has to pay for the bandwidth somehow I guess. *If* the article subsumes the information on BP usage, then I would agree to remove it; otherwise I don't feel it should be removed right now. YMMV. WolfKeeper 04:36, 6 February 2006 (UTC)

New External Link, Skin Cosmos Site about Acne. Other Skin Conditions are included. Easy to follow acne information, clean. Skin Cosmos Acne Information This site is managed by M.D Students and Ph.D Students.

Discussion forums are usuaully unsuitable as external links. JFW |  T@lk 04:08, 1 January 2006 (UTC)

The link is not to the discussion forum, but thanks for the information we are learning about wikipedia. Acne.org also has a discussion forum.

I want to put up an external link - Acne Home Remedies, that has many effective home remedies for acne. I really hope this will help the wikipedia's visitors.

I'd also like to suggest an external link - Acne Information. This site has articles on acne, acne statistics, acne depression, acne stress, and several other acne related topics. It's a good resource and should be of help to those who read the main article. If nobody has any objections, I'll add it in a couple of days.

I would like to put up an external link

• Acne Resources and Information Explain Acne

above added 16:43, 21 March 2006 by User:63.165.15.253

Can you tell us why that link is useful, and whether it is authoratitive and unbiased? JFW |  T@lk 21:27, 21 March 2006 (UTC)

A terrible link - merely gives a choice of buttons that perform a number of searches for adverts on google. No additional info on acne. David Ruben ^Talk 00:40, 22 March 2006 (UTC)

Just to review that everyone approves of all the current links:

1. http://www.acneinformation.org Acne Information
2. http://www.fact-sheets.com/health/what_is_acne/ Acne Fact Sheets
3. http://dermatology.cdlib.org/93/commentary/acne/hanna.html Acne vulgaris: more than skin deep
4. http://www.acne-resource.org/ Acne-resource.org
5. http://www.acne.org/ Acne.org

acne.org promotes its own programme, and I would suggest that single individual's websites are generally inappropriate for wikipedia.

There's absolutely no wikipedia rule against linking to single individual's websites- you just made that up. And it's a .org, not a .com website. WolfKeeper 02:52, 21 February 2006 (UTC)

I'm not claiming its any wikipeda rule, I just personally think commercial sites rarely add additional information that is of greater benefit than the free advertising they get, unless the article specifically is about that company (eg Coca Cola, The Atkins Diet, Walmart) or has special notability. David Ruben ^Talk 04:38, 21 February 2006 (UTC)

Look, as a very close analogy, the wikipedia links to Atkins sites. Atkins has a diet regimen and make money from their diet too. This is no different. Except he's not even charging to find out what his regimen is, he's got free videos and information telling you it exactly. The regimen is just a way to use standard benzoyl peroxide you can buy in any chemist/drug store, so that it works well. But you don't have to buy anything from him at all. So he has a regimen, and he sells supplies you could use, or not, big deal. This is not bad or wrong. I don't see that this is really what the commercial rule is talking about. WolfKeeper 02:52, 21 February 2006 (UTC)

I'm less worried (re right or wrong) about an individual's site trying to help others, its more that I see a problem of notability or of giving especially good additional information to a wikipedia article. To put it another way, what is so special about this site compared to the other 2,240,000 hits from a search for 'Acne support' on Google ? Hence the point I raised next about larger national organisations being preferable in my opinion - as they have multiple sources of info (review of current research articles, patient-written factsheets, input from professionals (dermatologists, paediatricians, specialist nurses, school nurses etc), surveys carried out by the group, and sufferers writing to ensure patient-useful information and support).

As far as acne.org goes, it credits its nice pictures from the NIH site, but that site ( http://www.niams.nih.gov/hi/topics/acne/acne.htm) has more information.

It has information on the disease of acne, but far less on using BP. WolfKeeper 08:10, 21 February 2006 (UTC)

I disagree that acne.org suggests a better technique for using BP; the advice to build up gradually and apply after washing is included in its prescribing datasheets & product information sheet (or at least it is in the UK). The site correctly, and with care to emphasise, urges people to build up its use slowly (once a day and then increase frequency), but to my patients I stress an even slower build up (apply for just 2 hours for a couple days then increase by 2hours every 2 days until can apply and leave on overnight). David Ruben ^Talk 04:38, 21 February 2006 (UTC)

That's not precisely the way he tells you to do it, and I'm not convinced that your way works as well. 2.5% is much easier to aclimatise to anyway, and upping it a couple of hours a day is probably overkill, so the person gets more acne in the meantime. 5% BP was far worse like that. You also failed to mention when and how to use moisturiser. These little details make BP work much better and reduce side effects (that frequently stop people using BP). There's also quite a few issues around what kind of moisturiser to use, how much of that to use; as well as exactly how much BP to use at each stage. This stuff may very well be explained in detail elsewhere on the web, but I haven't seen it. It's all a rather delicate balancing act between frying the bug and not frying your skin. WolfKeeper 08:10, 21 February 2006 (UTC)

So the only benefit of this site I can see is that it does seem a good price for a larger sized tube. David Ruben ^Talk 04:38, 21 February 2006 (UTC)

That's not why its being linked though. It's just subtleties of what is presented, that I don't think you've fully grasped. WolfKeeper 08:10, 21 February 2006 (UTC)

Look, I'm cool with it being removed, but to get there we need to either explain a detailed BP application guide in the wiki or link to it. The one's I've seen have been uniformly shit; even the sheets that come with products are really not that great. WolfKeeper 08:10, 21 February 2006 (UTC)

A National Acne/Dermatology patient group which is non-commercial & non-profit making would be better, but still questionable to fill up wikipedia with these. They give secondary rather than primary sources of data, so unless they are exceptionally good, are generally not helpful to expand on articles (anyone is free to do searches with Google). If the aim is to allow people to contact local support groups (vs provide additonal info) then remember wikipedia is not just for US or UK readers and we surely are not going to start to list for all conditions all support orgs in all English speaking countries (Canada, Carribean, Ireland, Australia, NZ, UK, etc, or even for each separate USA state org) ?

Might I propose that any suggestions for additonal links require active support from other editors (rather than assume passive agreement if no-one bothers to comment) ? David Ruben ^Talk 01:50, 21 February 2006 (UTC)

More usefully, might I suggest that you discuss link removal before unilaterally removing them? WolfKeeper 02:52, 21 February 2006 (UTC)

The hidden comment on the Links section requests discussion before adding new links (yes I was probably being was a little pedantic by not applying this to decision to delete), but there is little more than just a single proposer for each of the proposed links on this talk page. So similar to trying to reorganise the treatment section into order (OTC least aggressive first, through to GP prescriptions and finally dermatologists monitoring aggressive treatments), I tried to be bold - no intention to upset anyone intended :-) I generally prefer 1RR, so am happy to wait and see views others might make about what range of external links best improve this article. David Ruben ^Talk 04:38, 21 February 2006 (UTC)

• re Acne.org - Hmmm, you are winning me around. I would though include the site not under External links, but rather as a Reference to a modified BP last sentance of: "It may though cause local irritation and dryness, so should be introducted slowly". I would be very apprehensive about specifying in wikipedia "and also apply moisturisers", for the wrong product could end up blocking pores even further. I can't see how to add cautions about this and indicate what might be the correct type of moisturiser, without an inappropriately overly-long explanation, the quick solution is a reference. I also suggest linking not to the site's homepage as for an External Link, but as a reference directly to the advice at http://www.acne.org/regimen-instructions.html (or its preceeding page). PS indeed always start at 2.5% :-)

• re acne-resource.org - dispite its '.org' web name, it is just a misleading, alarmist, biased push to Truderma cloaked in support-information respectability
  • Its published by DTC Health whose own http://www.dtchealth.com site lists Truderm as one of their products.
  • Truderm is just an expensive multistage cleanser, exfoliator, & toner before " The Miracles of Benzoyl Peroxide" 2.5% & salycylic acid.
  • For example of push see the product comparison's "Truderma® comes out on top once again" (hardly surprising statement from the manufacturer) against just salicylic acid, roaccutane & retin-A, and seems to suggest only product warnings, cost, side-effects (repeating that of the warnings) distinguishes these with no indication of appropriateness for mild or severe degrees of acne.
  • On the prevention page the link titled 'Prescription Medications for Ane' infact goes to another version of Prevention where it states "Vitamin supplements play a major part in preventing and treating acne" - this is unsubstantiated, has no scientific basis and would be disputed by most doctors.
  • Finally under The Potential Dangers of Prescription Medications I am not surprised to see it leading with Isotretinoin and highlighting the most severe side-effect first, then a 'Drug-Free / Safer Options' section again plugging Truderm, before moving on to the risks of antiobiotics & hormonal therapy.
  • Acne-resource.org is not impartial, indeed see the disclaimer at the bottom of each page "These statements have not been evaluated by the food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease" - the use of the word 'This' (singular) shows the legal status of this promotional site.
  • So in summary, I think whilst some of the description is OK, much of the advice is wrong or cosmetics-industry biased, the review of treatments misleading & alarmist and the site little more than a commercial company's plug. This is a bad site to include in our article David Ruben ^Talk 13:58, 21 February 2006 (UTC)

Hi all. Sorry but I removed quite a few links before noticing your discussion here. I have since reverted. The links I removed were either blatantly promoting some product or were ad conduits via googlewords. Please consider removing the following links ...

• www.fact-sheets.com/health/what_is_acne/ - Contains no info the wikipedia article already has. Google adwords on right side.
• www.acneinformation.org - Site is extremely low on content very high on google adwords.
• www.acne.org/ - blatant commercial site

Monkeyman^{( talk)} 01:13, 25 February 2006 (UTC)

I have been persuaded of merits of acne.org (see above) - the description on shaving/wash/BP application routine is a good guide and makes no direct mention of his bulk-sized cheep product in the discussion.

I have though in expanding the info on BP use (including the relevant subpage vs homepage of acne.org as I had suggested above), transfered the references given to the newer <ref name="xxx"> reference details & links </ref> style. It makes reading the article in edit mode somewhat clumsy, but allows for duplicate references to the same reference and requires no manual ordering in the reference section as this is done for one with the markup <references/> :-) The article now has full details of its references rather than having to follow a link to find out.

To generate the PubMed reference details I used an automated tool, see description in WikiProject Clinical Medicine ( here) David Ruben ^Talk 02:33, 25 February 2006 (UTC)

Once again I have added a link to Acne.org's protocol page. Please take a look before deleting the link. I'll point out especially that a) the protocol can be used with any low-concentration benzoyl peroxide preparation, and the site makes that clear, b) the protocol is not described in the Wikipedia article body, and c) the protocol is unknown by most doctors and is not available from other websites or publications. 66.44.0.192 13:46, 17 June 2006 (UTC)

Can we add below link under "External links" on "Home remedy" page?

• Natural Remedies for Acne - This site is FREE (Non commercial) and managed by health professionals, hope this link will be useful for everyone.

—The preceding unsigned comment was added by Manjubalaw ( talk • contribs). 00:14, 20 September 2006

No - link provides uncited information and little if anything that adds to the current contents of teh article ("add content rather than external links"). States cause as being from "...wrong eating habits and chronic constipation" which is just nonsense (the constipation bit, if not the eating habits too - see current article's discussion of this misconception). I did like neat web page design though, but this is insufficient reason to add an external link. Suggest see WP:External links. David Ruben ^Talk 02:37, 20 September 2006 (UTC)

Manjubalaw "...wrong eating habits and chronic constipation" I dont think its nonsense....Irregular hours of eating, excessive starch consumption, too much of sugar, fried and fatty foods are also common causes of acne. Chronic constipation is another cause of acne vulgaris. If the bowels do not move properly, the waste matter is not eliminated as quickly as it should be and the bloodstream becomes surcharged with toxic matter. The extra efforts of the skin to eliminate excess waste result in acne and other forms of skin diseases.

I propose to add the largest non-profit acne home remedywebsite currently on the internet. I believe that offering home remedies for acne is something that people would be interested & very relevant in the treatment solutions. Most encyclopedias contain a huge list of treatments, not just viable commercial ones such as the laser light.

See WP:EL#Links_normally_to_be_avoided: this wouldn't add anything to the article that wouldn't be in the featured version.-- Steven Fruitsmaak ( Reply) 18:58, 30 October 2006 (UTC)

Up for approval Acne Information

This isn't a joke or anything, but I have acne on my scrotum (or at least they seem to be similar to pimples as they spew pus when successfully popped) and I want to know how to get rid of them. Anyone know what causes them and where I can find more info?

This is not an appropriate place for medical questions, as it is an encyclopedia. However, they are probably cysts. Ingrown hairs are another possibility. There is not much you can do to avoid either one, unless you've been doing something odd, such as waxing, applying substances to the area that may cause irritation or getting hit frequently in the groin. A doctor can get rid of the ones you already have. -- Kjkolb 08:40, 26 February 2006 (UTC)

I know this is not the place, but I feel sorry for the lad when a simple method like the following may be of help:

Do not eat eggs, chicken, or turkey meat for 2 months. Do not eat cakes, biscuits, candy bars, processed meat, mayonnaise - anything that contains egg. Make no exceptions - because it takes a LONG time for the (unknown) culprit to wash out of your system. Do not make any other changes in diet or hygiene. If it works and you have lost nearly all of your problem, eat egg or poultry meat for a test, once. Acne should recur after 5 or 7 days. If this method does not achieve any results at all, try something else. 121.209.50.103 ( talk) 06:14, 12 December 2008 (UTC)

Adult acne makes uncited claims of rising incidence in adults, has a brief description that adds nothing to fuller explanation in this article. Its one sentance mention of just some of the medicated products is in alarmist terms and then states herbal products are safe, yet there is no scientific evidence for their efficacy either.

