Wikipedia:Featured article candidates/Acne vulgaris/archive1

The following is an archived discussion of a featured article nomination. Please do not modify it. Subsequent comments should be made on the article's talk page or in Wikipedia talk:Featured article candidates. No further edits should be made to this page.

The article was archived by Laser brain via FACBot (talk) 15:04, 19 December 2016 [1].

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Acne vulgaris

Nominator(s): TylerDurden8823 (talk) 22:59, 9 November 2016 (UTC)

This article is about the very common chronic skin condition acne vulgaris. I believe the article should be featured as a significant amount of effort has been poured into this article (by multiple editors) to ensure that its discussion of acne vulgaris is comprehensive, accurate, and accessible to a general readership. This is a very important topic since the condition is nearly ubiquitous (one of the most common skin conditions worldwide). This article aims to provide all readers (general and professional) with an informative summary of the underpinnings of this condition and to address any questions those affected by the condition might have (e.g., safety and efficacy of various treatment modalities). I believe this article to be an example of Wikipedia's highest quality work but am certainly open to constructive feedback to further refine it to reach FA, if applicable. Thank you to those reviewing the article for your consideration. TylerDurden8823 (talk) 22:59, 9 November 2016 (UTC)

Comments by Seppi333

Criterion 3

I'm going to start with an image review (criterion 3).

1. All of the images except one have an acceptable reported copyright status; however, one image – COMMONS:File:Akne-jugend.jpg – is tagged as public domain but doesn't indicate the original source. This concerns me. I'm inclined to believe that it is PD, but I can't determine this for sure using a google image search or tineye search of the original image to find its original source. It's probably okay to use the current image, but I don't think it would too difficult to find a higher quality image for the infobox which has both an acceptable copyright status and clear attribution to its original source.
2. Per MOS:IM, all images should include alt text; hence, featured articles need to include WP:ALT text in order to satisfy criterion 2. I've added empty alt parameters to 4 images (1 in the infobox, 3 to existing image syntax). These images need to have appropriate alt text added to them. I added alt parameters with appropriate alt text to the 2 images in the gallery to serve as an example of what to write in the 4 other image alt parameters.
3. I made minor tweaks to the existing captions (removed periods in captions containing a sentence fragment; fixed grammar in 1 caption) to make them conform to MOS:CAPTION. No further changes to the captions are necessary IMO – the current captions seem fine.

Seppi333 (Insert 2¢) 21:34, 10 November 2016 (UTC)

Hi Seppi, thanks for getting the FA review started. For my edification, what's the concern about the image being public domain? I'm not well-versed in copyright policy so I'm not sure why that would be a potential issue. With that said, I'll look through Wikimedia to see if I can find a different high-quality image that has a more suitable copyright status so it's not an issue. I saw you added those alt parameters already so thank you for doing that. TylerDurden8823 (talk) 04:59, 11 November 2016 (UTC)

Perhaps this [2] would work better since its copyright status is CC by SA 4.0. Yes? Also, I noticed the hair follicle anatomy picture is also labeled as public domain. Is that in need of replacement as well? If so, this looks like it might be an improvement anyway [3]. TylerDurden8823 (talk) 05:07, 11 November 2016 (UTC)

@TylerDurden8823: Public domain is an acceptable copyright status. The issue is that the image which I've pointed out is not attributed to any source, so it's difficult to verify that it is indeed in the public domain. The picture you proposed as an alternative seems fine to me. Seppi333 (Insert 2¢) 18:54, 14 November 2016 (UTC)

I'd be content with passing this image review if only issue #2 is addressed, but it'd be an improvement if you could also find a better alternative image as described above in issue #1. Seppi333 (Insert 2¢) 21:34, 10 November 2016 (UTC)

@Seppi333:, I have filled in the alt text parameters and added the CC by SA pictures. I also noticed the featured article Alzheimer's disease has some pictures without alt text captions (perhaps this is something that needs to be addressed in the future). Please let me know if you see anything else that needs revision or if any additional changes are needed. Thank you! TylerDurden8823 (talk) 01:02, 16 November 2016 (UTC)

All issues have been addressed to my satisfaction. I'll do a review of the article's MOS compliance within the next week or so. Seppi333 (Insert 2¢) 23:24, 16 November 2016 (UTC)

@Seppi333:, are you still going to review the article's MOS compliance? TylerDurden8823 (talk) 05:50, 2 December 2016 (UTC)

Yes, I still intend to. I've been unexpectedly busy lately due to my off-wiki responsibilities, so I never really got around to doing it when I originally intended. I will do that review soon though. Seppi333 (Insert 2¢) 01:49, 4 December 2016 (UTC)

No problem, just checking. TylerDurden8823 (talk) 03:27, 4 December 2016 (UTC)

Criterion 2

I intend to take on a review of the article's compliance with the WP:Manual of Style (criterion 2) sometime this next week soonish.

