Wikipedia:Featured article candidates/Acne vulgaris/archive2

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 Sarastro1 via FACBot (talk) 23:37, 7 March 2017 [1].

---

Acne vulgaris

Nominator(s): TylerDurden8823 (talk) 15:01, 2 January 2017 (UTC)

This article is about the very common chronic skin condition acne vulgaris and underwent significant refinement during the last FAC. I strongly 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) 15:01, 2 January 2017 (UTC)

Comments by CFCF

Reserving a spot for a coming review (may not occur in its entirety before the 10th of January). Prior to the full review I may perform some minor c/e and adjustments. Carl Fredrik 💌 📧 18:44, 2 January 2017 (UTC)

Terrific, and thank you responding so quickly CFCF. I do have a question for you. What is it about the procedures part in the lead do you feel needs clarification? So far other readers have felt this section was clear so I'm curious to hear your thoughts about that part. TylerDurden8823 (talk) 19:13, 2 January 2017 (UTC)

Oh right: well procedures is a little vague — considering quite an industry exists offering all-manner of "facials". It would be better to explain this as "medical procedures" or some qualification that explains that much of what is on offer does not work. Carl Fredrik 💌 📧 10:41, 10 January 2017 (UTC)

I will start by going through the prose for issues with readability and clarity, diving into specific sources later. For what it's worth this likely fulfills all the criteria for FA already. However it is an important topic and when it reaches the main page the article should be a good as possible. Some early points:

• Images are important as there is significant variation in presentation:
  1. We should try to find images that show acne on different skin types. Acne looks very different on dark skin
  2. We should try to find quality images of acne of varying severity.

These are not necessarily requirements for FA, but if we can we should include them. I will take a look if I can find anything. Carl Fredrik 💌 📧 10:52, 10 January 2017 (UTC)

In principle, I agree with everything you said CFCF. We do have photos that exhibit some variance in acne severity and on different skin colors. We don't have any high-quality images of acne vulgaris on someone with very dark skin and my last review of the Wikimedia Commons images was unrevealing. If you know of a good image, I agree it would be worthwhile to include. I have no objection to rewording procedures as "medical procedures". I think the efficacy is well-addressed in the body and we don't go into significant detail about the relative efficacy of medications, lifestyle changes, or the medical procedures in the lead. TylerDurden8823 (talk) 03:16, 11 January 2017 (UTC)

I've been looking and will continue looking for images. Unfortunately there aren't that many in the medical literature that are free. Carl Fredrik 💌 📧 10:22, 11 January 2017 (UTC)

Yeah, that's pretty much what I expected but thanks for looking. TylerDurden8823 (talk) 18:48, 11 January 2017 (UTC)

I intend to keep my comments coming rolling and I hope they do not overwhelm you.

• This article currently redirects from "acne", yet makes no mention of other types of acne such as
  • acne rosacea
    • I'm not sure what you mean. When I search acne rosacea this redirects to the rosacea page. This is briefly covered in the differential diagnosis section. TylerDurden8823 (talk) 18:55, 11 January 2017 (UTC)
  • acne inversa (hidradenitis suppurativa, Wikipedia's use of that name is debatable, should potentially be moved to acne inversa)

There is some debate whether these should be classified as acne or not, but they are widely referred to as such and I think about a sentence differentiating them from acne vulgaris is due in the classifications section. I am able to provide you with a high quality source that describes both the classification as such as well as the controversy surrounding the classification.

That's a fair point. I have seen the literature refer to hidradenitis suppurativa as acne inversa. Which source did you have in mind for the classification/controversy? TylerDurden8823 (talk) 18:55, 11 January 2017 (UTC)

I wouldn't agree that the hidradenitis suppurativa page should be moved to acne inversa since it's not really a type of acne and its pathogenesis has more differences than similarities. I found a good 2014 Clinics in Dermatology review that sums it up nicely. I'll add a brief mention that it is sometimes referred to as acne inversa but is not truly a form of acne vulgaris. TylerDurden8823 (talk) 02:33, 18 February 2017 (UTC)

• No mention of "background erythema" — a strong factor differentiating acne vulgaris from acne rosacea
  • That specific phrase wasn't used but rosacea is discussed in the differential diagnosis section as above. TylerDurden8823 (talk) 18:55, 11 January 2017 (UTC)
• Blackhead is explained as an open pore, but is also referred to as an "open comedone", this should be in classification
  • I'm unclear on the suggested edit here. The discussion of blackheads' definition is within the classification section already. TylerDurden8823 (talk) 18:55, 11 January 2017 (UTC)
• Mention of juveline acne needed
  • I'm assuming you meant juvenile acne here (which doesn't even have a Wikipedia page to link to). Hasn't been featured in any acne review I've seen so far. If you have good sources demonstrating this deserves mention, I'll take a look. TylerDurden8823 (talk) 18:56, 11 January 2017 (UTC)
• Mention of papullopustules needed (simple as we mention both papules and pustules in the classification
  • I haven't seen this mentioned in any review I've seen so far. Do you have an illustrative source that mentions a papulopustule as a characteristic acne lesion? TylerDurden8823 (talk) 18:55, 11 January 2017 (UTC)