I suggest perhaps a brief mention in this Acne vulgaris article that acne can occur in adulthood too, and emphasise the possibe medical causes at this time of life (vs the factors already listed as predisposing to its cause in adolescence) e.g. Polycystic ovary syndrome & Cushing's syndrome. The Adult acne then becomes just a redirect to here. David Ruben ^Talk 14:51, 8 March 2006 (UTC)

Agreed. Adult acne was originally created with the sole purpose to advertise a linkfarm. Monkeyman^{( talk)} 14:58, 8 March 2006 (UTC)

I agree. Karl Stas 20:54, 8 March 2006 (UTC)

Please see text for requests for citations for both incidence and increasing prevelance. I wonder if this is not being confused with Acne Rosacea that occurs in middle/later life and often looks similar to Acne vulgaris. In particular I note the comment in Similar conditions section: "Rosacea (ro-ZAY-she-ah) sometimes called "Adult Acne" occurs in people of all ages...", which is factually incorrect as it does not occur in infancy/adolescents. If so, then this is not "adult Acne vulgaris" and a rewrite is needed to just indicate the possible causes as currently listed. David Ruben ^Talk 03:17, 11 March 2006 (UTC)

Below is the section "adult acne" that was merged into this article from the short-lived article adult acne. I have removed it and placed it here as it really needs some citations. I also don't see how at the moment why adult acne needs to have its own section as it seems to be covered in general withen the rest of the article.

Once perceived as a disease of adolescence, acne is now affecting 25% of the men and nearly 50% of the woman at some      
time in their adult lives.
citation neededThe likelihood of acne developing or recurring during adulthood has 
increased significantly over the past decade.
citation needed Certain causes are more likely to be a factor in adult acne. 
These include hormone changes induced by 
pregnancy, 
menopause, or the 
aging process, as well as 

Polycystic ovary syndrome and 
Cushing's syndrome.

-- Clawed 04:59, 12 March 2006 (UTC)

In the recent votes, 5 voted for redirect and 3 for merge. A single sentance definition is all that is required - the rest seems uncited drivel: whilst it may describe acne being on the back, it needs verification that it is:

• hereditary ? Needs citing that to a greater degree than acne vulgaris is weakly associated
• is a disctinct condition
• needs distinct treatment (acne over face + neck + upper chest is equally as extensive and likely to be easier to treat with single oral antibiotic capsule a day vs cream applied twice a day).
• more resistant to treatment - nonsense, there is nothing unique at this location in the body. Yes the skin is thicker and makes penetration by topical agents harder, but skin thickness variation is not unique to the back. The skin thickness varies over the face * upper chest too and may require different topical "aggressiveness" in the thicker ares and a "lighter" approach in the thinner areas. (we don't distinguish acne on the thinner skin of the temples from that on the cheeks)
• "Bacne is also one of the many side effects of steroid usage" - why single this out for duplicate mention (already covered in Acne#Causes of acne).

A quick search for 'Bacne' indicates on Google 26,100 hits of which the top listing sites are for the more cosmetic/advertising-linked sites that this article has already had edit conflicts over, wikiditionary & wikipedia itself. This is just over 0.07% of the 36,000,000 hits for acne itself. Finally PubMed (listing of much of world's medical journals/research) gave an impressive 0 hits !

Lets mention that acne on the back may require stronger topical agents in response to this area's thicker skin and that oral agents may therefore prove more effective and be easier to comply with, than trying to apply topical creams to this inaccessable location (depending upon whow flexible one is !). The rest, I think, should be copyedited out as duplication &/or speculation. David Ruben ^Talk 17:34, 11 April 2006 (UTC)

I think we should stay away from colloquisms like "bacne" and refer to acne on ones back as back acne.-- Clawed 21:18, 11 April 2006 (UTC)

Actually, I think it is noteworthy to mention bacne/backne as a vernacular term for acne found specifically on one's back.

I have mild to moderate acne, but I had this one deep-rooted zit that just wouldn't go away despite the topicals and anti-biotics. My dermatologist said something about it being too deep for my immune cells to get to or something, I don't remember exactly.. bottom line is he injected it directly with a shot of cortisone and told me it should go away. Can someone who knows more about this add info about it in the article? Thanks. - Seyon (on 22 April 2006)

I don't think it would be relevant to add to the article. Cortisone was used in the senario you described to calm down a single specific chronically inflammed area within the skin. One might similarly so treat keloid scar formation or a granuloma. However it is not treating a person's overall acne, indeed more general steroid application as a cream over the whole face does not form part of acne treatement, and I suspect would in the longterm both worsen the condition as well as causing the well recognised steroid skin thinning. High enough doses of steroids by mouth can cause Cushing's syndrome, one of whose features is development of acne. Hence I don't think a specific decission by your dermatologist, to treat a specific complication from acne, needs form part of a general encyclopaedic entry. David Ruben ^Talk 13:44, 22 April 2006 (UTC)

I don't agree. He did actually have a recognised treatment that dermatologists offer their patients. As such this needs to be in the wikipedia. WolfKeeper 16:27, 22 April 2006 (UTC)

Sorry, did not mean to suggest unusual or off-license use of a drug, but it is uncommon (vs all the patients who are successfully treated within General Practice and never need to see a dermatologist or ever then require this), and applied to an individual spot rather than to the overall acne a patient might have. If we are to include it then just a v.short mention perhaps in the section on acne scaring ? David Ruben ^Talk 19:37, 22 April 2006 (UTC)

Look, all I know is that I recieved this treatment, and neither the article on acne, nor the article on cortisone had any information as to what it does or how it works. Also, a quick googling of "acne cortisone injection" brings up a number of responses that seem to indicate this treatment is becoming more common for deep individual cysts. - Seyon

Note that Wikipedia, as an encyclopedia, offers a survey of information on various subjects, and is not intended to be a definitive anmd exhaustive source of information, and certainly is not a medical guide. -- Donald Albury^{( Talk)} 22:26, 22 April 2006 (UTC)

Wikipedia is no mere encyclopedia.. Anyway, the article as it stands is pretty extensive, which would give the casual reader the impression that it WAS comprehensive. So IMHO we either need to cut out a lot, or cover all angles. For this reason, I have added a short paragraph in the hormone section about cortisone injections. I am certainly no expert, and would prefer if someone more familiar with the subject reviewed it, but I've confirmed the information I added on several sites. Seyon

Aside from the fact that wikipedia does not give medical advice.... I think this is wrong place although not sure where to relocate for now. If a patient were to pick at an acne spot and develop a secondary staphloccus infection requiring flucloxacillin antibiotic, this is a specific treatment for an infrequent complication. Yet flucloxacillin has no effect on the general progress of a patient's acne, and it not included in current list of antibitics used in the normal treatment of acne. Likewise the main treatment group of "Hormonal" is/was about overall manipulating a patient's acne through use of the contraceptive pill or anti-androgen hormones. I'm tempted to move the paragraph to the section on treatment for acne scars, although the point of local steroid injection is to pre-empt scar formation. Perhaps a new section prior to that mentioning both local steroid injection and antibiotics for secondary infections (i.e. a sort of 'misalaneous treatment section') ? David Ruben ^Talk 04:46, 23 April 2006 (UTC)

I would like to suggest an addition to external links from Wilopedia in regards to acne. This article here: www.clearogen.com/research.html provides insight into research suggesting very positive results in treating acne from reducing (binding) free DHT in the skin, thus reducing oils and the associated bacteria and clogged pores. This is published research and data collected and interpreted by Dr Khadavi, baord dertified Dermatologist: www.clearogen.com/dr-khadavi.html —The preceding unsigned comment was added by Cainer ( talk • contribs).

Clearogen.com is a commercial site. Is there a location for this article ("Structure-activity relationships for inhibuman 5alpha-reductases by polyphenols") which is not hosted on a commercial site? I would accept it under those circumstances. Monkeyman^{( talk)} 22:47, 14 May 2006 (UTC)

I suggest to add Facts about adult acne located at www.iacnecare.com/adult-acne. The sites provides some fact about adult acne, cause and treatment. —The preceding unsigned comment was added by IntegrateIS ( talk • contribs).

I found great Acne Resources located at www.about-acne-cure.com. This web site provides useful information about acne cure and more. —The preceding unsigned comment was added by Chockdee ( talk • contribs).

Rejected. End of discussion. - O bli ( Talk) ^? 08:58, 17 May 2006 (UTC)

Aww, we should still be nice. - brenneman ^{L} 06:02, 15 June 2006 (UTC)

Another source I found for Acne Resources located at www.infofreesearch.com/acne/index.php They provides article and news information about acne and more. —Preceding unsigned comment added by Rcephuk ( talk • contribs)

This one is getting a bit large. Any suggestions for what could be summarised better, split into its own article, or doesn't have a source and can be removed? - brenneman ^{L} 06:02, 15 June 2006 (UTC)

I'm going to forge ahead, making notes here as I go. - brenneman ^{L} 04:09, 21 June 2006 (UTC)

Ok, I've removed the section on scar treatment as it was already being done at scar, plus I've removed two sections w/o any sources. - brenneman ^{L} 06:11, 22 June 2006 (UTC)

Treatments

• Material added

A large amount of unsourced material that is mostly duplicated in Scar#Treatments_for_skin_scars was added in the edit above. I've pasted in the table of contents from that page and a precis of the section added, noting where there is duplication.
brenneman ^{L} 03:37, 3 July 2006 (UTC)

Since there is no objection, I'm going to go back to the shorter version. - brenneman [ http://en.wikipedia.org/?title=Special:Log&user=Aaron+Brenneman<font color="black" t

I've just removed some recently added material that was without a source. Are there any sections that are biased/dubious that curretnly do not have sources? - brenneman ^{L} 02:21, 26 June 2006 (UTC)

I am going to go through and tighten the article, removing unsourced material. - brenneman ^{L} 00:07, 3 October 2006 (UTC)

The NYT Science Page, Questions and Answers, July 11, 2006, says that according to the latest scientific research, chocolate and fatty foods do not cause acne, or aggravate it. Skim milk, or nonfat milk, however, does: Three glasses a day increase the severity of acne by 22%. Das Baz 16:52, 22 July 2006 (UTC)

• Hello, how are links to websites that detail personal experience with acne handled around here? The page in question is: How I Got Rid Of Acne - it explains what this person used to clean up her face and what different products she tried. Thanks.—Preceding unsigned comment added by 67.69.136.26 ( talk) 17:42, 22 September 2006

These are covered by the policies WP:EL and Wikipedia:Spam#External_link_spamming. That link could be removed anytime because:

• It's not a unique resource.
• It contains unverified original research.
• Although not listed in the criteria, sites with heavy advertisements are usually avoided.

-- Steven Fruitsmaak ( Reply) 23:36, 22 September 2006 (UTC)

I seem to remember reading something about acne vulgaris being highly prevalent in people of Celtic descent. Is this true? Schprunkel 18:13, 12 January 2007 (UTC)

In the section Available treatments, the reference to www.CureAcneNaturally.com is spam. I erased that. 201.228.183.57 20:35, 16 January 2007 (UTC)

Does it seem to anyone else that acne, which common and "natural" in the 21st century, is totally absent from man's history overall? When was the last time you saw an old (pre-1900) picture of someone with acne? When have you seen cures for it in ads in old (19th century or earlier) newspapers? Where is it mentioned in old/ancient medicine? What about in literature? You would expect an event so "essential" to adolescence to have appeared as a rite of passage in some culture, but there is no mention of it!

So, does anybody have any information on why acne might not have appeared until around the 20th century? —Preceding unsigned comment added by 128.174.244.253 ( talk) 03:09, 6 February 2007

Need to get some good sources, but not 20th Century at all. http://www.stridex.com/hist_acne.htm discusses treatment in Roman times, http://www.romans-in-britain.org.uk/bio_augustus.htm discusses Emporer Augustus being affected by acne. David Ruben ^Talk 02:33, 6 February 2007 (UTC)

There's a mention of pigmentation "scars" in the article - I think this is called "hyperpigmentation" by dermatologists and applications of Hydroquinone or another skin-lightening chemical will improve the skin's appearance over time. Does anyone know of an actual medical article to cite for this? The term "pigmentation 'scar'" doesn't sound very encyclopedic. Dianelowe 21:00, 15 March 2007 (UTC)

According to the article at http://www.aafp.org/afp/20040501/2123.html , Azelaic acid is used to counter hyperpigmentation. Dianelowe 21:21, 15 March 2007 (UTC)

This http://www.dermanetwork.org/information/acne_scars.asp page also recommends microdermabrasion and chemical peels. Dianelowe 21:21, 15 March 2007 (UTC)

I am shocked to find only 5 pictures of people's acne covered skin. I was certain this article would contain at least 100. You all are letting down the readers of this article, of Wikipedia in general, and the entire human race by your shocking failure to post many, many, many more of these gross pictures. -- Xyzzyplugh 20:12, 19 March 2007 (UTC)

When building a web page one cannot pack it with pictures. Too many pictures slow down the loading of the page when someone is trying to open it. Then what do you think will happen next? Well...that person will simply click the back button on their browser and go to another website that doesn't have so many pictures. Aradom18 ( talk) 21:48, 20 April 2009 (UTC)

what the #13 has to do with benzoyl peroxide? the whole text just talk about it and then slap Isotretinoin references(and bad ones) out of nonwhere

I was surprised to find a lack of information on seaweed as a treatment, and am putting ( http://aalgo.com/facial-treatments.html) in the article as a reference to information I found when researching the topic. Although the article is on a site that sells the product, it still provides relevant information, and see no reason why it should be rejected. —Preceding unsigned comment added by Webspaced01 ( talk • contribs)

Could you please read WP:EL before you add external links? If you believe that you have additional information about seaweed for acne, then use reliable source to support your assertion. — Indon ( reply) — 09:46, 16 April 2007 (UTC)

I think this article should mention something about the fact that spicy foods can cause acne. ― LADY GALAXY ★彡 ^{Refill/ lol} 04:15, 20 April 2007 (UTC)

Alright, this is a message for Xyzzyplugh: If you want to complain about this shit, go here. I think its a much more appropriate place, and it won't kill you to look at those pictures of acne if you want to read the article. Thomasiscool 00:00, 22 May 2007 (UTC)

I'd like to add two external links to this page:
Acne Guide - A patient guide to Acne written by Drs. Jerry Tan, Guy Webster, Roy Geronemus, and Marianne O'Donoghue. No commercial affiliation of any sort.
Acne Treatment - A collection of articles on acne treatment from Skin Therapy Letter (Skin Therapy Letter© is indexed by the US National Library of Medicine and listed in MEDLINE and Index Medicus, as well as being a featured journal in the Dermatology Publisher's Circle of Medscape) No commercial affiliation either.

Please let me know if anyone has objections/questions. Thank you.

