Talk:Acne

Backne

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)

#13

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

Doing nothing as a treatment

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)

Diet

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 [1], 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: https://en.wikipedia.org/wiki/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. [2]

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)

Accutane

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)

smoking and acne

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)

On the bum

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)