@CFCF:, I have to question whether the term "papulopustule" is widely accepted as a proper term for a type of characteristic acne lesion. Use of this term does not appear to be widespread as evidenced by the paucity of mention in the medical literature, see here [2]. TylerDurden8823 (talk) 02:19, 18 February 2017 (UTC)

• We could potentially mention secondary infection with other microbes such as s. aureus
  • That's reasonable. Where in the article did you have in mind? TylerDurden8823 (talk) 18:55, 11 January 2017 (UTC)
• We should carry information on classification of scarring, mentioning: hypertrophic (common), keloid (rare)
  • This information is in the article in the scarring section. TylerDurden8823 (talk) 18:55, 11 January 2017 (UTC)

To fulfill this I can offer help finding images and accessing sources, mail me if you need help with sources. I have sources for all the statements above.Carl Fredrik 💌 📧 10:22, 11 January 2017 (UTC)

@CFCF:, I believe I have addressed each of the suggested edits. Are there any further comments or suggestions or would you be willing to support the FA nomination at this point? TylerDurden8823 (talk) 03:19, 18 February 2017 (UTC)

@CFCF:? TylerDurden8823 (talk) 18:34, 19 February 2017 (UTC)

I support the FA nomination. More work can be done, but when it comes to medicine — there is no article where this isn't the case. I may end up adding some things myself prior to the main page feature. Carl Fredrik 💌 📧 23:21, 21 February 2017 (UTC)

Comments by My Core Competency is Competency

Comment - Wow... You have done such a great job improving this article! Here are a few initial thoughts: Photodynamic therapy (PDT) is used to treat active acne, not just scars (I am most familiar with red light therapy; check Pubmed for a reference). Microneedling and subcision are two other common treatments for acne scars ([3], [4]). Cryotherapy with dry ice was once a very common treatment for acne (see [5]; you can probably find a better reference), maybe you can add it as a historical note (I think some docs still do this). Hydroquinone should definitely be mentioned for treatment of PIH. For meds where both oral and topical forms are avaliable, it should be made clear which form is being referred to in the article (for example, is "dapsone" being used to refer to oral dapsone or topical dapsone gel; the same applies to clindamycin as another example). I would like to see Whey protein specifically added as a cause (that's a big trigger in people taking protein supplements to enhance weight lifting). I know this is an article on acne "vulgaris", but it would be nice to see the various subtypes of acne briefly mentioned, including other conditions that are closely related (such as SAPHO and PAPA syndromes) (see: [6]). A bit more coverage of drug-induced causes would be a plus too, for example, acne from epidermal growth factor receptor (EGFR) inhibitors (cetuximab, panitumumab) and small-molecule tyrosine kinase inhibitors (eg, gefitinib, erlotinib, lapatinib (see [7]). Perhaps olumacostat glasareti should also be mentioned as a possible future treatment (see: [8]). Cosmetic adhesive pads could also be mentioned as a treatment (see here [9]). Also, some comments on the role of cosmetics/make-up might be beneficial (both with respect to concealing acne, as well as acting as a possible cause of acne (comedogenic vs non-comedogenic products)). Perhaps the US iPledge program should also be mentioned with regard to oral isotretinoin (see [10]). Though acne lesions are rarely biopsied to confirm the diagnosis, there are distinctive features visible in a skin biopsy specimen when examined by a pathologist under the microscope; it might be nice to have a description (and photo if possible) of that dermatopathology in the article (you may need a better reference, but see [11]). Would a "Notable cases" section be a good idea, as is seen with other FA's like here [12] and here [13], a "Etymology and pronunciation" section like here [14], and/or an "Other animals" section (apparently cats can get acne, see here [15]; though you'll need better sourcing for your article)? And a question I have is this, is it a problem that some of the references are quite heavily cited, such as this one: [16] (I don't know if there are any pertinent wikipedia policies regarding this)? There are many other fun references that could be used for this possible feature article (I think this is a great one, for example: [≤http://jamanetwork.com/journals/jamadermatology/fullarticle/479093]). Another thing you might try is to find author email addresses in the reference articles you have used and email those authors inviting them to comment here (that might give you some really useful feedback). Additionally, I wonder if the article name should instead be reversed to simply acne with a redirect from acne vulgaris (perhaps someone else at the Medicine project can chime in on that); then all the various subtypes could be merged into and redirected towards this article (most of which are stub type articles). Maybe a "Further reading" section could be added at the end of the article (obviously not required, but I find it to be a nice addition (see [17])). But overall, fantastic work! ---My Core Competency is Competency (talk) 14:24, 5 January 2017 (UTC)

Hi Core, that was a rather large block of text you left so I'll try to work through it in order.