R.B. 19:43, 29 May 2007 (UTC)

The second, third fourth and fifth paragraphs of this article should be deleted immediately. The information contained in these paragraphs is completely un-cited. These paragraphs are written sophomorically (in such a way as to be meaningless), contain inaccuracies and factually incorrect material, and serve only to perpetuate confusion on, and misinformation and misunderstanding of, an already too-misunderstood, myth-laden issue.

For example, the statement, "Surface infections are called zits whereas the deeper ones are called pustules" (besides suggesting acne is infectious, which it is not, although a proliferation of a constituent of the normal flora of the skin is involved), makes a useless and meaningless distinction, is incorrect and contradictory. "Zit" is a lay term, that is applied to any acne lesion (as the very first paragraph of the article itself states!), and "pustule" is a medical term, along with "macule", "papule", "nodule" and "cyst", describing various types of dermatological lesions, any of which may be symptomatic of acne. A "pustule", therefore, may be described as a "zit". A "pustule" would be "deeper" (to use the author's word, although, again, it is not the most useful, informative or descriptive) than a "papule" (the red or pinkish inflamed "surface" bumps commonly seen in acne and absent of the visible pus characteristic of a "pustule").

I came to Wikipedia as a single source for the latest references and cited material on the issue of acne vulgaris, as I do for many other subjects, and was shocked and horrified to see the inclusion of such blatantly un-cited and anecdotal material in an article that should be anything but. We must not allow this to continue to be the case. —Preceding unsigned comment added by 69.119.252.59 ( talk • contribs) 23:13, 23 August 2007

Rather than just deleting, rephrase or provide references for the bits that can be confirmed. Please note it is policy to sign talk pages (use 4 tildes) and repeatedly reverting other editors is disruptive - let them engage in a discussion here at the talk thread you started. More that 3 reverts is so disruptive that it warrants a temporary block to allow stability to return and then discussion to occur on the talk page. Anon blocked for 24hrs for x6 blankings (ie 5 reverts) as per WP:3RR. David Ruben ^Talk 22:53, 23 August 2007 (UTC)

The use of the 'expert attention' tag is unjustified; and by its own standards can never be removed, since how would we ever know if an expert ever edited this anyway? The wikipedia has no way to check credentials. There is a strong case for removing these tags from the wikipedia entirely.

Specifically, this article shows no signs of any major inaccuracies, acne is a condition of unknown cause, and the treatments are laid out and covered in reasonable detail and fairly and in context. More references would be desirable, but this article is by no means unreferenced, overall, this up-front tag is serving no purpose and shows no sign of ever helping, and I am removing it. WolfKeeper 12:59, 23 October 2007 (UTC)

The use of the "expert attention needed" tag is fully justified; this unreliable article could be the poster child for the "expert attention needed" tag.

Checking editor credentials is not the issue.

If this article accurately reflected and referenced information found in the review articles, guidelines, and medical textbooks in the Further reading section, it would not need the "expert attention needed" tag.

Specifically:

• The Primary causes section is inaccurate and completely unsourced.

I have tagged this section. WolfKeeper 17:28, 23 October 2007 (UTC)

• The Diet section gives undue weight to dubious speculative "causes" of acne that are not found in any of the reliable sources in the Further reading section.

I don't agree, there is now evidence that diet can make a difference to acne vulgaris. WolfKeeper 17:28, 23 October 2007 (UTC)

• Most of the Available treatments section is completely unsourced.

Most of it.. is completely.. these two phrases do not go together. WolfKeeper 17:28, 23 October 2007 (UTC)

• The History of some acne treatments section is completely unsourced.

I have tagged this section. WolfKeeper 17:28, 23 October 2007 (UTC)

• The Preferred treatments by types of acne vulgaris section that offers medical advice is completely unsourced.

I have tagged this section. WolfKeeper 17:28, 23 October 2007 (UTC)

Please see WP:MEDMOS#Citing medical sources:

Medical articles should be relatively dense with inline citations. It is not acceptable to write substantial amounts of prose and then add your medical textbook to the References section. It is too easy for a later editor to change the body text and then nobody is sure which statements are backed up by which sources. Unlike many established scientific disciplines, medicine attracts controversy and opponents on even the most basic and commonly held facts.

Most of this article is completely unsourced.

The article has over 43 notes, and a long list of references so that is not really true. I agree that it could do with more references; I do not agree that the expert attention needed tag makes sense for inadequately referenced articles (otherwise the entire wikipedia needs that tag...) WolfKeeper 17:28, 23 October 2007 (UTC)

The up-front "expert attention needed" tag serves a vital purpose. Alerting readers is especially needed for this article because readers may incorrectly assume that the reliable sources in the Further reading section were used as references in writing the article, whereas they were used only where explicitly cited for:

1. the second paragraph of the introduction
2. the first sentence of the third paragraph of the introduction
3. the last three sentences of the second paragraph of the Symptoms section.

Really, I consider this kind of tagging to be tendentious. If you find areas or sections of an article to be unduly referenced, you should tag it or fix it; rather than requesting some non-existent 'expert' to fix it for you. That isn't going to happen. Deal. WolfKeeper 17:28, 23 October 2007 (UTC)

69.208.163.216 16:38, 23 October 2007 (UTC)

All you've shown is that the article needs more sources. That is not the same as needing expert attention. WolfKeeper 17:28, 23 October 2007 (UTC)

On 30 March 2005 Karl Stas added this unsourced claim (and medical advice):

Seafood, on the other hand, may contain relatively high levels of iodine, but probably not enough to cause an acne outbreak. Still, people who are prone to acne may want to avoid excessive consumption of foods high in iodine.

On 13 January 2007 Fwdanby added a reference:

• Danby FW (2006). Acne and iodine: Reply. J Am Acad Dermatol. 56(1): 164-5. PMID 17190637, that concludes:

To summarize, there is no evidence to support iodides as a cause of comedonal acne.

On 24 October 2007, 69.208.163.216 removed the Seafood subsection of the Diet subsection of the Causes of acne section, which had said:

Seafood often contains relatively high levels of iodine. Iodine is known to make existing acne worse but there is probably not enough to cause an acne outbreak.PMID 17190637 Still, people who are prone to acne may want to avoid excessive consumption of foods high in iodine.

with this edit summary:

(→Seafood - rm unsourced seafood / iodine claim added 30 March 2005 by Karl Stas; source added 13 January 2007 by Fwdanby refutes claim)

69.208.163.216 05:17, 24 October 2007 (UTC)

So far as I can tell, you've removed a source and a paragraph that both say that iodine probably doesn't cause acne at normal levels. The bit that says that it's probably not a good idea to have a high iodine intake anyway is doubtless referenceable- I've seen that opinion elsewhere; and it was doubtless a notable one. WolfKeeper 13:48, 24 October 2007 (UTC)

So, essentially you've removed all references of iodine and acne from the wikipedia! So anyone searching for it on the internet (I just tried it) finds lots of dorky websites that all say that it probably does cause acne! Congrats! WolfKeeper 13:48, 24 October 2007 (UTC)

some guy that read a lot of books but has never been taught how to write a common sense encyclopaedic article is hijacking this page and completely replacing other people's stuff with a very dry and poorly accomplished text. I wrote about form and function, I wrote an introduction as introductions should be explaining the colour diversity dimensions form and distribution, causes, effects, basic social consequences, bacterial outline, etc etc...

the guy seems to think he is an authority on the subject but he has not been taught to make an introduction properly in wherever he has been taught,he has no understanding or common sense, dialogic or medical reasoning

All I know is that you rewrote the introduction to include a falsehood, namely that acne vulgaris is caused by staph. In practice, removal of P.Acne massively improves acne, even if staph still remains, and as I understand it, that is the current medical position. However staph and strep etc. are the bacteria that form the actual pustules, but the pustules seldom occur if P.Acnes is out of the picture; the converse is not true. WolfKeeper 00:19, 1 November 2007 (UTC)

an introduction should provide an overview of the main topics of the subject, depending on the style of the reference,encyclopaedia, science abstract, General reference....

whatever it is, it doesn't look like it's made for a general audience, it looks like some guy with little common sense writing highly technical stuff without actually explaining what it means...therefore I suggest that there should be a general introduction followed by technical explanations in a further parts of the article.

I am annoyed with them because they seem to be some kind of pharmacy shop or something, they have wiped off all the commonsense staff about treatment and replaced it with a pharmacy book explanation which is a ridiculous opinionated overview of treatment, the kind that is promoted by companies rather than scientists.

unfortunately some scientists are unable to differentiate between science and company promoted science, and to provide balanced information covering the topic globally

in any case I mention clinical lancing in the treatment if he would wish to look it up and make a section about it maybe he would learn something.

Re-add it, by all means; but reference it well; and add it as a treatment, not in the introduction. WolfKeeper 00:19, 1 November 2007 (UTC)

in the process he would also be explaining to people how to reduce problems by at least 50%-lancing is highly effective look the thing up as a treatment you complete bloody idiot before deleting it-would it cost to the pharmacy to much in lost sales to explain how to prevent lesions and bruising?

^^^^ paragraph is not the wikipedia way; the wikipedia is not a how-to, and if what you say is true, you should be able to reference it via verifiable and notable sources. WolfKeeper 00:19, 1 November 2007 (UTC)

there should be some guidelines to explain to people how to write an introduction -frankly in a proper educational institution, this introduction would get 3 out of 10, and the whole article would be a 5,

WP:LEAD WolfKeeper 00:19, 1 November 2007 (UTC)

Not impressed with the monopolistic idiot with no sense... introductions are things like age/population distribution/physical distribution/colour/microbiology/small-scale morphology ...

the introduction should be written in English, the guy obviously has absolutely no biological understanding of what is going on whatsoever...biology is all about cause and effect and so is medicine, maybe he should write a little bit of that in the introduction —Preceding unsigned comment added by Gt jaya ( talk • contribs) 22:49, 31 October 2007 (UTC)

The cause of acne is not actually known. It is known that staph is not the cause of acne though. P.Acnes probably isn't either, but its presence clearly makes the condition up to 10x worse. WolfKeeper 00:19, 1 November 2007 (UTC)

I don't know why the introduction didn't mention there were bacteria involved at all to begin with. let alone that it does not sound very like an introduction to a general reference. it spends half the time explaining about the technicalities of formation of plugs which is actually only 10% of relevant information of an introduction to the wider topic, irrelevant of what type of reference it is, just relative to the subject matter.

Re:Before editing this page a couple of months ago the introduction was a lot shorter and less informative than it was after. I replaced the information again because some guy takes it upon himself to replaced other people's text entirely which is something that is classed by wiki as bad form, its disrespectful to other users.

so for example if the introduction says something is red and appears mostly on the face and back, the correct thing to do is not decide you want to rewrite everything.

so in my previous example which noted discomfort, pressing behaviours, scarring, the correct thing sanctioned by wiki is not to be erase all this information and put your own interpretation. do you need references for that kind of information as well? Like if someone wrote that birds fly you don't need references for that, it's common sense.

regarding the cause, it is simple biology for the most part- what bacteria are involved(there are many)? what kind of structure does the bacteria infect and why? what happens when it infects? what cause-effects / reductionism is involved? the biological process of the immune reaction which actually causes the inflammation relative to the structures of skin involved? where the lymphatic system fits in? through what channel the infection spreads? why the skin is very reactive regarding immune system? all these things are very simple and common sense, and I think they are just as relevant in an introduction as throwing an in-depth terminology as a form of introduction. maybe people should do a separate page on the detail of skin maturation to mention what cells are involved and in what way.

also you might find time to explain what distributions in size and appearance the different elements take.

some things remain a mystery for example perhaps keratinisation as far as I know, but for the most part it's a basic cause and effect process related to fairly run-of-the-mill foreign bodies/immune reactions/biological concepts

relatively speaking this page is much better written <url> http://hcd2.bupa.co.uk/fact_sheets/Mosby_factsheets/acne.html</url>

similarly, if you're going to cover treatments only from the point of pharmacological products only, without mentioning perhaps control of food and skincare, it's also biased and misleading. —Preceding unsigned comment added by Gt jaya ( talk • contribs) 07:33, 4 November 2007 (UTC)

I just wanted to explain why I changed "Exposure ... narcotics ... , especially when abused intravenously." to "Exposure ... narcotics ... , especially when taken intravenously." There are legal, medical uses for narcotics, and in the context of Acne, I don't see why "abusing" narcotics intravenously would be any different than "using" narcotics intravenously. Since both are supposed risks, I changed the wording to "taken intravenously." All of these causes are unsourced anyway, so who the heck knows what's real anyway? (my edit shows up as anonymous because I wasn't signed in, but it was me.) 05:22, 6 November 2007 (UTC)

I have just come across the Zeno which seems a plausible device. I have cited their summary of their clinical trial data which is perhaps not independent enough but seems a reasonable start. Colonel Warden ( talk) 13:05, 2 January 2008 (UTC)

Really?! 128.243.220.21 ( talk) 16:09, 28 April 2008 (UTC)

The linked article is up for deletion and looking likely to go. When it does, the link will be removed. -- Escape Orbit ^(Talk) 16:16, 28 April 2008 (UTC)

Ah - was bold and already removed the section. Butt acne is not recognised form of acne (look up ICD10 codes) and nor is it acne, let alone acne vulgaris (common acne) - but rather covers a variation on sweat rash perhaps leading to folliculitis. David Ruben ^Talk 18:38, 28 April 2008 (UTC)

I only get pimples if I use certain kinds of Shampoo on my hair, even if the shampoo is on my entire body the pimples only occur on my face in the places where pubescent acne occurs. I know this could be considered a rash but it is pimples and it has been suggested that the article on pimples be merged with this one. Is there any research on allergens causing acne? It took me many years to figure out that- hey if I use my moms shampoo my acne goes away, plenty of people could benefit from this kind of research. 66.140.72.126 ( talk) 19:10, 12 May 2008 (UTC)

Pimples merger closed as a rejection. What you describe may be pimples, and seems a reaction to an external agent, but that does not make it acne vulgaris ("vularis" = common form). Urticaria & especially contact dermatitis might be a better terms for what you describe. 00:25, 13 May 2008 (UTC)

Ok, I can't find any sources on this, but i have always used surgical spirit to dry out spots, which then fall off. am I the only one that has ever heard of this? i was surprised to not see any references to this in the article —Preceding unsigned comment added by UltraMagnus ( talk • contribs) 23:04, 30 July 2008 (UTC)

Why does this article have no lead section? This is very odd, I've never seen an article of this size without one. - kotra ( talk) 00:04, 20 December 2008 (UTC)

Would be nice if people could spell SENTENCE this way.