More to come. Seppi333 (Insert 2¢) 21:34, 10 November 2016 (UTC)

Initial comment from Jim

We don't normally have references in the lead since it's just summarising the presumably fully referenced text in the body. Can you clarify why you have deviated from this practice? Jimfbleak - talk to me? 16:40, 12 November 2016 (UTC)

I've seen featured articles with references in the lead that are well-accepted (e.g., Parkinson's disease, rhabdomyolysis, and Alzheimer's disease to name a few) and didn't see that it excludes it from being an FAC here [4]. I don't see mention of that as a criterion in the featured article criteria discussing the lead or citations. I hope that explains but I'm not married to the idea if that's a widely held view that's going to prevent it from progressing to FA). TylerDurden8823 (talk) 17:30, 12 November 2016 (UTC)

For medical pages we do normally have references in the lead and this practice is supported by WP:MEDMOS Doc James (talk · contribs · email) 05:29, 16 November 2016 (UTC)

Comments from Opabinia

• In the lead, you gloss "sebum" as pipelinked "oil from the skin", and the next usage of "sebum" occurs without explanation. Either the lead should have a parenthetical (sebum), or the next use should have a parenthetical (oil...).

Hi @Opabinia regalis:, I'm assuming when you say pipelinked that you mean wikilinked, right? Regarding the sebum issue, the signs and symptoms section does say seborrhea (I don't think that's much of a jump from sebum given the common root of the word) and defines that as oily secretions from the skin). TylerDurden8823 (talk) 18:06, 7 December 2016 (UTC)

I mean wikilinked specifically with a pipe ;) Which is used a lot here as a way to link to articles whose titles are technical or unfamiliar, e.g. [[sebum|oil from the skin]]. In this specific case, I think there's a question of who the article anticipates as readers. The population who fails to understand things like "oral" is not also capable of connecting "sebum" with the unfamiliar "seborrhea". Opabinia regalis (talk) 21:30, 8 December 2016 (UTC)

I see, I didn't realize there was a term for that. My goal is for the article to be for a general audience (lay and professional alike). Wikipedia should (and does) strive for an 8th grade reading level so I am a firm proponent of simpler is better. I personally have no objection to use of the term "oral" over "by mouth" and think both would be relatively easy to understand. As I said before, other editors have thought otherwise. @Doc James:, care to weigh in? TylerDurden8823 (talk) 21:37, 8 December 2016 (UTC)

IMO we should use simple language in the lead. Than in the body more complicated language can be used with the simple term in brackets. Doc James (talk · contribs · email) 21:39, 8 December 2016 (UTC)

Writing parts of this particular article at an eighth-grade level makes sense given how many affected people are actual eighth-graders ;) Opabinia regalis (talk) 07:19, 11 December 2016 (UTC)

• I also don't get much out of piping "cleanliness" to "hygiene", which is not a complex word, and is more specific.

I am unclear what the proposed change is here-are you advocating for a switch in the word cleanliness to hygiene or eliminating the wikilink? TylerDurden8823 (talk) 18:06, 7 December 2016 (UTC)

I'm suggesting using and linking the word "hygiene", rather than linking through a term that was presumably chosen to be "simpler". Opabinia regalis (talk) 21:30, 8 December 2016 (UTC)

Hmm, I'm unsure about this one. It seems somewhat subjective to me. I could conceive of a general audience being more familiar with the word clean (or variations of it) than hygiene but it seems like a minor point to me. I don't feel too strongly about this one. TylerDurden8823 (talk) 21:50, 8 December 2016 (UTC)

• The lead doesn't mention hormones, but the article goes into some detail on the topic - seems like it warrants a mention.

Oral contraceptives are mentioned in the lead and are hormonal. TylerDurden8823 (talk) 18:06, 7 December 2016 (UTC)

As above, who's the audience? If "teenager", they can't be counted on to know that contraceptives are hormones. Opabinia regalis (talk) 21:30, 8 December 2016 (UTC)

I've added the word hormonal for clarity and clarified that androgens are hormones. TylerDurden8823 (talk) 21:48, 8 December 2016 (UTC)

• I know it's a thing in medical articles, but every time I see this trend toward writing "by mouth" instead of "orally" it makes me want to throw up a little. (You know, by mouth ;) Especially in contrast to "topical", which is much less "simple" and understandable! The phrase "by mouth formulations" is awful.