• I'll look into the photodynamic therapy part to see if I can find high-quality evidence to support the assertion that it's used for both acne & acne scars and report back with what I find.

So, just to clarify, the article does not say photodynamic therapy is used solely for acne scars. I think the article makes it pretty clear that it's used for acne vulgaris itself too since it discusses its mechanisms involve reducing bacterial (e.g., P. acnes) load and reduces sebum production. TylerDurden8823 (talk) 06:10, 7 January 2017 (UTC)

• The microneedling search you linked there is mainly from one journal (which is not MEDLINE-indexed) and was not mentioned in a slew of high-quality review articles so I would question how common this really is as a treatment for acne and/or acne scars. I'll have to look into the subcision part more.

I've added a few lines about the microneedling treatment in the procedures section for the sake of being comprehensive. It appears to have received limited study for acne vulgaris and scarring so far but it has been reviewed in JAAD so I agree that it's worth mentioning. TylerDurden8823 (talk) 06:57, 7 January 2017 (UTC)

• I'll look more into cryotherapy but very few (1-2) cover this topic for acne vulgaris so if it was once common (per that 1968 paper), it doesn't appear to be anymore.

I performed another search for cryotherapy and acne vulgaris and there's very little mention. Cutis has an article that discusses it but it's a low impact journal so it's questionable whether it really merits inclusion in the article since it doesn't appear to be a prominent treatment. TylerDurden8823 (talk) 07:20, 7 January 2017 (UTC)

• I'll take another look at the PIH section re: hydroquinone.

A brief section discussing hydroquinone has been added to the treatment section since it is a frequently used treatment for acne-associated PIH. TylerDurden8823 (talk) 23:49, 7 January 2017 (UTC)

• The mention of other acne subtypes would add unnecessary length to the article (which is already quite long, IMO) and there are dedicated Wikipedia pages to drug-induced acne (although those need a considerable amount of work). I believe those pages would be the more appropriate places to include discussion of the medications you mentioned (e.g., EGFR inhibitors).
• I'll take another look at the dapsone bit to see if that requires clarification.

I've clarified that topical dapsone was meant in one sentence where it was ambiguous. The formulation of clindamycin under discussion is clear in each instance it is mentioned in the article. TylerDurden8823 (talk) 23:35, 7 January 2017 (UTC)

• Do you have a high-quality source you can cite regarding the whey protein claim? Most review articles state diet has not been conclusively linked to acne vulgaris incidence or severity as the current article states.

per [18]...[19]review-[20]--Ozzie10aaaa (talk) 18:34, 9 January 2017 (UTC)

Yeah, I don't see whey specifically mentioned there. Also, @My Core Competency is Competency:, in [21] you said you thought the article could do with a good copyedit. Where do you think it could use this specifically? If you can identify problematic areas, I'm happy to address them. TylerDurden8823 (talk) 21:41, 9 January 2017 (UTC)

• The source you linked for the cosmetic adhesive pads is not a high-quality one (not a MEDLINE-indexed journal).
• If you have good sources to suggest for inclusion regarding the makeup to conceal acne, that might be a useful addition to the society/culture section so I'd be interested to hear your suggestions about that.
• I think specific mention of the US IPledge program might be a bit too U.S.-centric for the article but that's just my two cents. If the consensus is that this is okay for inclusion, it might be worthwhile mentioning in the retinoid or society/culture sections.
• A brief addition of the histopathology is not a bad idea but it will be hard to incorporate that into simple language for a general readership. I'll look into that more.
• I'm unsure about a notable cases section. It might be a reasonable addition to the society/culture section if we can find good examples.
• I personally don't think the etymology section is particularly important since that's discussed in the history section.
• It's okay to cite a review heavily if it's an influential and important review. I think there is definitely adequate diversity in the reviews included in the article considering there are over 100 references. Additionally, many of the claims referenced to that article are also supported by other reviews as well so I think we're fine there.
• The JAMA article you cite is an old primary source so I wouldn't recommend its inclusion.
• The further reading suggestion is a nice one if you have any specific sources you would like to present for review.
• I would vote to keep the article as acne vulgaris since it's established in the very beginning of the article that it's referring to what is colloquially called acne. I think naming the article itself "acne" is too vague since there are so many subtypes. @Doc James:, @Opabinia regalis:, @Seppi333:, @CFCF:, any thoughts about these suggestions? TylerDurden8823 (talk) 03:19, 6 January 2017 (UTC)

Tyler, my initial comment was from just an initial skimming of the article. I can give you more feedback once those initial issues are fully addressed (and I do think you have overlooked a few of my initial comments (probably by accident)). With regard to copy editing, again it is not my strength, but I can say that subjectively (to me), this article does not flow/read like one of Wikipedia's best articles. Here are just two examples/honest questions I have:

"Boxcar scars are round or ovoid indented scars with sharp borders and vary in size from 1.5–4 mm across." Is the right type of dash used here and should there be a space between the "4" and "mm" ? (I don't know) Is a comma needed after "ovoid"?