A leader for such an article is very difficult, because like with so many skin problems, there is often a lack of solid scientific evidence but a lot of guessing regarding the large variety of symptms, possible causes, external, internal and how they relate to that particular individual. Like cancer, acne is not a word that describes one specific condition. It describes pimples with pus, of different severity and, in all likelihood, different causes. Specification has been difficult, as food, water, air pollution, beauty products, genetic make-up, metabolism, and possibly the state of mind/stress/hormones are interacting to produce these impurities which can occur all over the body but are most common in the face. Suggestions for treatment vary accordingly.

These types are most common: ........ I'm not an expert but this is how I would tackle a leader. 121.209.50.82 ( talk) 04:20, 14 January 2009 (UTC)

Lead has been re-added. - kotra ( talk) 23:41, 27 January 2009 (UTC)

There is no discussion of "popping zits" ? Should this be included? Kirsted ( talk) 05:56, 23 January 2009 (UTC)

Absolutely. And squeezing blackheads too, although blackheads seem to get their own article, far shorter than this one. People have argued that this is not a 'how to' site, but spot squeezing is a common activity that deserves mention IMO Traveller palm ( talk) 10:04, 7 March 2009 (UTC)

Does anyone have any information as to weather or not caffiene causes acne and if it is by a significant amount. Please add this information to the article if you have it, i would really like to know. —Preceding unsigned comment added by 71.201.34.215 ( talk) 13:56, 19 February 2009 (UTC)

Caffiene on its own is not an acne stimulating agent but as with pretty much every chemical some people may find that it aggravates their condition, if you want to know if cutting it from your diet will help you the only way is to try it. If you do try goodluck, I made an attempt and failed, had withdrawls too. Fists ( talk) 05:43, 22 February 2009 (UTC)

The article refers in the "history of..." section to "what were known as 'chastity pimples'". Is there any evidence that this term was actually used? A search finds very little other than things using the info from this page. It sounds plausible given the notion that some might hold that sex would cure them , but at the same time it sounds unlikely that a term referring to this would become widespread. Billwilson5060 ( talk) 10:46, 4 March 2009 (UTC)

For the record, I later found a couple of references here: [3] [4] that attributed it to a researcher named Pick and a Bavarian term. Billwilson5060 ( talk) 13:13, 30 April 2010 (UTC)

After a year of languishing the identical worded acne scar treatment merged with acne scarring. Now Acne scarring's almost wholy unreferrenced paragraphs need trimming down per WP:Verify, and then incorporating into a subsection of Acne#Treatment. David Ruben ^Talk 01:22, 21 April 2009 (UTC)

Support - as per nom. --- kilbad ( talk) 01:52, 21 April 2009 (UTC)

Support. Yes indeed. SNALWIBMA ( talk - contribs ) 07:50, 14 May 2009 (UTC)

The article states that acne "is caused by changes in the pilosebaceous units" due to "an increase in male sex hormones"..."most common during adolescence". Is the difference between adult skin and a child's skin simply a side effect of male sex hormones? Or is there some evolutionary purpose for the oiliness of mature skin? 98.149.117.42 ( talk) 05:43, 29 April 2009 (UTC)

---

Peanuts? I always get pimples after eating peanuts. Is it just an allergy or is peanuts also causing Acne? —Preceding unsigned comment added by 200.2.169.42 ( talk) 22:38, 9 August 2009 (UTC) I USE THE POPING AND ISOPROPOLY..STINGS....BUT DRIED UP IN TWO DAYS.... —Preceding unsigned comment added by 66.183.65.160 ( talk) 06:56, 9 October 2009 (UTC)

Cystic acne used to have its own article, but it now redirects here. The lumps that come with it aren't really cysts - they are boils. Grundle2600 ( talk) 21:57, 24 December 2009 (UTC)

Might be a link or mention of Bukowski's Ham on Rye, his coming of age novel with great amounts of info on Acne Vulgaris and a sensitive account of what it is like to have it. Timbabwe ( talk) 18:39, 7 January 2010 (UTC)

I have moved a bunch of primary research from this article and begun adding reviews. For people who wish to join in feel free. Doc James ( talk · contribs · email) 08:42, 16 August 2010 (UTC)

I can't help but ask if diet is really as unrelated to acne as some people say.

If there is a relationship, even if it is a little tenuous, can acne be induced in any of the primates by preventing them from having enough vitamin A, and, perhaps, by simultaneously increasing their testosterone levels? If acne can be induced in primates, the main page of this article should be changed to read it is primarily a human skin disease.

I wouldn't be too surprised if this sort of thing has been tested over and over again, especially in trials with chimpanzees. Does anybody know of a reliable authority to quote? 216.99.219.38 ( talk) 06:33, 1 October 2010 (UTC)

Would need a ref. -- Doc James ( talk · contribs · email) 04:40, 4 October 2010 (UTC)

acne free skin needed —Preceding unsigned comment added by 117.206.101.60 ( talk) 08:25, 18 January 2011 (UTC)

Recently on a trip to the town of Jalostotitlan, Jalisco in Mexico, I found the cure for Acne. In a pharmacy called La Farmacia de el Caballito, I bought a product (compost) called Agua Maravillosa (Magical water). I was told by locals that this product did wonders and to my surprise this product does work and is very inexpensive about 8 ounces for $1.50. The product does not come with any labels or instructions it is mixed on a daily basis by the pharmacist who told me to soak a cotton ball and applied to clean skin two to three times a day. All I can tell you is that this product smells like formaldehyde. M.R. —Preceding unsigned comment added by 98.202.4.106 ( talk) 17:22, 18 January 2011 (UTC)

Hello, I was just wondering if we could have a section on the psychological effects of acne (Especially teenage acne)? Such as depression, social reclusion, esteem-issues, feelings of failure and disappointment, being bullied, failing at school & work etc.

I for one became suicidal and ruined my education because I had acne. I also developed a chronic case of body dysmorphic disorder. Can we link these diseases as well?

Thank you,

Alexei-Arbeaux. —Preceding unsigned comment added by 80.73.215.166 ( talk) 20:11, 18 April 2010 (UTC)

I disagree. It could be applied to any condition or disease. —Preceding unsigned comment added by 87.115.142.143 ( talk) 18:26, 4 January 2011 (UTC)

I agree and second this suggestion. Acne is especially likely to cause the psychological trauma the OP describes given its obvious cosmetic nature and prevalence in adolescence. There's plenty of literature on this: http://www.ncbi.nlm.nih.gov/pubmed/15778823 http://www.ncbi.nlm.nih.gov/pubmed/17004999 http://www.ncbi.nlm.nih.gov/pubmed/18330741

The mere fact that psychological harm is caused by other disorders should not preclude a discussion of its characteristic presentation in the context of acne.

And lets not forget this often cited quote: "There is no single disease which causes more psychic trauma, more maladjustment between parents and children, more general insecurity and feelings of inferiority, and greater sums of psychic suffering than does acne vulgaris." — Preceding unsigned comment added by Jkom329 ( talk • contribs) 08:54, 27 February 2011 (UTC)

"Other associations such as chocolate and salt are not supported by the evidence" < WRONG! "The study identified crude associations between acne and high intake of chocolate and chips and low intake of vegetables." > http://www.sciencedaily.com/releases/2009/09/090915192230.htm —Preceding unsigned comment added by 184.98.46.61 ( talk) 14:01, 6 April 2011 (UTC)

This could be related to the glycemic index... Dark chocolate probably has a much lower glycemic load than milk chocolate, due to the absence of added milk (which also contributes) and sugar. For chips, it may not be the salt but in fact the high fat and starch content which both (as I understand) contribute to a high glycemic index. I'd say that foods that tend to be salty also tend to be high in fat/carbs, but obviously this isn't always the case... perhaps this ought to be illustrated in the article. -- SweetNightmares (awaken) 17:13, 26 July 2011 (UTC)

I've tagged the section using the {{peacock}} template, which apparently isn't available for only a section, because I believe it to be the most appropriate tag here. It sounds pretty biased and has no references, and the microdermabrasion article also has related problems. I doubt there's much science to back the process up or even to distinguish it from dermabrasion, and personally I believe it needs to be deleted, along with its parent article. -- SweetNightmares (awaken) 18:49, 27 July 2011 (UTC)

===Recommendations===

In the UK the National Health Service offers detailed justified recommendations ^[1]. A summary follows. Note that benzoyl peroxide is the only medication of those listed that is available over the counter in the UK.

Mild Acne

"Mild acne" consists of blackheads and whiteheads - and will often not be described as acne, as there are few if any "zits". Topical retinoid (tretinoin, isotretinoin, or adapalene) or benzoyl peroxide as first-line treatment. Topical antibiotic or azelaic acid if both topical retinoids and benzoyl peroxide are poorly tolerated. Consider prescribing a standard combined oral contraceptive in women who require contraception.

Moderate acne (papules and pustules)

Limited acne which is unlikely to scar:

• Prescribe benzoyl peroxide or a topical retinoid first-line. Azelaic acid is an option if other drugs are poorly tolerated.

Combined treatment should be considered in all people with moderate acne:

• Benzoyl peroxide combined with a topical antibiotic is the usual preferred regimen.
• Other options include a topical retinoid combined with benzoyl peroxide (but this may be poorly tolerated) or a topical retinoid combined with a topical antibiotic (but this may promote bacterial resistance).
• Consider prescribing an oral antibiotic (tetracycline, oxytetracycline, doxycycline, lymecycline, or erythromycin) if topical treatment cannot be tolerated, if there is moderate acne on the back or shoulders (where it may be particularly extensive or difficult to reach), or if there is a significant risk of scarring or substantial pigment change.

Consider prescribing a standard combined oral contraceptive in women who require contraception.

Severe Acne (nodules and cysts, as well as papules and pustules)

There is a high risk of scarring. Refer all people with severe acne for specialist assessment and treatment (for example with oral isotretinoin), and consider prescribing an oral antibiotic in combination with a topical drug whilst waiting for an appointment. Oral tetracycline, oxytetracycline, doxycycline, or lymecycline are first-line options. Erythromycin is an alternative if tetracyclines are poorly tolerated or contraindicated (such as in pregnancy). Minocycline is not recommended. Benzoyl peroxide or a topical retinoid are recommended as adjunctive treatment for most people. Azelaic acid is an alternative, but avoid the use of topical antibiotics with oral antibiotics. Consider prescribing a combined oral contraceptive in women who require contraception.

References

1. ^ http://www.cks.nhs.uk/acne_vulgaris

This ref could be used to support some of the content already here but no reason to duplicate it. Doc James ( talk · contribs · email) 18:17, 7 January 2012 (UTC)

• Seminar doi:10.1016/S0140-6736(11)60321-8 JFW |  T@lk 23:17, 28 January 2012 (UTC)
• 2013 review in the BMJ out this week [5] Might be time for a good updating. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 19:17, 13 May 2013 (UTC)
• And another [6] Doc James ( talk · contribs · email) (if I write on your page reply on mine) 19:23, 13 May 2013 (UTC)

The text absolves pure chocolate from any blame, despite suggestive recent studies. I'm curious as to the quality of the evidence for chocolate's 'not guilty' verdict. The review study ( full text) cited is a sketchy affair, and itself cites a pathetic 1965 study Chocolate as a Cause of Acne: a Dissenting View ( PMID  14327774) as proof.

We need to keep in mind that a very influential 1969 study ( PMID  4243053 — a clinical trial) appeared to scotch any association between chocolate and acne. This study made a big impact, and has been cited dozens of times in other journal articles, including (apparently) the review study above that is quoted in our article. But it has recently been roundly criticized, not least because it was funded by the Chocolate Manufacturers' Association of the United States of America.

There have now been a few suggestive studies worth looking at in this respect. They may warrant inclusion into the text.

• From 2011 — Chocolate and acne: how valid was the original study? (questions the validity of the seminal study absolving chocolate) ( PMID  21679875)
• From 2011 — Exacerbation of facial acne vulgaris after consuming pure chocolate (discussed in the BBC link below) ( PMID  21920227)
• From 2013 — Chocolate consumption modulates cytokine production in healthy individuals. (concludes that chocolate consumption influences acne, although it does not discern between pure chocolate and milk chocolate) ( PMID  23465690)
• These developments are discussed at the BBC, at WebMD, Confectionery News and at NatureWorldNews.

So simply sticking to the 1960s line that "chocolate has no effect" is incorrect, and excluding these studies on the basis that they have not had time to be included in a new review study seems unnecessarily cautious. MLPainless ( talk) 01:47, 19 May 2013 (UTC)

No we are sticking to proper secondary sources. When high quality secondary sources change there position so will we. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 01:52, 19 May 2013 (UTC)

Have a look at the secondary source. Tell me that's a quality source. MLPainless ( talk) 01:55, 19 May 2013 (UTC)

Which secondary source? Doc James ( talk · contribs · email) (if I write on your page reply on mine) 02:27, 19 May 2013 (UTC)

The one you use in the article : full text MLPainless ( talk) 22:02, 19 May 2013 (UTC)

No I would not call [7] this a great source. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 00:17, 20 May 2013 (UTC)

Exactly. So we agree on the low quality of that secondary source. So given that, it may be worth noting that it relies on another poor source (the manufacturer-funded study). Just sayin'. Do we want just one sentence devoted to chocolate and acne, or do we want to flesh it out a little? MLPainless ( talk) 03:00, 21 May 2013 (UTC)

I didn't think "pimple" was a specific dermatology term? It looks out of place alongside papule etc. Lesion ( talk) 19:07, 16 November 2013 (UTC)

"As of 2012, evidence for light therapy and lasers is insufficient to recommend them for routine use.[41]"

• This conclusionary statement appears in an overview article by Titus and Hodge focusing on topical astringents and oral medication. They have done zero research on light therapy, and are hardly an authoritative source on the subject. Conversely, there are at least four articles available at nih.gov which attest to the efficacy of light therapy in the treatment of acne.
• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2923954/
• http://www.ncbi.nlm.nih.gov/pubmed/20098847
• http://www.ncbi.nlm.nih.gov/pubmed/16249142
• http://www.ncbi.nlm.nih.gov/pubmed/12413768 — Preceding unsigned comment added by 67.173.115.228 ( talk) 16:58, 21 December 2013 (UTC)

"Light therapy is an expensive treatment modality[2] and while it appears to provide short term benefit, there is a lack of long term outcome data or data in those with severe acne.[42]"

• Compare this to the clearly positive description of another personal care practice in the Wikipedia article titled " Tooth brushing." Light therapy is like brushing your teeth. It provides a short term benefit, but must be repeated daily or even more frequently to keep up with the growth of new bacteria. When light therapy is viewed as a form of hygiene, it can be characterized as an important part of skin care for people who are prone to acne breakouts. Inexpensive LED composite bulbs are now available which are intended to be used for this purpose, and do what they are claimed to do. — Preceding unsigned comment added by 67.173.115.228 ( talk) 16:51, 21 December 2013 (UTC)

Re. light therapy sources, all those 4 studies are primary sources. Medical content on Wikipedia needs to be sourced to reliable secondary and tertiary sources (see: WP:MEDRS).