This is a style thing and medical editors have disagreed on this one. Some editors believe topical/oral is simple enough whereas others do not and believe terminology such as applied to skin or by mouth is simpler/more accessible even though I agree with you that it's not the optimal prose. TylerDurden8823 (talk) 18:06, 7 December 2016 (UTC)

I suggest at least rewording "by mouth formulations", which is both painful English and actually harder to understand. Opabinia regalis (talk) 21:30, 8 December 2016 (UTC)

That's done. I agree that the term "oral" should be sufficiently simple for the vast majority of readers at an eighth grade reading level as is the term "topical" and sounds less awkward. TylerDurden8823 (talk) 21:48, 8 December 2016 (UTC)

• While we're on the subject of simplicity, an appositive explanation for "comedones" in the classification section would be a good idea.

That's a good suggestion. I've addressed this. TylerDurden8823 (talk) 18:06, 7 December 2016 (UTC)

• In the signs and symptoms section, you write "The appearance of acne varies with skin color." - this seems to warrant more coverage, or illustrative images if we have them. IIRC poor coverage of the appearance of dermatological conditions on dark skin is a common failing in medical and health education.

This is actually addressed in the photos if you look at them carefully. The images in the signs & symptoms section show a fair-skinned white woman with severe nodular acne whereas the introductory photo shows a darker skinned male and shows some variation there. I'll take a look and see if we have additional images for better illustration of this point but we must be cautious not to overload the article with too many photos. I do think there is such a thing as too much. TylerDurden8823 (talk) 18:06, 7 December 2016 (UTC)

I think the infobox picture is very good. The statement that appearance varies by skin color, without either describing or illustrating what the variation consists of, seems incomplete. Since this is a sort of a summary/introduction to the subsections that follow, adding that hyperpigmentation is an example of this variation (or is it the primary difference?) would help. On the images below, it just seems like odd positioning to have a light-skinned person immediately following the section about hyperpigmentation and its more frequent occurrence in darker-skinned people. Ideally an image in that section would show hyperpigmentation on dark skin, though I didn't come up with any compatibly licensed ones on a quick search. Opabinia regalis (talk) 21:30, 8 December 2016 (UTC)

Yes, hyperpigmentation is definitely the primary difference but there are no illustrative images for me to add to the article (I checked today). TylerDurden8823 (talk) 21:52, 8 December 2016 (UTC)

I quickly looked through the usual suspects in open-source publishing and all I found was Figure 12 of this paper describing skin diseases in Cameroon - unfortunately the nevus is much more visually prominent than the acne. Opabinia regalis (talk) 23:03, 8 December 2016 (UTC)

Yeah, and it's not the best example of PIH either. I wouldn't recommend using that particular picture. TylerDurden8823 (talk) 02:32, 9 December 2016 (UTC)

@Opabinia regalis: and @Doc James:, what do you think about a subsection in the treatment section devoted to PIH? Yay or nay? Do you think this would be better suited to the PIH main page (which appears rather undeveloped)? Mention is given to various treatments in the different subsections regarding whether they can help with PIH but I'm just wondering if a subsection dedicated solely to it in the treatment section might be of benefit to readers instead. Thoughts? TylerDurden8823 (talk) 17:45, 15 December 2016 (UTC)

I think what we have here is long enough and further details belong on the subpage. Doc James (talk · contribs · email) 18:14, 15 December 2016 (UTC)

• Next subsection, "The scar is created by an abnormal form of healing..." - this has the sound of oversimplified prose trying to avoid a technical term, but then I click through to the source and find that it discusses "an altered wound healing response" without much more explanation. This isn't my area of expertise at all, but this sounds like either a) there's a sentence's worth of explanation from another source that could be offered here, or b) if not, the existing text of that paragraph could use a bit of copyediting.

In truth, there aren't all that many secondary sources discussing the pathogenesis of acne scar formation. I will see if I can find one that explains in a bit more depth. In terms of copyediting, what changes are you suggesting and why does that phrase seem oversimplified to you? It is important that we do keep the article accessible to a general audience too. TylerDurden8823 (talk) 18:06, 7 December 2016 (UTC)

It sounds like a circumlocution for a technical term judged too "complex", but it turns out it apparently isn't. Even something like "The scar is the result of abnormal wound healing..." sounds better to me, but this is subjective. Opabinia regalis (talk) 21:30, 8 December 2016 (UTC)

Sure, I've simplified the wording a bit. TylerDurden8823 (talk) 22:00, 8 December 2016 (UTC)

• Since there's only two images in the "pigmentation" section, maybe use normal images (or {{multiple image}}) instead of the gallery? (Also would be great to have an image of a darker-skinned person here, since those with darker skin are more susceptible to hyperpigmentation.)