"Frequently used combinations include the following: antibiotic + benzoyl peroxide, antibiotic + topical retinoid, or topical retinoid + benzoyl peroxide." Should plus signs be used here? Or should there be words instead?

I think you should have multiple copy editors look this article over again.

Whey protein is mentioned in the full text of that article (search reference 18 for "Whey"). And with regard to references, the ones I provided above were just to get you started. I realize better sources need to be found for some of the facts/issues I mentioned (but they are out there and you can find them). On a related note, think about what your audience would want to know about; take a young woman for example. She is going to want to know about cosmetics (do they cause acne, can she use them). There needs to be some coverage of cosmetics, including cosmetic adhesive pads, etc.

My feeling is that opinion on the length of a FA is irrelevant and subjective (it takes the length it takes to make an excellent article). My preference would be that you change the article name to "acne" and redirect from "acne vulgaris" as well and merge in all the obscure subtypes of acne into this article (like pomade acne - that is never going to be more than a ~1 sentence stub anyway). Once all those are merged in (see here for a good list [22]) then you can have a really interesting "etymology section" talking about all the obscure names, including what "vulgaris" means (common). Plus, people are going to search for "acne" not "acne vulgaris".

While this may be controversial, and I don't have strong feelings about it, Brad Pitt might be one option for a "notable cases" section (Google him and acne scarring - he is "known" for his bad skin).

Here are some ISBN's for further reading: 0723435715, 032331967X, 0323244750, 0071669043.

--My Core Competency is Competency (talk) 23:31, 9 January 2017 (UTC)

Which specific comments do you think I have overlooked Core? I'm pretty sure I addressed just about everything you mentioned earlier and have incorporated many of your suggestions into the article. The ones I didn't were generally ones I disagreed with or did not see good sources to support the idea. No comma is needed after the word ovoid and I'm pretty sure that type of dash was felt to be okay by Grammarfascist (and many others who have read through so far so I'd be surprised if someone changed that) and none of the aforementioned seemed to have any issue with the + sign (but if someone vociferously advocated for the word "and" there, I wouldn't be opposed since it's so minor a change). I'm not really sure why the article doesn't read to you like one of Wikipedia's best. I think article length is important (within reason) for the sake of readability. We must keep in mind that this is an encyclopedia for a general readership and if it's endlessly long then few will read it. I'm going to agree with Opabinia and say the article should remain acne vulgaris. I think the other acne articles simply need to be developed. If we add in all the other forms of acne, that's going to lengthen the article even further. The article does come up if the term "acne" is searched so we should be okay there, but I'd be interested to hear what other members of the community have to say about these matters. I'll take a look into the whey/acne link but from what I've seen the consensus amongst secondary sources is there is no convincing link at this time. Lastly, why do cosmetics need to be discussed in this article? As above, what reference(s) do you suggest for this? TylerDurden8823 (talk) 05:27, 10 January 2017 (UTC)

So, looking into the question of a link between whey and acne, I find it interesting that the most recent JAAD guidelines from 2016 say that observational evidence (often very limited by retrospective design and self-reporting to say the least and no RCT evidence) has suggested a link between dairy and acne severity but found that milk (especially skim) was associated yet cheese and yogurt were not. It strikes me as peculiar that other dairy products such as yogurt would not show the same correlation if this were truly attributable to whey protein. Granted, this is totally my own analysis on the matter and inadmissible as WP:OR, but I felt it was worth mentioning all the same. Taken together, since whey protein is mentioned in a JAAD 2014 review already included in the article, I think it's reasonable to allow brief mention but whey protein's link does not seem to have much evidence behind it at this time. I have added a brief statement covering the topic. TylerDurden8823 (talk) 05:44, 10 January 2017 (UTC)