The evidence for toothbrushing with fluoride toothpaste twice daily is solid and accepted as the mainstream view, but we should not use arguments based on observations of other articles to justify changes here.

If you have a WP:MEDRS source to support your claim "Inexpensive LED composite bulbs are now available which are intended to be used for this purpose, and do what they are claimed to do." please provide it. Thank you, Lesion ( talk) 17:07, 21 December 2013 (UTC)

So... the Titus and Hodge quote stays because they are secondary and four independent studies which corroborate each other must be disregarded because they are primary? What is wrong with this picture? Useful life-changing information is being suppressed. — Preceding unsigned comment added by 67.173.115.228 ( talk) 18:27, 24 December 2013 (UTC)

WP:MEDRS is in place in an attempt to make sure medical content on Wikipedia reflects mainstream medical opinion. You can imagine what things would be like if primary studies were allowed... it would be a free-for-all and any page could be manipulated to reflect fringe theories. Ofc, this is what things are like to an extent, but it would even more so were it not for this guideline. Just need to find a secondary or tertiary source, ideally a systematic review or meta analysis, which supports these treatments. Lesion ( talk) 19:58, 24 December 2013 (UTC)

We have a good secondary source here [8] Will look at the question of different rates in different regions further tonight. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 15:08, 18 January 2014 (UTC)

Yes appear to occur less often in rural / non Westernized populations. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 00:14, 22 January 2014 (UTC)

This ref say no global variance [9] Doc James ( talk · contribs · email) (if I write on your page reply on mine) 00:18, 22 January 2014 (UTC)

Found a good textbook. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 00:37, 22 January 2014 (UTC)

Acne might cause small maccules of hyperpigmentation if there is scarring (which image does show) ... not sure this is described as orange skin...looks like the orange color might be an artifact of the lighting and color settings of the camera that took the pic. Lesion ( talk) 17:14, 31 January 2014 (UTC)

Agree acne does not cause jaundice. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 17:18, 31 January 2014 (UTC)

Fulltext available here: http://jddonline.com/articles/dermatology/S1545961614P0428X -- Siddhant ( talk) 19:48, 13 April 2014 (UTC)

Thanks. We more or less state this already. Will incorporate soon. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 04:39, 16 April 2014 (UTC)

. — Preceding unsigned comment added by Drole007 ( talk • contribs) 10:44, 20 April 2014 (UTC)

GA toolbox
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This review is transcluded from Talk:Acne vulgaris/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: Bluerasberry ( talk · contribs) 16:49, 3 February 2015 (UTC)

Review by bluerasberry

I am here in response to a request at WP:MED.

Per Wikipedia:Manual_of_Style/Medicine-related_articles#Diseases_or_disorders_or_syndromes, I expect to see a "society and culture" section when that is relevant to the disease. For this to be promoted, I wish to see some coverage of social stigma, economics of treatment, and something about class distinctions and global perspective. Currently there is no social coverage of this.

•  Done TylerDurden8823 ( talk) 07:11, 17 February 2015 (UTC)

The management section does not have an explanation of the default treatment option, which is doing nothing in particular. Also I would like to see some ranking of the treatments to indicate which response is most common. Some of these treatments are probably not common.

•  Done I think I've addressed this now. TylerDurden8823 ( talk) 07:11, 17 February 2015 (UTC)

In the differential diagnosis section, I would like to see at least one differentiation made, perhaps between this condition and another common condition.

•  Done TylerDurden8823 ( talk) 07:11, 17 February 2015 (UTC)

In all of these things I am happy with 1-2 sentence presentations and linking to a source. I expect that sources would be easy to find for all of these if someone checked PubMed and Google Scholar. Blue Rasberry (talk) 16:49, 3 February 2015 (UTC)

Fair points Blue, let's put it on hold and I'll make the necessary revisions. TylerDurden8823 ( talk) 17:04, 3 February 2015 (UTC)

Can you clarify what you mean about the ranking of treatments to indicate which response is most common? Do you mean a ranking of the treatments in terms of how effective they are or which treatment has the highest response rates? TylerDurden8823 ( talk) 06:21, 7 February 2015 (UTC)

The text does not make clear what most people do when experiencing acne. Just based on information presented in the article, it seems like people who experience acne might commonly respond by getting a prescription for retinoids followed by laser resurfacing, because about 15 treatments are presented without indicating which ones are odd or unusual. I have insight to know that acne is usually mild and requires no intervention from a health professional, and when there is a health intervention, some of these are more common in all cases, some are a response to severe acne, some are not common, and I am not sure that some are used at all. I would like to see these differentiated in some way between what is typical and what is unlikely to be of interest to most readers learning about this condition. Blue Rasberry (talk) 18:21, 7 February 2015 (UTC)

Okay, that's clearer. I'll see what I can do. TylerDurden8823 ( talk) 07:42, 9 February 2015 (UTC)

• Koo, JY; Smith, LL (September 1991). "Psychologic aspects of acne". Pediatric dermatology. 8 (3): 185–8. PMID  1836060.
• Niemeier, V; Kupfer, J; Gieler, U (December 2006). "Acne vulgaris--psychosomatic aspects". Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG. 4 (12): 1027–36. PMID  17176410.
• Goodman, G (August 2006). "Acne--natural history, facts and myths". Australian family physician. 35 (8): 613–6. PMID  16894437.
• Dréno, B (2006). "Assessing quality of life in patients with acne vulgaris: implications for treatment". American journal of clinical dermatology. 7 (2): 99–106. PMID  16605290.
• Thomas, DR (2004). "Psychosocial effects of acne". Journal of cutaneous medicine and surgery. 8 Suppl 4: 3–5. PMID  15778823.
• Lowe, JG (undefined NaN). "The stigma of acne". British journal of hospital medicine. 49 (11): 809–12. PMID  8334485. {{ cite journal}}: Check date values in: |date= ( help)
• Ou, HT; Feldman, SR; Balkrishnan, R (June 2010). "Understanding and improving treatment adherence in pediatric patients". Seminars in cutaneous medicine and surgery. 29 (2): 137–40. PMID  20579603.

Blue Rasberry (talk) 17:24, 3 February 2015 (UTC)

Thanks, that'll save me some time. I'll probably be able to work on it possibly this evening or tomorrow. TylerDurden8823 ( talk) 21:23, 3 February 2015 (UTC)

✓ Pass All the issues I raised have been addressed. It is my opinion that this article has coverage of all topics which are described in the medical manual of style and that the coverage is sufficient to meet the standards of a WP:GA health article. In my evaluation, I only checked for scope and extent of coverage, so for this article to pass GA, it needs to be evaluated from other perspectives. Blue Rasberry (talk) 15:51, 17 February 2015 (UTC)

Thanks blue, so what do I need to do now? I've searched more and I really don't seem to be able to find any reputable sources to verify that many people do not treat their acne and that the decision to treat it usually stems from the severity & duration of the problem. With respect to evaluating the article from other perspectives, are you saying additional reviewers are needed? Or are you saying the review is not yet done? I'm confused... TylerDurden8823 ( talk) 17:45, 17 February 2015 (UTC)

TylerDurden8823 I am happy with the "doing nothing" section as it is, and in my opinion, a section like that can stay in a GA. I think that I was diligent in searching for sources on this issue and I know that you were too. I would be content if someone removed the section if they disagreed with it and noted this on the talk page, but unless that happens, I prefer to leave it as it is.

For this to pass GA it needs to be further reviewed. I think GAs work better when several people review the article, perhaps 3 total, and speaking only for myself I encourage multiple people to review parts rather than having one person review all. By Wikipedia:Good_article_criteria#The_six_good_article_criteria, I confirmed points 3 entirely and 4 in the parts we discussed. Someone else needs to sign off on the other parts, including "well written", "verifiable", "neutral" (for what I did not cover), "stable", and "illustrated". I trust you know how to solicit for more comments. For what I did, I continue to support he pass for GA, despite leaving in citation needed tags which I know is typically problematic but in this case I support WP:IAR because I think the article makes more sense and is improved with those in here. Blue Rasberry (talk) 20:13, 18 February 2015 (UTC)

Okay, I was unfamiliar with the idea of multiple people reviewing a single article for GA, but I'm fine with that as well and it makes good sense to me too as a form of checks/balances. I'll see if I can get additional reviewers on board to continue the process. Thanks for everything Blue! TylerDurden8823 ( talk) 20:35, 18 February 2015 (UTC)

TylerDurden8823 has asked me to do some additional reviewing, as discussed above. This will be my first foray into this side of the review process, so please bear with me if I screw anything up. DoctorJoeE  ^{review transgressions}/ _{talk to me!} 18:31, 24 February 2015 (UTC)

Review by DoctorJoeE

Apologize for the delay, but I have a lot on my plate at the moment. I will begin by recommending that the "doing nothing" section be struck completely. This is pure WP:OR, as freely admitted in the section immediately below this one ("It is my expectation...", etc.). And it's not true, to the best of my knowledge and belief. There is certainly no published data to support it. On the contrary, most teens and nearly all adults with acne vulgaris intervene in some way, if only with OTC products or whatever their friends are doing. Acne is not a self-limited disease in the same way that, say, traveler's diarrhea is -- years go by, typically, before it subsides, leaving behind scarring and other undesirable sequellae. The American Academy of Dermatology and American Academy of Pediatrics actively discourage doing nothing, because of the substantial scarring risk, among other factors. It may be true that a majority of people do not seek professional treatment or prescription products, but again, I can't cite a source for it. It may also be true that many people in third-world countries do not seek treatment due to higher priorities and a lack of financial resources -- but again, no data that I'm aware of. So I would strongly recommend taking this bit of pure speculation out of the article entirely. More suggestions to follow. DoctorJoeE  ^{review transgressions}/ _{talk to me!} 20:58, 26 February 2015 (UTC)

I'm fine with this and doing it now. TylerDurden8823 ( talk) 06:00, 27 February 2015 (UTC)

•  Done TylerDurden8823 ( talk) 06:06, 27 February 2015 (UTC)

Are there any other changes to make or is this ready for GA? TylerDurden8823 ( talk) 22:53, 2 March 2015 (UTC)

Any other suggestions @ DoctorJoeE: or are we good? TylerDurden8823 ( talk) 08:08, 4 March 2015 (UTC)

Again, apologies for delays. There are a few minor additions and modifications to content that I'd like to make myself, when I can free up some time to dig up the proper RS -- but for the review itself, I see no significant problems in the "well written", "verifiable", "neutral", "stable", or "illustrated" categories. I think we're good. DoctorJoeE  ^{review transgressions}/ _{talk to me!} 18:48, 4 March 2015 (UTC)

Terrific! @ Bluerasberry:, are we all in agreement that this is ready to be promoted to GA? Or do you feel further review is needed? Two reviewers should be sufficient don't you think? TylerDurden8823 ( talk) 19:14, 4 March 2015 (UTC)

TylerDurden8823 Two is sufficient but I will not be the one to close this GA. Either DoctorJoeE can or a third can. Blue Rasberry (talk) 19:16, 4 March 2015 (UTC)

Okay, DoctorJoeE, ready to close? TylerDurden8823 ( talk) 19:48, 4 March 2015 (UTC)

Ready. Anything specific I need to do? (I'm new to this.) DoctorJoeE  ^{review transgressions}/ _{talk to me!} 01:47, 5 March 2015 (UTC)

Yes, it appears there are a few fairly easy steps for you to pass the article if you deem it ready for GA status. The instructions are on the WP:GAN page for reviewers and there are detailed instructions there (the steps seem to be pretty simple). I tried copying the instructions here but the formatting was screwy. Let me know if you need any help! Thanks again for reviewing! TylerDurden8823 ( talk) 05:11, 5 March 2015 (UTC)

The article Acne vulgaris you nominated as a good article has passed ; see Talk:Acne vulgaris for comments about the article. Well done! If the article has not already been on the main page as an "In the news" or "Did you know" item, you can nominate it to appear in Did you know. DoctorJoeE  ^{review transgressions}/ _{talk to me!} 02:42, 7 March 2015 (UTC)

Awesome! Thanks again to Bluerasberry and DoctorJoeE for all of your hard work reviewing the article and to Doc James for making the article better! TylerDurden8823 ( talk) 04:53, 7 March 2015 (UTC)

Acne is a condition which sometimes gets no formal medical treatment and no alternative medicine which would be described as such.

In doing the good article review, I thought that there should be a section in treatment on "doing nothing". I checked for sources in Cochrane, PubMed, Google, and Google Scholar, and every paper I found talked about treating acne and nothing I found was about not treating acne.

It is my expectation that a large number of people with acne, probably the majority, do not have it severe enough to seek medical treatment for it. Because I did not want the article to convey that most people have to get treatment for acne, I put in a section about "doing nothing" even though I found no sources to support this. I tagged my statements as "citation needed".