What does the t|multiple image command do? I tried it and it didn't show the images at all. TylerDurden8823 (talk) 18:06, 7 December 2016 (UTC)

It's a template for formatting images. Sounds like a syntax problem if nothing shows up? It would allow the images to float inline with the text at normal thumbnail size, rather than interrupting the text with small images as in the gallery format. Opabinia regalis (talk) 21:30, 8 December 2016 (UTC)

It probably was a syntax problem as it just showed the brackets, etc but didn't actually change the photos as it did for you when I tried it. I think it looks fine the way you've changed it now that it's to the side. TylerDurden8823 (talk) 22:00, 8 December 2016 (UTC)

• The subheads in the "cause" section aren't parallel: "genetic", "hormones", "infectious", etc. (Also "causes" is more natural, I would think?)

Causes is fine, but can you clarify what you mean about the subsections not being "parallel"? I'm not sure what you mean. TylerDurden8823 (talk) 18:06, 7 December 2016 (UTC)

I mean parallelism (grammar); they're not all the same part of speech: some are nouns (hormones) and some are adjectives (genetic, infectious). Opabinia regalis (talk) 21:30, 8 December 2016 (UTC)

Okay, they're all nouns now. That's been addressed. TylerDurden8823 (talk) 22:00, 8 December 2016 (UTC)

• The genetics section could use a copyedit; "The genetics of acne susceptibility is likely polygenic" is awkwardly phrased, and is the TNF SNP in the last sentence in a member of the family other than TNF-alpha? If not, then it reads weirdly to have TNF-alpha mentioned with the abbreviation, and the spelled out in the next sentence.

Do you have a specific proposal? How is that phrasing awkward? I've seen many articles use wording just like that before without an issue. And no, the TNF SNP is regarding to specific mutations in the TNF gene family. The abbreviation part is fixed. TylerDurden8823 (talk) 18:06, 7 December 2016 (UTC)

"The genetics...is polygenic" is awkward wording. I'm no copyeditor, but just "Acne susceptibility is likely polygenic" or an explanatory "...is likely an effect of multiple genes sounds better. Opabinia regalis (talk) 21:30, 8 December 2016 (UTC)

I like the suggestion and have incorporated it into the article. The simplification of polygenic was a particularly nice touch and definitely necessary. I had overlooked that as jargon on previous reads. TylerDurden8823 (talk) 22:00, 8 December 2016 (UTC)

• The sentence "Acne that first develops between the ages of 21 and 25 is uncommon" seems oddly placed in the "hormones" section. Obviously the connection is puberty, but it's a distraction from the flow of discussion about the biology of hormones. Maybe move this to the epidemiology section?

That sounds reasonable to me. This has been addressed. TylerDurden8823 (talk) 18:06, 7 December 2016 (UTC)

• The first paragraph of the "hormones" section says people with CAIS don't get acne. Interesting, I didn't know that! Then the second paragraph has that "conversely" sentence that pipelinks androgen insensitivity syndrome and says it's rare, citing a different source. The pipe text obscures the interestingness of these observations, and also makes it hard to parse whether it's just "rare" in general insensitivity but never found in complete insensitivity, or whether two different studies found different results.

In truth, I hadn't noticed that subtle distinction on previous readings between CAIS and just AIS. Before looking into it further, my guess would be that acne does not occur at all with CAIS and rarely in AIS due to AIS not being a complete insensitivity, but I will look into it further to clarify. I'm not sure what you mean about the "pipe text obscuring the interestingness of these observations". What is the proposal for the wikilinks exactly? TylerDurden8823 (talk) 18:06, 7 December 2016 (UTC)

That was my guess also. I mean that you've written [[androgen insensitivity|insensitive to the effects of androgen]], obscuring the term "androgen insensitivity", which makes it less likely anyone will notice the pattern. I don't have a proposal for the wikilinks because I don't know whether there really is a direct relationship between degree of androgen insensitivity and lack of acne (as seems plausible). Opabinia regalis (talk) 21:30, 8 December 2016 (UTC)

So, I looked back at the 2014 AJCD review cited about the rarity of acne in those with androgen deficiency or complete insensitivity and it says the following: "those with androgen deficiency or insensitivity do not tend to develop acne [55–57]." Overall, it's slightly nebulous and doesn't explicitly state those with CAIS never develop acne and those with incomplete AIS can develop acne but rarely. This reference [5] states men with androgen insensitivity do not develop acne (but didn't say whether this encompasses all affected by AIS or if partial vs complete makes a difference). Since the wording from the 2014 AJCD review leaves a bit of wiggle room (do not TEND to develop acne), this suggests that it is possible but highly unlikely and rare (which makes sense since androgens are key to acne but not the whole story) so I think the current wording is appropriate. TylerDurden8823 (talk) 17:59, 15 December 2016 (UTC)

• The sentence "Anabolic steroids are commonly found in over-the-counter bodybuilding supplements." sounds like they're supposed to be there, but clicking through to the source reveals these are unlabeled additives.