Things you have yet to address at all: adding brief mention of other conditions that are closely related (such as SAPHO and PAPA syndromes) (this is a separate issue from adding in the subtypes of acne), adding mention of olumacostat glasareti as a possible future treatment, adding an "other animals" section, and emailing article authors for feedback. With regard to copy editing, if you can get User:Tony1 to look at this article and he thinks it's ready for FA status, then I would be satisfied on this point (I did post on his talk page here [23]). I have also already answered "why do cosmetics need to be discussed in this article" and references are out there (search through here [24] and see more specifically here [25], [26], [27], [28]). With regard to other initial content issues that remain unresolved, I suggest you solicit many more opinions from other less biased third party users regarding: mention of the US IPledge program, addition of notable cases, addition of an etymology section, addition of cryotherapy, changing the article name to "acne" and merging in all the various subtypes (including adding drug-induced causes of acne), addition of dermpath findings, the presence of heavily cited sources (is that a problem?), addition of a "Further reading" section. I would love more users (10+ ?) debating these issues, not just you and I and two other users (this is healthy for the FA process). For the time being, I oppose this nomination.--My Core Competency is Competency (talk) 13:54, 10 January 2017 (UTC)

FWIW, there is essentially zero chance of 10+ users weighing in on topics like "should olumacostat glasaretil be covered". (But here's one more: there's no need to add unproven, still-in-development possible treatments to an already long article about a disease with many existing treatments.) Also, Wikipedians are perfectly capable of making judgments about whether an article meets the FA criteria; while there have been other projects aimed at soliciting external review, contacting outside authors has never been an expectation at FA. As for the cosmetics thing, see also my comments in the first FAC about body image and media representations - I could believe there's an article waiting to be written at acne in popular culture, but I'm not sure it needs to be in this article. Opabinia regalis (talk) 00:59, 11 January 2017 (UTC)

I don't think it is unreasonable to hope for more users participating in this FA review, even if they don't chime in on all the questions raised. Regarding asking outside authors to review this article,I suggested that idea thinking it might be helpful, not an expectation (though I have brought it up again as Tyler did not respond to the idea); I don't feel strongly about this issue. Cosmetics, on the other hand, I do. This is a general article about acne with no mention of cosmetics, no matter how brief - it is a major omission. I don't think a whole section is necessarily needed, but some type of coverage is. And concerning olumacostat glasaretil and "there's no need to add unproven, still-in-development possible treatments", have you read the "research" section in this article? By your reasoning essentially that entire section should be deleted (which I would not agree with). --My Core Competency is Competency (talk) 02:10, 11 January 2017 (UTC)

Well, I think it's slightly premature to oppose the nomination based on the above issues since I'm actively addressing them. I have tried getting other editors over here (pinged above for opinions though I think 10+ is a little ambitious) but I'll ping them again. @Doc James:, @Seppi333:, @CFCF:, @Ozzie10aaaa: any thoughts about Core's suggestions and concerns? More opinions are always welcome and strongly encouraged. Core, I'll try to address your concerns that have not been sufficiently addressed. I left a comment for Tony yesterday so we'll see if he answers soon and has any additional ideas for copyediting but I did make some tweaks yesterday that should improve the article's readability. Regarding your suggestions/concerns above, I'll address them in order.

• I had previously grouped the concern you had about SAPHO and PAPA syndromes into the same issue as not mentioning the various acne subtypes. I'll look into this issue more to see if mention is warranted and report back soon.

So, looking into the matter further, the most recent reviews I found discussing SAPHO syndrome specify that acne conglobata and acne fulminans occur in up to 25% of patients with this rare syndrome and these seem to be regarded as dermatologic entities distinct from acne vulgaris (unless I'm missing something) but other reviews do mention variable severity of the acne so perhaps acne conglobata and fulminans are simply severe forms of the acne vulgaris spectrum. Is that correct Core or would you view that as a misrepresentation of the definition of acne conglobata and fulminans? If these are just severe variants of acne vulgaris, then I agree it's worth mentioning and have a good review article from Clinics in Dermatology I can use to add this information and a few other syndromes. TylerDurden8823 (talk) 03:08, 11 January 2017 (UTC)

• I did briefly look at the olumacostat glasareti trial you linked earlier. I have to look into it more to see if it merits brief mention in the research section.

I think this is still too preliminary to warrant mention after further review of the cited trial. The results are encouraging but it's a single phase IIa trial of relatively short duration. The other treatments mentioned in the research section are largely reviewed in a secondary source so I think we can wait for a secondary source to emerge covering olumacostat glasareti (very interesting novel MOA though!). TylerDurden8823 (talk) 03:21, 11 January 2017 (UTC)