I expect that there must be sources talking about the health consequences of not treating acne, and I think they should be used in this section, but I could not find them now. Blue Rasberry (talk) 15:49, 17 February 2015 (UTC)

I'll continue to look as well, but my search so far has basically been the same (that all papers generally recommend and discuss treating even mild acne as a preventive measure for the negative psychiatric sequelae of the disorder). I'm sure you're right that the reality of the situation is that many people do not seek treatment because their case is so mild and simply use an OTC cleanser, but so far I haven't come across a good source for that information. TylerDurden8823 ( talk) 17:35, 17 February 2015 (UTC)

I've searched additional reviews and the consensus in the literature really seems to be that even mild cases of acne should be treated. At minimum, I'm seeing topical therapies being recommended for mild acne and I haven't seen any discussion (qualitative or quantitative with supporting statistics) discussing the idea that many people with acne do not seek treatment. I think we would be on safe ground to not include that in the article. I haven't been able to find a single reliable WP:MEDRS source yet that says this, have you? If not and we have given it a real effort, I would ask what else needs to be worked on before upgrading the article to GA class. TylerDurden8823 ( talk) 06:57, 18 February 2015 (UTC)

• My understanding of the literature is that in clinical trials, doing nothing performs no better than placebo, although this is because it is the placebo ;) GliderMaven ( talk) 19:11, 19 February 2015 (UTC)
  • Doing nothing is slightly different than placebo. Placebo is doing something but with no therapeutic effect. Placebo's are often better than nothing. Doc James ( talk · contribs · email) 21:40, 19 February 2015 (UTC)

Journal of Clinical, Cosmetic and Investigational Dermatology

Hi Tyler, I see you reverted my edits. What is wrong with the source, in your view? Also, you undid my edit for flow. It would seem better not to have "Acne mostly affects skin with a greater number of oil glands including the face, upper part of the chest, and back" in the middle of a paragraph about causation. SarahSV ^(talk) 20:38, 17 November 2015 (UTC)

Hi SV, as described in my edit summary [10], the article and journal are not MEDLINE-indexed (it's PubMed-indexed but that's different), which is considered to be a WP:REDFLAG (please see discussion here: /info/en/?search=Wikipedia:Identifying_reliable_sources_(medicine)#Biomedical_journals). The presence or absence of MEDLINE-indexing is considered to be a marker of quality as is impact factor (this journal does not appear to have one that I can find). Together, these factors make the source seem dubious. At the very least, we can find better articles from core dermatology journals with better reputations that are MEDLINE-indexed and have respectable impact factors when possible.

For the other edit, I disagreed with the move because this would have 1) led to both the first and second paragraph starting with the word acne (sounds repetitive to the reader) 2) seemed to make more sense with the sentence after it from the 2005 NEJM review since these areas are predisposed to sebum production, which increases in puberty (as discussed in more depth in the pathophysiology section). It seemed choppy to talk about the sites of skin acne tends to affect followed by suddenly diving into genetics causing most cases and then cigarettes. The first half of the causes & pathophysiology paragraph discusses risk factors and the second half discusses (briefly) the pathophys. Why do you think it should go in the beginning of the paragraph followed by genetics and smoking? TylerDurden8823 ( talk) 21:27, 17 November 2015 (UTC)

Hi Tyler, I think if you want to take this to FAC, it will need a bit of polishing because the writing is fairly choppy in places.

Re: diet, the disputed source and several other reviews seem to make clear that there's a relationship between acne, milk and hyperglycemic carbohydrates. Where you say the evidence is weak, what does your source say exactly? It seems odd to rely on one source for that, where so many others appear to identify a relationship.

Re: the disputed source. You use the same author as a source elsewhere. The source in question is:

• Melnik, Bodo C. "Linking diet to acne metabolomics, inflammation, and comedogenesis: an update" Journal of Clinical, Cosmetic and Investigational Dermatology, 2015:8, 15 July 2015, pp. 371–388. PMID  26203267

SarahSV ^(talk) 22:06, 17 November 2015 (UTC)

Do you have specific suggestions for the writing? I'm happy to take suggestions for improving the flow of the writing/decreasing choppiness. Please be specific regarding areas for improvement on that front. As for relying on one source, that's not uncommon if few high-quality secondary sources have been published on a specific topic. We'll simply need to add more high-quality sources as they emerge for reinforcement though it's really not a controversial statement to say the evidence is weak. Please note it is discussed earlier in the paragraph that there is no high-quality evidence establishing a clear link between diet and acne in general so the claim of weak evidence for dairy is consistent with that as well. As for using the same author, the author is not the issue. It's about the publication that article was published in. TylerDurden8823 ( talk) 22:15, 17 November 2015 (UTC)

The Bhate reference (the most recent of the four) very clearly states the evidence is limited: "In a further systematic review in the 2011–2012 update, a PubMed search of articles published in English yielded 23 studies.[5] The papers included were minimally critiqued, and based on objectively limited evidence. The authors concluded that ‘for now, an acne patient could be advised to limit diary intake while supplementing his/her diet with calcium and vitamin D’. However, results should be treated with caution as recommendations were being made on limited observational evidence, which highlights the need to explore the relationship between dairy products or other dietary factors, such as glycaemic load and acne in better longitudinal studies." Even the other references including Melnik's older 2009 review use terms such as "a growing body of evidence" also reinforcing the idea that evidence for this idea was limited at the time of publication. Is the issue with the specific word "weak" or the claim overall? TylerDurden8823 ( talk) 22:25, 17 November 2015 (UTC)

The review you cite above looked at 2011–2012, but the source I added is 2015 and there are other recent ones that seem to agree. SarahSV ^(talk) 00:00, 18 November 2015 (UTC)

The author is Bodo C. Melnik, Department of Dermatology, University of Osnabrück. The journal is Clinical, Cosmetic and Investigational Dermatology. The journal's editor is Jeffrey M. Weinberg, assistant clinical professor of dermatology, Columbia University College of Physicians and Surgeons. [11]

I don't know what the impact factor of that journal is, or to what extent that matters, but this 2014 review article in the Journal of the American Academy of Dermatology implies that there is a link (though I can only see the abstract): "The dermatoendocrinologic mechanism for the effects of glycemic index/glycemic load and milk on acne is described, as well as related clinical evidence for dietary modifications." Do you have access to that article? SarahSV ^(talk) 00:15, 18 November 2015 (UTC)

The impact factor is 0.00 ( http://www.researchgate.net/journal/1178-7015_Clinical_Cosmetic_and_Investigational_Dermatology). Similar to whether it's MEDLINE-indexed or not, the impact factor is widely considered to be a marker of quality (albeit an imperfect one). It raises doubts about a source though when you start to see several of these issues with a given source. I have no qualms about the journal's editor or Dr. Melnik's association with the University of Osnabruck. Regardless, the JAAD source would be a better source. TylerDurden8823 ( talk) 04:01, 19 November 2015 (UTC)

"No high-quality evidence"

A question – the article says: "The relationship between diet and acne is unclear as there is no high-quality evidence."

The source for that sentence is: Davidovici BB, Wolf R (January 2010). "The role of diet in acne: Facts and controversies". Clinics in Dermatology (Review) 28 (1): 12–6. doi:10.1016/j.clindermatol.2009.03.010. PMID  20082944.

What does that source say that is summarized as "there is no high-quality evidence," and what is the date range of the studies the source reviewed? SarahSV ^(talk) 23:17, 17 November 2015 (UTC)

I've already mentioned the specific issues with the 2015 source provided. Which high-quality reviews more recent than Bhate's 2014 review article are you referring to? If you have access to post-2014 reviews of high-quality stating that there is a clear relationship between dairy consumption and acne severity, please present them here. And yes, the sentence for the "no high-quality evidence" bit is the 2010 article you mention here but the dairy portion has four different references (2009-2014 publications) behind it since you were initially discussing the relationship between dairy & carbohydrate consumption and acne so that's what I addressed in my last response. I simply mentioned that the first sentence of the paragraph is also consistent with that statement.

The abstract from that very paper should be a giant clue that evidence is very limited: "We reviewed the up-to-date literature regarding acne and culprit foods such as dairy products, chocolate, and fatty foods. Unfortunately, after reviewing the existing data, there are no answers but there are definitely more questions, because there is no clear proof about whether these issues are facts or misconceptions." Furthermore, the conclusion states (rather unambiguously) that high-quality evidence is lacking as seen here: "Despite the inundation of epidemiologic studies, mostly of unsatisfactory quality, and the abundance of beliefs and perceptions among acne patients about the role of diet in the pathogenesis of acne,74 there is a paucity of reliable information." I hope that answers your questions. TylerDurden8823 ( talk) 00:01, 18 November 2015 (UTC)

The language of the abstract was a clue of a different kind, namely that "no clear proof" doesn't mean much. Would you mind emailing me a copy of it? SarahSV ^(talk) 00:18, 18 November 2015 (UTC)

It's still very strongly suggestive (though I agree the abstract is a concise, but less specific clue) but the conclusion quote is quite unambiguous. TylerDurden8823 ( talk) 00:37, 18 November 2015 (UTC)

Also just added a newer 2014 review from the Journal of the American Academy of Dermatology, which specifically states that evidence for milk restriction is low (Level III evidence) from observational studies, that randomized controlled trials are needed to better answer the question, and that evidence is insufficient to warrant a recommendation to avoid milk to improve acne. If you need access to the article, let me know and I'll send you a copy. TylerDurden8823 ( talk) 00:15, 18 November 2015 (UTC)

Thank you, that would be very helpful. SarahSV ^(talk) 00:18, 18 November 2015 (UTC)

Certainly, I'll send it shortly. TylerDurden8823 ( talk) 00:37, 18 November 2015 (UTC)

I was suprised to see that this common portmanteau for acne occuring on ones back was left out of a discussion about acne. I thought it would have its own article.

Really? TylerDurden8823 ( talk) 02:38, 2 January 2016 (UTC)

It's too bad this drug is so maligned now. I was prescribed Accutane at 15/16 (was on it for 6 mos.), and it was really a miracle drug.

I'm 39 now, and still have the occasional pimple/whitehead, but I could have been the poster child for ravaging, disfiguring Acne before I took this treatment. I would do another round of Accutane, but I understand the government is involved in all stages of the treatment now, and I'd rather not get involved with this. This is something that should be between a doctor and their patient, and nobody else.

I think most of the topical stuff like Benzoil Peroxide/salicylic acid, etc. *may* work for the "typical" teenage acne, but it's never done a damn thing for me. 24.51.217.118 ( talk) 04:01, 26 November 2015 (UTC)

Hi 24, the article does mention that salicylic acid is less effective than retinoid therapy (which would include accutane). Benzoyl peroxide and salicylic acid are often used first because they are topically applied and have better side-effect profiles than systemic retinoids like accutane. It is widely recognized that accutane is more effective, but it also has more adverse effects and this is why it is used for more severe forms of acne when first-line treatments fail or are inadequately effective. I don't believe this Wikipedia article has maligned the medication, but has simply provided a balanced discussion of its superior efficacy and higher rates of side effects (it's common with many medications to see higher efficacy come with higher rates of side effects). TylerDurden8823 ( talk) 02:48, 2 January 2016 (UTC)

Results: Six studies were selected. The first meta-analysis, including all studies, showed a non significant role of smoke in the development of acne: OR 1.05 (95% CI: 0.66–1.67) with random effect estimate. The second meta-analyses, including data stratified by gender, showed a OR=0.99 (95% CI: 0.57–1.73) for males and a OR of 1.45 (95% CI: 0.08–24.64) for females, using random effect for the heterogeneity in both cases. The third meta-analysis, included studies with a quality score >6 resulted in an estimated OR= 0.69 (95% CI: 0.55–0.85): in this case it was possible to use the fixed effect estimate. The last meta-analysis, concerning the severity grading, showed a non-significant result: OR=1.09 (95% CI: 0.61–1.95) using the random effect approach.

Conclusions: The first two meta-analyses found no signification association between smoking and the development of acne. However, when we performed the analysis with only good quality studies, the protective significant effect was evident.

http://ijphjournal.it/article/view/5708 — Preceding unsigned comment added by 37.229.111.127 ( talk) 23:24, 2 February 2016 (UTC)

After doing a search on PubMed, this journal does not appear to be MEDLINE-indexed (verifiable here: http://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Ital+J+Public+Health%22[Title+Abbreviation]) and with a low impact factor this makes the source questionable. However, upon further review I have come across higher-quality sources in the medical literature that do indicate that the relationship between cigarette smoking and acne severity is more controversial than I was previously led to believe. Therefore, I will amend the current discussion in the article but will cite the higher-quality sources. TylerDurden8823 ( talk) 00:01, 3 February 2016 (UTC)

What causes it specifically on the bum or buttocks or arse (or near the arse hole)-- 178.106.99.31 ( talk) 23:44, 25 May 2016 (UTC)

Here's a few non-medical ideas that might be interesting to add to this article. All of these were taken from the third chapter of https://books.google.com/books?id=S-rNTj6IlVAC

• The first medical paper exclusively on acne was published in 1885.
• The supposed cause has changed over time. Masturbation and excessive sexual thoughts were a popular theory for a long time (into the early 20th century among dermatologists). After that, bacteria and rituals of cleanliness take over. Since dermatology grew out of studying syphilis, and since the most important differential diagnoses were syphilis and cutaneous tuberculosis, then assuming any zit-filled face might be associated with a serious and disreputable infection was perhaps not entirely unreasonable in the public mind.
• Pre-1930s, it was considered mostly a middle-class female worry, especially to the extent that a girl's future prospects depended upon being able to marry to her financial advantage. Acne was associated with dirt, sex, ill health, and ugliness, which is everything that a well-brought-up girl shouldn't have been.
• During the Great Depression, young men with acne had a harder time getting work, leading to worries about a disaffected generation of poor young men. During WWII, severe acne in dirty tropical conditions caused some men to breakout in such severe and widespread acne that they were declared medically unfit for service in tropical climates.
  • It is at this point that the medical thinking changes from "oh, those vain girls" or "those boys with dirty thoughts" to thinking that acne could ruin a young person's life, cause disabling psychosocial distress, and even prompt suicide.
• Treatments for acne intersected with skin lightening creams among African-Americans. Hyperpigmentation is more common (as noted in the article), and before the 1960s and 1970s, the social discomfort with darker skin was more pronounced.
• Treatments: Dermatologists railed against beauty salons treating acne (surgically) until that was banned. Their treatments included an assortment of prescription creams, synthetic estrogen (in the belief that acne was caused by estrogen deficiency), and Röntgen ray treatment (the "cure acne by giving you skin cancer" method).