I'm not sure why it would come off like they're supposed to be there but I can add a clarifying statement that they're inappropriate additives/contaminants, etc. if that's unclear. TylerDurden8823 (talk) 18:06, 7 December 2016 (UTC)

Probably because you already know that ;) Opabinia regalis (talk) 21:30, 8 December 2016 (UTC)

That's fair. I'll think of a way to clarify that bit. TylerDurden8823 (talk) 22:21, 8 December 2016 (UTC)

That's done. I think the new sentence with an additional secondary source should be clearer. TylerDurden8823 (talk) 18:27, 15 December 2016 (UTC)

• The "infectious" section doesn't mention whether P. acnes is also a normal component of skin flora (I think so?)

It depends on the type of P. acnes. As it says in the article, "There are specific sub-strains of P. acnes associated with normal skin and others with moderate or severe inflammatory acne."TylerDurden8823 (talk) 18:06, 7 December 2016 (UTC)

Oops, you're right, I missed that. Opabinia regalis (talk) 21:30, 8 December 2016 (UTC)

• I know, MEDMOS and all, so just thinking out loud, but to me it seems strange to go through many paragraphs of possible causes before explaining the pathophysiology that would allow a reader to put those causes in biological context.

That's MEDMOS for you. Do you have a specific suggestions here? Are you suggesting putting the pathophys section before the causes section? TylerDurden8823 (talk) 18:06, 7 December 2016 (UTC)

Offering the idea for consideration. Opabinia regalis (talk) 21:30, 8 December 2016 (UTC)

Regarding this particular suggestion (and since it's my first FAC), I would elect to ask for someone a bit more familiar with MEDMOS than myself. @Doc James:, is it ever acceptable to deviate from WP:MEDMOS structure in an FA if it enhances the flow of the article? In this case, the proposal would be to put the pathophysiology section immediately before delving into the various proposed causes. TylerDurden8823 (talk) 22:21, 8 December 2016 (UTC)

I am a big fan of following a fairly set ordering of sections. This has the benefit of those who use us lots and those who edit lots to always know where to find specific information. Causes gives an overview and pathophysiology gives more indepth details for those who want it. Doc James (talk · contribs · email) 22:45, 8 December 2016 (UTC)

• Skipping ahead a bit, the "retinoids" section could also benefit from copyediting. The first two sentences are a bit jarring: a list of retinoids, then "Like isotretinoin, these retinoids are related to vitamin A..." - why separate isotretinoin out here, before we've been introduced to the fact that it's administered differently? And while we're at it, in the paragraph about isotretinoin side effects, surely its teratogenicity is worth a mention here, not just way down below in the pregnancy section?

I'm not sure what you mean when you say a sentence is jarring. Did you mean it's a bit too abrupt or choppy there? The first sentence in the retinoids paragraph is not a list but discusses how retinoids work to address different facets of acne pathophysiology. Did you mean in the second paragraph? I feel it's better to keep the teratogenicity discussion to the pregnancy section to avoid repetition and keep the article coherent. If multiple editors feel the article would benefit from repeated mention, then we can certainly consider an additional mention in the retinoid section though this would then open up the entire medication section to discussing the teratogenicity (or lack thereof) of each agent in each paragraph (slippery slope and leads to a lot of repetition). TylerDurden8823 (talk) 18:06, 7 December 2016 (UTC)

Second paragraph, yes, sorry. All retinoids are related to vitamin A, so why "Like isotretinoin,..."? Abrupt, yes, but mostly it's just unclear why isotretinoin is being singled out here; a "like X, Y..." construction would usually signal that X has already been discussed, but here it's only covered a paragraph later. (Maybe it used to be the other way around?) More importantly, I really do think teratogenicity has to be mentioned briefly here along with all the other effects of the drug rather than shuffled off to "pregnancy" - for one thing, the people reading this section can't be relied on to read the whole article, and people who believe they're not going to get pregnant aren't going to read the pregnancy section, even if their belief is inaccurate. Opabinia regalis (talk) 21:30, 8 December 2016 (UTC)