• I don't feel strongly about the other animals section but certainly don't think its absence should preclude an FA nomination from going through. I'd be curious to hear what other editors think about this idea.
• I don't see where you explained the need for discussion about cosmetics. In your original suggestion, you mention cosmetic adhesive pads should be mentioned and link to a non-MEDLINE indexed journal (which I did address above since it's not a high-quality source though I'm sure you're right that high-quality sources do exist). Additionally, you suggested mentioning the use of makeup as a cause of acne but I believe this belongs in the acne cosmetica article. With respect to the use of makeup to conceal/minimize the appearance of acne, I believe that may have a place in the society & culture section though I would need a good source (thanks for linking the PubMed search-I'll explore that).
• I think it's reasonable to have other opinions on the IPledge question. I still think it's a bit too U.S. centric but if consensus says otherwise I'm happy to mention it.
• I'm looking into dermpath findings so stay tuned (This was addressed above as a good suggestion in my earlier comments and it hasn't been forgotten).
• I maintain that with >100 sources there is adequate diversity despite some reviews being heavily cited (as above, this is addressed by the fact that most of the statements supported by some of these heavily cited reviews are verified in others).
• I don't feel strongly about the notable cases section but I think it's optional and shouldn't preclude upgrade to FA.
• I still don't think cryotherapy is worthy of mention and would be WP:UNDUE. It's very sparsely mentioned in recent high-quality literature (from the search I did anyway but if you come across high-quality sources really discussing it, please let me know)
• I think the mention of the drug-induced acne belongs in the acne medicamentosa article since that seems to have enough of a distinction to not call that true acne vulgaris but a more specific form of acne. TylerDurden8823 (talk) 02:54, 11 January 2017 (UTC)

Tyler - I can see you are working hard on this article, and you’re doing a good job! I took some time to reflect about this FAC the last hour, and I really don’t want to dig in any further on these issues. Whatever you all decide is fine with me. If you do end up adding a notable cases section, you could reference celebs who have admitted to having acne and endorsed Proactiv in commercials (see specifically [29]). I will not stand in your way any further and look forward to seeing what the ultimate acne FA looks like! --My Core Competency is Competency (talk) 03:10, 11 January 2017 (UTC)

@My Core Competency is Competency:, that's entirely up to you. I'm certainly not trying to dissuade you from participating. In fact, I encourage you to stay and wait to see what other editors think since we value your input. As you can see, I am incorporating many of your suggestions and I do think they are helpful. I'm not suggesting that you're obstructing anything but I do disagree with some suggestions you've made (that's certainly allowed and okay-this is why we have discussion). Since you're a dermatologist, can you weigh in on the question I posed about the acne conglobata/acne fulminans and SAPHO/PAPA syndromes? If you could provide some insight about that, it would certainly help clarify whether their mention is appropriate. TylerDurden8823 (talk) 03:21, 11 January 2017 (UTC)

I must say I do not agree with MCCiC about mentioning SAPHO and PAPA, these are just one of a multitude of disorders that display acne as part of their presentation. I mean if we don't stop there we're going to have to list them all by name. Certain mention of disorders which present themselves with acne may be due, including acne medicamentosa, but hardly more than a sentence, making it undue to mention SAPHO and PAPA by name.

We should remember that this is a Wikipedia FA, not a full Cochrane review, frankly these requirements strike me as far from what FA entails. None of our FA's are anywhere near perfect, and if we expect perfection we will simply get nothing. Carl Fredrik 💌 📧 09:49, 11 January 2017 (UTC)

Comments from Opabinia

I reviewed this article in some detail in the previous FAC round and just re-read it. While I still think there's probably room to expand the "society and culture" section, I haven't found as much material as I would've expected and think this subtopic may actually be better off covered elsewhere, somewhere like body image. In response to the above, I think the article's current name is preferable. I'm out of nitpicks and I support this nomination. Opabinia regalis (talk) 21:54, 9 January 2017 (UTC)

I feel like I reviewed this ages ago, so I was surprised to see it pop up again on my watchlist recently. Regarding some of the issues raised below, I had also suggested including more on the social/cultural aspects of the condition, and I agree with Sarah on the narrow point that MEDRS refers to medical claims and should not be used to exclude sources from other academic disciplines that relate to social/cultural/etc. issues. However, at the time I looked for potential sources on this, I found much less than I was expecting. There is plenty of primary material (magazine articles, makeup ads, TV sitcoms and young adult books with pimples as plot points, and so on) and plenty of academic work on body image in teenagers, but surprisingly little of the latter specifically about acne. "There must be sources!" isn't really an argument, or an actionable recommendation. I'd be in favor of a brief mention of the size or scale of acne-related product sales in the cosmetics industry, though, if you can find sources on that. Opabinia regalis (talk) 23:57, 27 February 2017 (UTC)

Hi, Opabinia, I hear you. There's no dispute about whether MEDRS applies to social/cultural things. I'm fine with using non-medical sources but they still need to be high-quality sources (and preferably ones I have access to so I can read them and then add them). However, cosmetics do indeed have ties to medical phenomena. That's an indisputable fact that remains pertinent to the conversation. I have been working on many different issues (feel like I'm pulled in all directions) and it is on my list of "to-dos" for this article to expand the S&C section with some high-quality sources. TylerDurden8823 (talk) 02:46, 28 February 2017 (UTC)

Comments by Seppi333

Continuing from where I left off during the last nomination...