I hope this is a helpful list of ideas that might be interesting for this article. WhatamIdoing ( talk) 00:41, 13 December 2016 (UTC)

Interesting stuff and I agree it might be useful for the history and/or society & culture sections but I don't have access :/ TylerDurden8823 ( talk) 05:17, 12 January 2017 (UTC)

TylerDurden8823 — Mail me. Carl Fredrik 💌 📧 21:00, 7 March 2017 (UTC)

Here's a high-level summary of the suppports, opposes, and outstanding items from the FAC #2 nomination, as mostly stated in your own words. YMMV so if I've glossed over something you feel is critical please feel free to elaborate. My aim is to get this list down, and keep it down, to something manageable, reasonable, and surmountable. Sandbh ( talk) 04:55, 10 March 2017 (UTC)

@ CFCF:

• I support the FA nomination. More work can be done, but when it comes to medicine — there is no article where this isn't the case. I may end up adding some things myself prior to the main page feature.

@ My Core Competency is Competency:

• I took some time to reflect about this FAC the last hour, and I really don’t want to dig in any further on these issues. Whatever you all decide is fine with me.

@ Opabinia regalis:

• I'd be in favour of a brief mention of the size or scale of acne-related product sales in the cosmetics industry, though, if you can find sources on that.

I added a source for US sales in 2015. Sandbh ( talk) 05:44, 12 March 2017 (UTC)

@ Seppi333:

• Support promotion based upon my review of the MOS and images (criteria 2 and 3)

@ SlimVirgin:

• I agree with My Core Competency is Competency that cosmetics should be discussed.

I see that some development has occurred wrt cosmetics. Sandbh ( talk) 06:04, 12 March 2017 (UTC)

@ WhatamIdoing:

• Concealer is, in Western societies, a gendered product, which may account for its relative lack of prominence in articles like this and in academic sources. This article should mention the type of product and link to the page. Depending upon the content, a trade rag might be a perfectly acceptable source (e.g., for "sold X million in Europe last year" claims). OTOH, I think that should be considered ===Self-care=== rather than ==Society and culture==.
• Acne cosmetics should probably be mentioned and linked in the article, under ===Differential diagnosis===.
• Here's a few non-medical ideas that might be interesting to add to this article. All of these were taken from the third chapter of https://books.google.com/books?id=S-rNTj6IlVAC

I'll go and look this one up in a couple of days. Sandbh ( talk) 05:33, 12 March 2017 (UTC)

Or not, since I see it's already been cited. Sandbh ( talk) 05:49, 12 March 2017 (UTC)

@ Bruce1ee:

• Support the prose as a non-medical lay reader

@ Hanif Al Husaini:

• No outstanding concerns that I could see. Sandbh ( talk) 04:55, 10 March 2017 (UTC)

@ Victoriaearle:

• Victoria, I've probably done you a disservice but I couldn't see any showstoppers from you. Sandbh ( talk) 04:55, 10 March 2017 (UTC)

• Replying to the ping: Some comments were left out. No need to notify me again; I've unwatched here. Victoriaearle ( tk) 15:41, 12 March 2017 (UTC)

User:Sandbh

• Lean support, at this time. I believe the following are outstanding:

1. I've requested a trimming of citations in the lead so that the only ones left are for items that are truly contentious, so current that they're still developing, or horrendously complex. (I can't see anything in the lead that qualifies.)
2. Concerns about the potential for oral contraceptives causing acne

   See my talk page, here

3. Concerns about the chocolate discussion
4. Concerns about the construction of the antibiotic subsection
5. Another ten or so minor items.

@ Lingzhi:

• No outstanding concerns that I could see. Sandbh ( talk) 04:55, 10 March 2017 (UTC)

@ John:

• Leaning oppose. I share Sandbh's concerns. This is a good article and the minor problems with prose and image formatting would be easy to fix. There are problems of coverage which are harder to fix. The article at present over-emphasises the medical aspects of the condition over the cultural ones. The smoking thing bothers me. There are a bunch of minor things that added together tilt me in this direction.

Me (Sandbh) again
I look at this list as it currently stands and feel that, with patience and a bit of help, it's quite doable. Sandbh ( talk) 04:55, 10 March 2017 (UTC)

Sandbh, a major issue for me was how the sources were chosen. That wasn't fully reflected in my oppose, because it took time to look through them, but the more I looked, the more it seemed that there was no pattern to source selection. I would prefer to see fewer sources, where we know that they're the best available.

For example, a PCRM source was used for diet, despite their COI; it was used for chocolate—no COI there—but that made it an even odder choice, and one part of what they said was left out. An article from the Osteopathic Family Physician is used nine times; I can't find a PMID and the DOI leads to a generic Elsevier page with no abstract. Then there's the smoking issue. In 2016 the article said the link between acne and smoking is well-established, sourced to a 2012 review; the next year, based on a 2013 review, it said the link was not well-established, and smoking might even help acne. Which is the better source? What do the preponderance of sources say?

I've added a URL to the Osteopathic Family Physician article, and I see it's now cited twice. Sandbh ( talk) 06:00, 12 March 2017 (UTC)

I don't think that PCMM source is there any more, nor for chocolate. Sandbh ( talk) 06:19, 12 March 2017 (UTC)

Smoking will be done soon. Sandbh ( talk) 06:21, 12 March 2017 (UTC)

I'd like the authors to be able to explain how the sources were chosen, so that we can be sure the article reflects the best sources, and sure that dermatologists would find nothing surprising and nothing important missing. If I were writing this, the first thing I'd do is write to a few dermatologists and ask them to read it. SarahSV ^(talk) 20:28, 10 March 2017 (UTC)

I agree with SarahSV here. As many will attest, I personally don't care how references are formatted, but I do care about how they are used. I similarly brought this up at the FAC. Also, though it is only my opinion, I feel certain references are too heavily referenced (see here for example: [12]). -- My Core Competency is Competency ( talk) 21:22, 10 March 2017 (UTC)

Very interesting. When I develop articles I seek to draw on the recognised sources in the field, supplemented by more specialised journal articles. It would not normally occur to me, in the context of an FAC review, to check the basis of selection of the references. I have asked external experts in their field to review some of my work and that has always worked well, in my experience. So, there are two more things to add to the do list. On the smoking issue my impression of the several sources I've looked at is that the jury is still out. Mind you, I haven't done what I would call a thorough look at literature here. At one recent point there were about five cites in the article supporting the jury is out position but Tyler removed some of those due to reliability concerns. That's fine, it just reinforces my impression that there is no firm consensus about the influence of smoking. I'll probably add a list of these cites here, plus synopses, in attempt to assess what the consensus is, and reduce duplicate efforts. If you refer the article for a look by an external dermatologist could you please flag that here so that we can all look forward to the outcome. Please note that I have other articles and projects, and RL obligations, in train so helping to progress acne vulgaris will be somewhat of a slow time activity for me. Sandbh ( talk) 22:14, 10 March 2017 (UTC)

Oh, brother. Facepalm. TylerDurden8823 ( talk) 22:45, 10 March 2017 (UTC)

This sounds like a request to write an essay on why certain sources are used more often than certain others, and (a) I'm not finding anything like that in the FAC requirements and (b) this article isn't at FAC any longer anyway.

MEDRS has some pretty good advice on source selection, and AFAICT it was followed appropriately. When citing medical information, the point is to support the individual statement, using any suitably reliable source that reflects the mainstream POV (or a minority POV, if you are presenting a minority POV in that statement). There is no requirement to use "the best" source (even if you could explain why one recent review in a reputable journal is actually "better" than another recent review in a reputable journal), so long as the source clears the already high (some editors say "excessively high") bar for being reliable in the first place. WhatamIdoing ( talk) 16:04, 12 March 2017 (UTC)

On the other question I raised, is citing the same source many times (see: [13]) a problem? I ask because I honestly don't know the answer (I just remember in school that heavily using one source was frowned upon for research papers (but that was not Wikipedia)). -- My Core Competency is Competency ( talk) 13:38, 13 March 2017 (UTC)

Smoking and acne sources

Sources

Year	Citation	Extracts	Assessment/comments
1993	Mills CM, Peters TJ, Finlay AY. "Does smoking influence acne?" Clin Exp Dermatol 1993; 18:100–101 PMID  8481981	"One hundred and sixty-five patients with acne completed a questionnaire on smoking habits. ... The findings of this study support the hypothesis that some component of cigarette smoke, possibly nicotine, has an anti-inflammatory action on acne."	Primary source; included because Bhate and Williams rely on it. According to Firooz et al. (2005), this was the first study to examine a link between smoking and acne.
2001	Schafer T, Nienhaus A, Vieluf D, et al. "Epidemiology of acne in the general population: the risk of smoking". Br J Dermatol 2001;145:100–104. PMID  11453915	"Smoking is a clinically important contributory factor to acne prevalence and severity."	Primary source; included because several secondary sources rely on it.
2005	Firooz, A; Sarhangnejad, R; Davoudi, SM; Nassiri-Kashani, M (2005). "Acne and smoking: is there a relationship?". BMC Dermatology. 5 (2). doi: 10.1186/1471-5945-5-2 PMID  15790395 PMC  1079805	"There are contradictory reports on the relationship between acne vulgaris and cigarette smoking. The objective of this study was to examine the relation between acne and cigarette smoking in a case-control study. An association between acne and cigarette smoking was not found in this study."	Primary source
2005	Zülal, Erbagci; Bayram, Nazan (2005). "Smoking and Skin: A Critical Literature Review on the Association between Smoking and Benign, Premalignant and Malignant Dermatological Disorders", in J. H. Owing (ed.), Smoking and Health: New Research, Nova Publishers, 140ff.	"Between the various causative and exacerbating factors, the effect of smoking is currently unclear. Whereas some study results showed that smoking is a clinically important contributory factor to acne prevalence and severity, the others found an insignificant or even an inverse relationship between acne and smoking habits."	Zülal is a dermatologist, Bayram a respirologist. Offers a review of the research.
2006	Klaz I, Kochba I, Shohat T, et al. "Severe acne vulgaris and tobacco smoking in young men". J Invest Dermatol 2006; 126: 1749–1752. PMID  16645586	"There was an inverse, dose-dependent relationship between severe acne prevalence and daily cigarette consumption. ... The inverse relationship became statistically significant from 21 cigarettes a day ..."	Primary source; included because Bhate and Williams rely on it. In the "Discussion" section, it offers a good overview of previous research.
2009	Capitanio, B; Sinagra, JL; Ottaviani, M; Bordignon, V; Amantea, A; Picardo, M (2009). " Acne and smoking". Dermato-endocrinology. 1 (3): 129–135. PMID  20436880	"Contrasting data are available on correlation between acne and smoking habit. Data on the correlation between acne and smoking are still controversial. The lack of significant statistical difference between smokers with and without acne regarding the cumulative smoking dose (considering that the calculation does not take numerous variables into account such as type of cigarettes smoked, manner of smoking, passive smoking, possible suspension periods, inaccurate number of cigarettes referred, possible variations in the number of cigarette smoked) could suggest that the clinical expression of acne in these patients could be related to genetic predisposition."	Primary source
2010	Metelitsa AI & Lauzon GJ 2012. "Tobacco and the skin". Clinical Dermatology. 28 (4): 384–390. doi: 10.1016/j.clindermatol.2010.03.021. PMID  20620754	"Smoking negatively impacts the health of the skin as it does every organ system. Dermatologists need to encourage their patients to discontinue this deleterious habit.."	Good coverage on the deleterious impact of smoking on the skin
2012	Knutsen-Larson S, Dawson AL, Dunnick CA, Dellavalle RP. "Acne Vulgaris: Pathogenesis, Treatment, and Needs Assessment", Clinics in Dermatology, Jan;30(1):99–106. PMID  22117871	"The link between smoking and acne is well established."	Relies on Schafer et al. (2001).
2012	Alice Mannocci, Leda Semyonov, Rosella Saulle, et al. "Association between smoking habits and acne vulgaris. A case-control study", Italian Journal of Public Health, 9(3), 2012.	"The association between acne and smoke shows an increased risk (OR=7.26) with a statistically significant CI. Moreover, people ≥ 18 years of age have twice the risk compared to persons < 18 years of age (OR=2.31)."	Primary source; included because La Torre et al. (2013) rely on it.
2013	Bhate, K; Williams, HC (March 2013). "Epidemiology of acne vulgaris". The British Journal of Dermatology (Review). 168 (3): 474–85. doi: 10.1111/bjd.12149. PMID  23210645.	Whether or not acne is caused by, exacerbated, improved, cured, or is not associated with smoking remains controversial.31,125–130 An earlier case series suggested an inverse relationship between acne and smoking, suggesting an anti-inflammatory effect of a component found in cigarettes.125 Later, in 2001, a larger cross-sectional analysis of 896 young people found a statistically significant correlation between acne prevalence and the number of cigarettes smoked per day and a dose-dependent relationship between consumption and severity (not affected by age, sex or social class).31 A large-scale, questionnaire study of 27 083 military men between 1983 and 2003 found the prevalence of acne to be lower in active smokers, with a dose-dependent inverse relationship between severe acne prevalence and cigarette consumption from 21 cigarettes per day and higher.131 ... Further observational research is likely to perpetuate previous problems in reporting bias and confounding. Clinicians are recommended to advise against smoking despite some evidence suggesting it is beneficial with regard to acne."	Relies on: ref 31: Shafer et al. (2001) ref 125: Mills et al. (1993) ref 131: Klaz et al. (2006
2013	La Torre G, Gerald G & Semyonov L, Smoking-related diseases epidemiology, in G La Torre (ed.) 2013, Smoking Prevention and Cessation, Springer, New York, pp. 57–106 ( 85–86)	"Acne vulgaris has a multifactorial pathogenesis, but the contribution of smoking show contradictory results...some studies have shown that cigarette smoking aggravate acne (Schafer et al. 2001; Green and Sinclar 2001), others did not confirm this association (Jemec et al. 2002) or even showed a protective effect (Klaz et al. 2006; Rombouts et al. 2007)." ***** "Recently, Mannocci (2010) carried out a systematic review and meta-analysis concerning the association between acne and smoking. The first meta-analysis, including all studies, showed a nonsignificant role of smoke in the development of acne...The last meta-analysis...showed a nonsignificant result. The first two meta-analyses found no significant association between smoking and the development of acne but the analysis with only good quality studies showed a protective significant effect."	Offers details, cites its sources, explains the back and forth.
2014	Rigopoulos, D; Korfitis, C (2014). "Acne and Smoking". In Zouboulis, C; Katsambas, A; Kligman, AM. Pathogenesis and Treatment of Acne and Rosacea. Berlin: Springer-Verlag. pp. 167–170. ISBN  978-3-540-69374-1.	"The association between acne and smoking constitutes an ongoing subject of debate. Several studies have been conducted albeit producing inconsistent results."
2015	Alice Mannocci, Leda Semyonov, Rosella Saulle, et al. "Association between smoking habits and acne. A case-control study and a systematic review and meta-analysis" (pdf), Epidemiology, Biostatistics and Public Health, 12(1), 2015.	"In conclusions, smokers have higher risk to develop acne, especially males. Conclusions are not robust, because of heterogeneity definitions of smokers and acne grading."
2016	" Acne: Overview. PubMed Health. Cologne: Institute for Quality and Efficiency in Health Care. July 2016. Retrieved 12 March 2017	"It is not clear whether there might be a connection between smoking and acne."
2017	DiPiro JT, ‎Talbert RL & ‎Yee GC 2017, Pharmacotherapy: A Pathophysiologic Approach, 10th ed., McGraw Hill, New York, p. 1536	"Studies examining the relationship between tobacco smoking and acne show inconsistent results; however dermatologists have begun to counsel people to quit tobacco smoking as a potential auxiliary treatment for acne."	The last bit about counselling appears also in the 2011 8th ed.