That's simply a remnant of how it was originally written and just never removed or modified. Isotretinoin does stand on its own in a way as its the sole oral retinoid used in most places and is probably the most effective/most teratogenic but I can try to come up with a smoother transition. As for the teratogenicity, that's fair since those who take isotretinoin have to sign the pledge to use contraception, etc. so I suppose it does deserve some mention there. I've added two sentences there briefly discussing the matter. TylerDurden8823 (talk) 19:02, 15 December 2016 (UTC)

I've addressed the copyediting request and added a bit more in the initial paragraphs of the management section for broad strokes. Let me know if the flow is better or if you identify any other areas in need of further refinement. TylerDurden8823 (talk) 18:50, 15 December 2016 (UTC)

• "By mouth" again. If they're reading straight through, people have by this point followed along through "Activation of TLR2 and TLR4 by P. acnes leads to increased secretion of IL-8, TNF-α, and IL-1α." and "squalene oxidation leads to increased activity of the 5-lipoxygenase enzyme responsible for conversion of arachidonic acid to leukotriene B4" but you're dodging the word "orally"?

Yes, I know, this was not solely my choice. See above about debate amongst medical editors regarding best terminology to use. TylerDurden8823 (talk) 18:06, 7 December 2016 (UTC)

• I can't figure out how you chose the order in which the treatments are listed. Diet first, sure. Benzoyl peroxide next, sure - that's very common and OTC. But why the retinoids next, with azelaic acid (nope, not alphabetical) and salicylic acid (nope, not "OTC first") only after that? Why hormones in the middle, when that mostly applies to women?

Retinoids are listed next because they are first-line just like benzoyl peroxide and among the most effective. Antibiotics are then listed because they are also very commonly used and effective and then hormonal agents (used a bit less but still quite effective). Azelaic and salicylic acids are similar in their mechanisms of actions and are both regarded as somewhat less effective but well-tolerated therapies and are generally considered 2nd line, which is why they are lower. Then, the section dives into more specialized topics (e.g., combination therapy, procedures, pregnancy considerations, etc). TylerDurden8823 (talk) 18:06, 7 December 2016 (UTC)

Maybe specifically list in the intro paragraph to that section which are "first" or "second-line"? I'm surprised that salicylic acid would be classified that way, because surely just about everybody tries salicylic acid and benzoyl peroxide before seeing a doctor, since they're cheap and widely available. Opabinia regalis (talk) 21:30, 8 December 2016 (UTC)

Salicylic acid is known to be less effective than first-line therapies (e.g., BPO or retinoids) but BPO and salicylic acid are available OTC (whereas retinoids generally are not) so access is a big part of why use of salicylic acid is so prevalent. As for saying what's first-line in the introductory paragraph of the treatment section, I think that's fine. TylerDurden8823 (talk) 22:21, 8 December 2016 (UTC)

I've added a sentence in the early part of the management section clarifying which therapies are regarded as first-line. TylerDurden8823 (talk) 18:27, 15 December 2016 (UTC)

• There's a big section on treating acne in pregnant women, and the teratogenic effects of some otherwise common treatments, but it seems like somewhere else in the article (causes?) should mention that acne is common in normal pregnancies and maybe briefly explain the likely mechanisms.

The mechanisms aren't different as far as I know. The pregnancy section is needed as a separate section because there are additional considerations when discussing treatment (e.g., teratogenicity of various treatments). Not sure if any of the reviews discuss the epidemiology of acne in pregnancy but I'll take a second look. If so, this might be a reasonable addition to the epidemiology section. TylerDurden8823 (talk) 18:06, 7 December 2016 (UTC)

I mean explain the fact that normal hormonal changes due to pregnancy can affect acne, which I might have missed but don't see anywhere. Pregnant adult women who suddenly have pizzafaces are a likely audience for this article, because everybody knows teenagers get zits, but it's often unexpected as an effect of pregnancy. Opabinia regalis (talk) 21:30, 8 December 2016 (UTC)

I don't think I recall seeing any mention in those reviews that pregnancy is expected to typically worsen acne but I'll recheck. TylerDurden8823 (talk) 22:21, 8 December 2016 (UTC)

Actually it would be interesting either way, because this is definitely a meme. You could try this one. Opabinia regalis (talk) 07:19, 11 December 2016 (UTC)

So, I looked into this further and one of the recent reviews from Clinics in Obstetrics & Gynecology said pregnancy is not reliably associated with acne severity. This has been incorporated into the article so readers will now have some context about that particular aspect of the intersection between acne and pregnancy. TylerDurden8823 (talk) 20:49, 15 December 2016 (UTC)

• When I read "Numerous natural products have been investigated..." I first think natural products, not woo ;) Seems better to say "alternative treatments" or something, rather than play into the whole "medicine isn't natural!" rhetorical framing.