I'm going to take on a review of the article's MOS compliance (criterion 2) now. Seppi333 (Insert 2¢) 20:51, 11 January 2017 (UTC)

• Criterion 2a (MOS:LEAD): pending review. Seppi333 (Insert 2¢) 21:04, 11 January 2017 (UTC)

  I've made a few minor edits to the lead to improve clarity/flow. Overall, the lead appears to conform to MOS:LEAD. It has an appropriate image/infobox, the first sentence adequately establishes the scope and is correctly formatted, it is composed of exactly 4 paragraphs which is consistent with the paragraph limit for long articles, and the lead paragraphs adequately summarize the article IMO. As of right now, I think that the current lead conforms to criterion 2a. Seppi333 (Insert 2¢) 17:24, 1 February 2017 (UTC)

• Criterion 2b (MOS:LAYOUT): since this is a medical article, the section ordering is indicated by MOS:MED. From looking at the TOC and a cursory inspection of the sections (mainly to identify any single sentence paragraphs and see how section hatnotes were used), I can see that the layout conforms to MOS:MED#Diseases or disorders or syndromes. There's no issues with the formatting in the EL section, the image layout is fine (per my image review during the last nomination), and the correct infobox for a disease ({{Infobox medical condition}}) is used in the article.
  In a nutshell, I see no issues with the current layout. Seppi333 (Insert 2¢) 21:04, 11 January 2017 (UTC)

• Criterion 2c (MOS:CITE): pending review - reviewing citation formatting and consistency is rather tedious, so I'll probably end up doing this last. Seppi333 (Insert 2¢) 21:04, 11 January 2017 (UTC)

Does the article pass this criterion in your view @Seppi333: or are additional edits needed? TylerDurden8823 (talk) 18:53, 10 February 2017 (UTC)

@TylerDurden8823: I'll take a look tomorrow. Seppi333 (Insert 2¢) 22:56, 11 February 2017 (UTC)

Sounds great, thank you! TylerDurden8823 (talk) 23:04, 11 February 2017 (UTC)

I spot-checked about a quarter of the ~100 references in the article and every one of them is consistently formatted. I'm satisfied with the reference formatting based upon that sample. Seppi333 (Insert 2¢) 01:34, 13 February 2017 (UTC)

• Criterion 2 overall (general WP:MOS compliance): I've gone through the article to find and fix formatting issues relevant to MOS:NUM/MOS:DATE (partially done via script), MOS:NBSP/MOS:DASH (partially done via script), MOS:TEXT, and MOS:ABBR. The revisions made by me and the nominator during my image review in the last FAC fully addressed my concerns relevant to MOS:IMAGE and MOS:ALT/MOS:CAPTION. I'm not going to go through every aspect of the MOS since this isn't actually necessary for FA promotion; however, based upon a fairly thorough examination of the article's source and the article itself, I don't see any further issues with any of these components of the MOS. Seppi333 (Insert 2¢) 21:04, 11 January 2017 (UTC)

Thank you Seppi, that sounds great. Once you've finished reviewing the last few criteria about the lead and citation formatting/consistency, please be sure to let me know if anything needs fixing and I'll attend to it immediately. Once that criterion is satisfied, please let me know if there are other issues you see with the article (if you care to comment on them) and elaborate if you support or oppose the FA nomination. TylerDurden8823 (talk) 05:03, 13 January 2017 (UTC)

@Seppi333:, any updates on your assessment of MOS compliance? TylerDurden8823 (talk) 03:51, 20 January 2017 (UTC)

I'll follow up soon. Sorry for the delay. Seppi333 (Insert 2¢) 03:01, 21 January 2017 (UTC)

@Seppi333:, any update? TylerDurden8823 (talk) 03:11, 1 February 2017 (UTC)

Sure. I've reviewed the lead section. I'll tackle the citations sometime in the next week or two. This is going to be pretty tedious. From a cursory look, the author and date formatting is slightly inconsistent. E.g., some dates use a day, month, and year - others just use a month/year. I'd suggest just cutting the day and using a consistent month/year format. The author formatting in most citations is "[last name], [first and middle initials w/o periods]; [2nd author last name], [2nd author first and middle initials]; etc."; however, some citations include a period in the initials or do not initialize the authors' first names and middle initials. Seppi333 (Insert 2¢) 17:33, 1 February 2017 (UTC)

I'll work on tweaking the citations for consistency to make your review easier when you do it. Thanks for reviewing the lead! TylerDurden8823 (talk) 02:01, 2 February 2017 (UTC)