Discussion

@ SlimVirgin: How does this lot look? Sandbh ( talk) 05:12, 12 March 2017 (UTC)

Sand, here are a few more recent sources: [14] and [15] TylerDurden8823 ( talk) 05:45, 12 March 2017 (UTC)

Thank you Tyler. I can only access the first of these two articles. Like the other articles it says that conflicting results have been demonstrated. Sandbh ( talk) 11:24, 12 March 2017 (UTC)

Sandbh, this is excellent, thank you. I had started looking at the sources' sources. I've only looked at two so far, but both relied on Schafer et al. (2001). PMID  11453915 This apparently concluded that there was a dose-dependent relationship between number of cigarettes smoked and acne severity. But that's an aside. Your list of secondary sources is enough for us to summarize.

SarahSV ^(talk) 05:52, 12 March 2017 (UTC)

Excellent, thank you very much! The do list begins to shrink. Sandbh ( talk) 06:02, 12 March 2017 (UTC)

SlimVirgin: With my NPOV hat on, despite the distasteful topic, this is what I'd be inclined to mention about smoking (left out the cites for now):

Causes

Risk factors for the development of acne, other than genetics, have not been conclusively identified. Possible secondary contributors include hormones, infections, diet and stress. Smoking generally has a detrimental impact on the skin and, for this reason, dermatologists have been encouraged to counsel their patients to stop smoking. There are case reports suggesting a benefit for some other skin conditions. Nicotine patches or tablets may therefore (potentially) have secondary therapeutic applications, subject to further research confirming their efficacy for these uses.

Studies investigating the impact of smoking on the incidence of acne have been inconclusive.

The last sentence is a deliberate one-sentence paragraph. How does this look? Thank you. -- Sandbh ( talk) 12:01, 12 March 2017 (UTC)

I find that paragraph somewhat difficult to read, and it could do with some rephrasing. Also we generally avoid case-reports, so I don't think that merits inclusion. The 2005 source is rather old and I would also prefer omitting that one entirely in favor of the newer ones. Carl Fredrik 💌 📧 16:12, 12 March 2017 (UTC)

Except for the last sentence, all of the stuff on tobacco and nicotine feels off-topic for this article. It should be included in Health effects of tobacco instead (which, at a brief glance, does not appear to mention skin damage at all).

Also, I'd appreciate it if we specified "smoking tobacco", because tobacco is not the only thing that people smoke. WhatamIdoing ( talk) 16:25, 12 March 2017 (UTC)

@ Sandbh: La Torre, Semyonov and Giraldi (2013), 84–86, is quite detailed ( La Torre bio). It discusses the studies that showed a connection, that didn't and that seemed to show a protective effect. And it cites its sources, so this article could cite those too where appropriate. SarahSV ^(talk) 22:18, 12 March 2017 (UTC)

Very cool feedback, thank you Carl, WhatamIdoing, and Sarah. Sandbh ( talk) 22:24, 12 March 2017 (UTC)

Sandbh, I've added a few more, noting which studies several of the secondary sources cite. I've also noted which are the primary sources. SarahSV ^(talk) 00:42, 13 March 2017 (UTC)

Source suggestion for history

• H. C. Douglas and Shirley E. Gunter, "The Taxonomic Position of Corynebacterium acnes", J Bacteriol. 1946 Jul; 52(1): 15–23. PMID  16561149

SarahSV ^(talk) 23:55, 13 March 2017 (UTC)

Have trimmed as number of primary sources. We really need to use high quality secondary sources per WP:MEDRS. Doc James ( talk · contribs · email) 18:21, 13 March 2017 (UTC)

What reference will you allow me to use in order to be able to include this text that you have removed twice now? Just point me in the right direction, and I will use whatever reference you prefer:

Liquid makeup that is made with an oil-free vehicle without alcohol or perfume is preferred over oil-based cosmetics, as the latter can cause or worsen acne. Oil-free cosmetics are often referred to as noncomedogenic, meaning they do not cause acne. ^[1]

I am also surprised to see my addition of olumacostat glasareti (" Olumacostat glasareti may be a future treatment option." ^[2]) removed, but that you are ok with the references for the acne vaccination. Perhaps you should strip out all the references you don't like and the associated content, and let's see what the general Wikipedia community thinks of the change? I would be open to that experiment.

Thanks -- My Core Competency is Competency ( talk) 18:55, 13 March 2017 (UTC)

There is not much for review articles but here is a major medical textbook [16] which I have added to support non-oil based measures.

There is a strong consensus for high quality secondary sources over primary sources.

Have improved the refs to support the stuff on the acne vaccines.

There are zero review articles on olumacostat so IMO adding it is undue weight. Doc James ( talk · contribs · email) 20:02, 13 March 2017 (UTC)

The way you have chosen what should and should not be included in this article is not consistent; however, as per my usual M.O., I am not going to push harder on the inclusion of these sentences (or the other sentences you have removed). In the end, it is the reader who loses out, not me. -- My Core Competency is Competency ( talk) 20:23, 13 March 2017 (UTC)

It is not much more work to find better sources. Not sure why the resistance?

The percentage of treatments that make it to market following a phase 2a trial is very small. That a phase 2a trial has been done is simply not notable in a general encyclopedia. Doc James ( talk · contribs · email) 20:26, 13 March 2017 (UTC)

Did you switch contexts here? Above, you say that "there are zero review articles" about that drug, but here you are saying that "it is not much more work to find better sources". If there truly are zero review articles, then even an infinite amount of extra work isn't doing to find the non-existent sources.

And if these sentences refer to different subjects, then I'd like to suggest that it's more friendly to upgrade someone else's sources than to blank their contributions, and it's a lot easier to upgrade the sources if the sentence isn't lost somewhere in the edit history. For those who haven't heard this speech from me personally a dozen times already, the WP:BURDEN is for the original editor to provide exactly one (=1) source that the original editor (=not any other editor) honestly (=including honest mistakes) believes is adequate (=not 'the best possible' or even a 'better' source) to demonstrate that the material can be verified in a source. Much of what's been removed has cleared that bar with room to spare.

There's been a lot of editing and a lot of ideas here recently. Not everything that's being added is "polished" or "perfect" on the first try. Let's please attempt a gentler approach, in which we collaborate and build together and give each other some time and space, instead of blanking less-than-perfect first efforts within hours (or even minutes). If something bugs you, then try fixing it or tagging it before you consider blanking it, or even just waiting until next week to see if it's gotten better. The world isn't going to end if we have an extra sentence or two about something accurate and verifiable but relatively unimportant in the article for a few days. WhatamIdoing ( talk) 06:11, 14 March 2017 (UTC)

Some of it is supportable by major textbooks rather than review article which you will notice I added. Doc James ( talk · contribs · email) 16:07, 14 March 2017 (UTC)

Could the one use of "greasy" be changed to "oily" as the latter is often used in this article (9 times by my count). "Oily" seems to me to be just a bit more precise. -- Mahākāśyapa ( talk) 19:29, 30 March 2017 (UTC)

User:TylerDurden8823 about this diff - I just reviewed this page and its archive and I don't see anywhere that this "was requested by the Wikipedia community"; having this section runs against MEDMOS, actually. None of these people are described as having influenced the history of the condition. Where did the community request this? Jytdog ( talk) 06:45, 12 March 2018 (UTC)

Hi Jyt, this was discussed at length during the FA review. Many people voiced that the article felt "overmedicalized" and wanted more discussion about acne in society. With that said, I'm not attached to the content so if the community wants it out, I have no issue with that. TylerDurden8823 ( talk) 17:41, 12 March 2018 (UTC)

Thanks for replying. That content is all about advertising for one drug, and the Forbes piece (while by a staff member so OK) is really about the company's marketing strategy to get people to think about the drug as an ongoing treatment regimen not a spot treatment, using celebrities saying that is how they use it. If we are going to have content from that source it should be up on that level; as it stands it basically furthers the companies marketing. So I am going to remove it again... hope that is ok with you and everybody. Jytdog ( talk) 17:50, 12 March 2018 (UTC)

Sounds good! TylerDurden8823 ( talk) 18:10, 12 March 2018 (UTC)

As a condition that affects 80% of people at some point in their life, we should not list people with the condition unless they have had a major effect on the condition. Ie like Michael Jay Fox and Parkinson's. Doc James ( talk · contribs · email) 19:25, 12 March 2018 (UTC)

Readers of the Nutrition section might need more clarifications on how to weigh the evidence. It is already great that differentiations such as observational evidence and randomized trials are mentioned. I would like to add more guidance. Findings since 2015 might be integrated:

Fiedler (2017) 
[1]
 Link 
https://ww.ingentaconnect.com/contentone/mjl/adv/2017/00000097/00000001/art00003

Juhl et al (2018) 
[2] 
Link 
https://www.mdpi.com/2072-6643/10/8/1049/htm

Vaughn and Sivamani (2015) ^[3]

 Link 
https://www.liebertpub.com/doi/abs/10.1089/acm.2014.0261?casa_token=IhoVMwq9qtwAAAAA:200D6P3VmjWC3GxAptBGN_3ygteRkjy4a1WEpYtg9UOzhNvouHGrPZxWUApqcv035eGQ0THpLOww

Additionally there is Logan's ^[4] "The Clear Skin Diet" with round-about 200 sources relating to the topic. Source 2: Link https://ww.amazon.com/Clear-Skin-Diet-Alan-Logan/dp/1581825749 Logan gives a non-academic summary of acne research up until 2007. The book as a source is likely not to wikipedia standards, as BallenaBlanca points but the sources they use may be.

Hypochonda ( talk) 20:06, 15 December 2018 (UTC)

It is important that you read and apply these Wikipedia policies WP:MEDRS. The first is a MEDRS source, the other is not.

Best regards. -- BallenaBlanca 🐳 ♂ (Talk) 21:05, 15 December 2018 (UTC)

Hypochonda ( talk) 08:29, 16 December 2018 (UTC)

Please, do not edit your messages after they have been answered. You have altered the meaning of my response. When I answered you, there were only two references.

What you must do is create a new message following the last one.

Please, see WP:TALK.

But do not worry, it's normal to make mistakes at the beginning!

Best regards. -- BallenaBlanca 🐳 ♂ (Talk) 15:03, 16 December 2018 (UTC)

Sources

Year	Name	Summary	Evaluation
2018	Juhl et al. [1]	coming soon	coming soon
2017	Fiedler et al. [2]	coming soon	coming soon
2016	Kucharska [3]	Literature Review ?	Recommends patients to keep food diaries and exclude foods that exacerbate acne

Milk

Year	Name	Summary	Assessment/comments
2018	Juhl et al. [4]	14 studies, n=78529 ' 'In conclusion, any dairy, such as milk, yogurt, and cheese, was associated with an increased OR (pooled random effects odds ratio) for acne in individuals aged 7–30 years. However, results should be interpreted with caution due to heterogeneity and bias across studies.' '	coming soon
2015	Vaughn & Simavani [5]	Results: A total of 312 articles were found and a total of 4 studies met inclusion criteria. Three studies evaluated the effects of ingestion, while one evaluated the effects of topical application. All studies noted improvement with the use of fermented dairy. Conclusions: Overall, there is early and limited evidence that fermented dairy products, used both topically and orally, may provide benefits for skin health. However, existing studies are limited and further studies will be important to better assess efficacy and the mechanisms involved. || coming soon
2014	Grossi et al. [6]	Conclusion: Our analyses confirm the link between several dietetic items and acne. When providing care, dermatologists should also be aware of the complex interconnection between dietetic factors and acne.	can someone who knows what semantic connectivity map approach is comment ?

Hypochonda ( talk) 08:18, 18 December 2018 (UTC)Hypochonda please note that this is a work in progress and that I do not have a medical background. Misrepresentation will inevitably occur.

If I want to "clean up" this section, am I allowed to delete my own content and replace it ? -- Hypochonda ( talk) 10:02, 25 December 2018 (UTC)

Glycemic Index

@ Doc James: with regards to this edit, the source doesn't support that statement. I changed the statement in this edit to reflect the source text, which says:

Acne is a follicular disease, the principal abnormality of which is impaction and distention of the pilosebaceous unit. The cause of the hyperproliferation of keratinocytes

and the abnormalities of differentiation and desquamation are unknown. It is likely that hyperresponsiveness to the stimulation of sebocytes and follicular keratinocytes by androgens leads to the hyperplasia of the sebaceous glands and the seborrhea that characterize acne.

— James, WD (April 2005). "Acne". New England Journal of Medicine (Review). 352 (14): 1463–72. doi: 10.1056/NEJMcp033487. PMID  15814882.

The previous statement seems reasonable if it would've been sourced, but it needs accurate sourcing if we are to keep it.

-- Treetear ( talk) 16:34, 24 December 2018 (UTC)

It supports the involvement of androgens. Have adjusted a bit to make it clear we are talking about the underlying mechanism. Best Doc James ( talk · contribs · email) 01:46, 25 December 2018 (UTC)

Perfect, agree with your adjustment. Thank you Doc James and Merry Christmas! -- Treetear ( talk) 15:26, 25 December 2018 (UTC)