IMO, this part is okay as it stands. The natural products are actually discussed (e.g., bee venom & tea tree oil) but other alternative/not "nature-derived/natural" treatments are discussed later (i.e., cupping therapy) so there is a clear distinction between the two. TylerDurden8823 (talk) 18:06, 7 December 2016 (UTC)

Ehhhh, I wouldn't say "zomg, can't be a featured article if you say 'natural product'!" but it seems pointless to deliberately use an ambiguous term here, especially since some of the medical treatments are indeed "natural products" in the chemistry-term-of-art sense. Opabinia regalis (talk) 21:30, 8 December 2016 (UTC)

I'm still not understanding your point. Sure, the term "natural product" is ambiguous but the term "alternative therapy" is no more specific. TylerDurden8823 (talk) 22:21, 8 December 2016 (UTC)

Well, are the natural products tetracyclines or tea tree oil? ;) Maybe "complementary medicine", with link, since that's what the source used in its title. Opabinia regalis (talk) 07:19, 11 December 2016 (UTC)

• Am I missing the connection between Cleopatra and acne, or is this a kind of flowery way of saying "documented as early as 60BCE-ish"? Probably wise to give a date.

I don't think the referenced articles provided specific dates but I'll recheck. Yes, this is simply a stylistic choice saying that acne has been long documented. TylerDurden8823 (talk) 18:06, 7 December 2016 (UTC)

I was going with the date of Cleopatra's death ;) Another "who's the audience" issue - do the people who don't understand "orally" or "sebum" know when Cleopatra ruled? Probably not. Opabinia regalis (talk) 21:30, 8 December 2016 (UTC)

I have no objection to adding that (though I thought contextually it was pretty clear that it was a LONG time ago since the next sentence talks about sixth century Greeks). TylerDurden8823 (talk) 22:21, 8 December 2016 (UTC)

• I have an ongoing and admittedly idiosyncratic campaign to get people to stop describing major scientific contributions as "seminal".

You'll have to elaborate on why this word is problematic because myriad scientific and encyclopedic articles use it so the issue with it is unclear to me at this time. TylerDurden8823 (talk) 18:06, 7 December 2016 (UTC)

Oh, no doubt it's widely used. It also subtly perpetuates the notion that ideas, specifically, have fathers - it originates with the notion that Big Ideas come from Great Men. Whenever I feel tempted to use it in my own writing I try to sneakily replace it with some kind of egg/pregnancy/nurture metaphor ;) Opabinia regalis (talk) 21:30, 8 December 2016 (UTC)

Oh, it's the masculinity of the language that you find irksome, I see. I think alternative terms here would likely sacrifice some terseness, don't you think? The word may have male semantic roots but I think the word is fine here and won't have any negative effects on women. If you have a compelling argument that it might, let me know, but I don't think male semantic roots require avoidance of a given word (as long as it's used appropriately). TylerDurden8823 (talk) 22:21, 8 December 2016 (UTC)

• Need to rephrase "modernly accepted idea".

Why? This is accurate. It is widely accepted by dermatologists that acne's pathophysiology is explained by a cascade of related events. And what are you suggesting as a rephrasing of this phrase? TylerDurden8823 (talk) 18:06, 7 December 2016 (UTC)

Maybe this is an ENGVAR thing? I'm a native speaker of American English and "modernly" sounds wrong. Opabinia regalis (talk) 21:30, 8 December 2016 (UTC)

No, I'm a native speaker of American English as well and it sounds fine to me. What term would you propose be used in its place? TylerDurden8823 (talk) 22:21, 8 December 2016 (UTC)

It sounds weird the way "appealable" or "usuality" sound weird - perfectly understandable, but kinda "off" in formal writing. I'd probably just shorten that sentence to "this led to the current understanding that..." or similar. Opabinia regalis (talk) 07:19, 11 December 2016 (UTC)

I suppose it's a style thing. I typically think of the term "modernly" as being acceptable in formal writing depending on the circumstances but I'm not overly attached to it. For the sake of simplicity, I've omitted it as you suggested since I don't feel strongly about this minor matter. TylerDurden8823 (talk) 20:49, 15 December 2016 (UTC)

• Tangent: US population: ~319 million. UK population: ~64 million. So the US has 5x the population but only 1.4x the doctor visits for acne? That whole socialized medicine thing must be good stuff ;)

Indeed, cultural differences/norms may also play a role in the difference in willingness to pursue medical attention about it. Many teens suffer in silence or stick to going to the pharmacy to self-treat (and often have poor results). TylerDurden8823 (talk) 18:06, 7 December 2016 (UTC)

