Talk:Acne/Archive 1

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References

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)

Humans vs primates

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)

pimple

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

Treatment

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)

Psychological Effects of Acne?

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 (talkcontribs) 08:54, 27 February 2011 (UTC)

Chocolate

"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)

Microdermabrasion

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)

Already covered

===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.

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)

Lancet

Chocolate

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 [3] 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)

Dermatology terms mixed in with layterms in lead?

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)

Regarding the section titled "Procedures":

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


"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)

Epidemiology

We have a good secondary source here [4] 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 [5] 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)

Orange skin

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)

[new paper] Diet and Acne Update: Carbohydrates Emerge as the Main Culprit

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 (talkcontribs) 10:44, 20 April 2014 (UTC)

GA Review

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.

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.

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.  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)
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)

Your GA nomination of Acne vulgaris

The article Acne vulgaris you nominated as a good article has passed Symbol support vote.svg; 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)

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 [6], 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:
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. [7]

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)

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)

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)