This was an offhand tangent, but that's actually an interesting question. Damn near everybody had zits as a teenager, and skin care is a pretty big industry, but relatively few people go beyond the drugstore for treatment. Is there data on the rate at which people seek actual medical care, or whether that has changed over time? "Number of doctor visits" is a presumably easy to measure but sort of unintuitive statistic. Opabinia regalis (talk) 21:30, 8 December 2016 (UTC)

I think some epidemiology articles do mention number of doctor visits though I can't recall if they stratify by nation. It would be important to know between the US and UK if the proportion of those most affected by acne (e.g., those in their teenage years and twenties) is significantly different. If not, this might explain why the numbers are not all that dissimilar (though this is merely speculation on my part). TylerDurden8823 (talk) 22:21, 8 December 2016 (UTC)

• I'm surprised the "society and culture" section is so brief, considering that apparently 90% of Western teenagers have had noticeable acne and obsessing about zits seems like a common teenager theme. I wonder if there's more to be written here, especially from more sociology- or literature-oriented rather than medical sources.

If you have some example sources to propose, let me know. There is sparse mention in the medical literature and is an area in need of further examination. TylerDurden8823 (talk) 18:06, 7 December 2016 (UTC)

You've already cited medical sources that report on the effects of acne on self-image and psychological well-being, but body image and beauty ideals, especially in young people, are also studied in other disciplines, and I'd be pretty surprised if there weren't sources in women's studies or media studies that cover acne. That said, this is waaaay outside my field, so I can't really suggest anything in particular; I'm just suggesting that it's worth looking specifically for those types of sources. Opabinia regalis (talk) 21:30, 8 December 2016 (UTC)

My concern is that this is an article about a medical condition and most sources that will discuss the sociocultural aspects will be from media and such sources are often considered unreliable for use in medical articles. TylerDurden8823 (talk) 22:21, 8 December 2016 (UTC)

I'm not suggesting using them for medical claims. Imagine trying to write leprosy without any sources from history or literature? I don't know if there are any relevant sources, but the point of those sourcing guidelines is to keep bullshit medical claims from infecting articles, not to keep entire academic fields out. Pinging WhatamIdoing because she often has good things to say on these issues when they come up at WT:MED. Opabinia regalis (talk) 07:19, 11 December 2016 (UTC)

MEDRS says, "the high-quality popular press can be a good source for social, biographical, current-affairs, financial, and historical information in a medical article". Something like https://books.google.com/books?id=S-rNTj6IlVAC might be usable. WhatamIdoing (talk) 22:19, 12 December 2016 (UTC)

• Speaking of which - it wasn't till I got to that last bullet that I realized the word zit doesn't occur in this article! In fact there's another, much less developed but somewhat redundant article at pimple. I can't help thinking these should be merged, but if you'd understandably rather not, then it would still be good to copy or summarize some of this material into the pimple article, because pimples/zits/etc will be common search terms.

I think it's better to leave them separate and have a wikilink to the term pimple instead. I do see how slang terms such as zit(s) will be a frequently searched term but hopefully this article will educate a lot of readers. One addition I am looking into is a good place to address some other myths or misconceptions about acne (e.g., the effects of squeezing pimples on acne severity/persistence-believe it or not, PubMed searches turned up nothing). TylerDurden8823 (talk) 18:06, 7 December 2016 (UTC)

These pageview stats are interesting - acne vulgaris gets the most views, but pimple - which is, by comparison, a pretty bad article - still gets about 25% of the traffic on the subject. I think you have a good idea to add more on misconceptions. Opabinia regalis (talk) 21:30, 8 December 2016 (UTC)

Opabinia regalis (talk) 06:40, 7 December 2016 (UTC)

It doesn't surprise me that the pimple page gets a fair amount of views. My guess is acne probably gets the most and fortunately that redirects here. If the pimple page is in need of work, then we should do that too but I don't think we need to merge. TylerDurden8823 (talk) 22:21, 8 December 2016 (UTC)

Coordinator note: This nomination seems to have stalled and there is no support for promotion after several weeks. Therefore, I will be archiving the nomination. —Laser brain (talk) 15:04, 19 December 2016 (UTC)

• Closing note: This candidate has been archived, but there may be a delay in bot processing of the close. Please see WP:FAC/ar, and leave the {{featured article candidates}} template in place on the talk page until the bot goes through. --Laser brain (talk) 15:04, 19 December 2016 (UTC)

The above discussion is preserved as an archive. Please do not modify it. No further edits should be made to this page.