• Support promotion based upon my review of the MOS and images (criteria 2 and 3). Seppi333 (Insert 2¢) 01:33, 13 February 2017 (UTC)

Coordinator comments

I think we are OK for source and image reviews. That leaves us still needing a spot check of sources for accuracy and close paraphrasing; I'll leave a note at WT:FAC. Additionally, I'd just like a non-medical editor to glance over the prose to check for accessibility for the general reader. Sarastro1 (talk) 12:50, 22 February 2017 (UTC)

Comments from SarahSV

Hi TylerDurden8823, I have a question about this sentence: "Cigarette smoking is not recommended as an approach to improving the appearance of acne because of its numerous adverse health effects." Young people with acne reading that might think it would be helpful to start or continue smoking. What does the source say to support the sentence? SarahSV ^(talk) 03:19, 25 February 2017 (UTC)

I'm not entirely sure what this sentence means, especially within that paragraph: "Other workers have voiced concerns related to creating a vaccine designed to neutralize a stable community of normal skin bacteria that is known to protect the skin from colonization by more harmful microorganisms." SarahSV ^(talk) 03:34, 25 February 2017 (UTC)

Hi SlimVirgin I'm happy to answer your questions. I'll address them in order. Regarding your question about the first sentence you mentioned about cigarette smoking, that seems like a very significant misreading of what it clearly says-that cigarette smoking is NOT recommended as a way to improve acne. The reason this sentence is included is because the relationship between cigarette smoking and acne severity is unclear and studies have been mixed (as it mentions in that paragraph). Some studies say smoking cigarettes makes it worse, others say it has no impact, and others say it improves acne appearance. However, since cigarette smoking is known to have numerous harmful effects on a person's health, it's obviously not recommended for this purpose since reliable and safe medical therapies are available. Here are some pertinent quotes from the cited article: "Whether or not acne is caused by, exacerbated, improved, cured, or is not associated with smoking remains controversial.31,125–130" and "Although it is possible that smoking could ameliorate acne, further experimental research in this area is unethical due to the harmful effects of smoking. Further observational research is likely to perpetuate previous problems in reporting bias and confounding. Clinicians are recommended to advise against smoking despite some evidence suggesting it is beneficial with regard to acne."

With respect to the second sentences you mentioned, the article is referring to concerns being raised about vaccines aimed against P.acnes. on the skin. "P. acnes is thought to contribute to the process of acne but is also a part of the normal skin's flora of bacteria/microorganisms and therefore concerns have been raised about designing vaccines training the immune system to target this particular bacterium since the skin's natural bacteria flora is thought to have beneficial properties as well. I hope that clears up the confusion. If not, I'm unsure what is confusing you about the sentence. Please let me know, thanks! TylerDurden8823 (talk) 03:51, 25 February 2017 (UTC)

Thanks for the replies. I didn't misread the first sentence. I know what it says, but any hint that smoking might help acne could cause teenagers to start or continue smoking. I think we shouldn't mention that unless the source is very clear that it might help (but that, of course, no one should smoke for that reason). As it stands, it seems like a passing remark in the source. Remember that his/her readership and ours are very different.

Re: the second sentence. The sentence makes no sense in the context of that paragraph. Who are the "other workers"? What kind of workers, and in what sense "other"? Is it the vaccine from the previous sentence or some other? SarahSV ^(talk) 04:20, 25 February 2017 (UTC)

• Other problems:

• There's almost nothing in "society and culture" (which is a poor choice of headings; I know it's MEDMOS, but that offers suggestions—no need to stick to them if they don't make sense). You mention anxiety, depression, etc, under "prognosis", but it might be better here (along with social isolation, employment problems, thoughts of suicide).
• "There is no clear evidence that use of oral retinoids increases the risk of psychiatric side effects such as depression and suicidality." Then why mention it? You should first explain what the issue is, then you can offer rebuttal. That's the problem with the smoking sentence too.
• I see you changed the smoking section on 3 February 2016 to say the opposite of what it said before. The current version depends heavily on Bhate and Williams (2013). Can you say why you're prioritizing that source? SarahSV ^(talk) 05:08, 25 February 2017 (UTC)

The article simply reflects what the literature states-that it's unclear how smoking influences acne but it's not recommended to be used as a tool to help acne. I think it's fine as it is but I appreciate the feedback. I don't think teenagers will interpret these statements as an endorsement of smoking for acne. I believe others who have reviewed the article would agree since no one has seen these statements as problematic or ambiguous. I think it's quite clear and doesn't even hint that smoking might help. I disagree with the characterization of the smoking sentence as needing a better definition of why smoking is not recommended. I think that's clearly explained. Exactly as you said, the article states that smoking should not be used for this purpose (or any really, but that's a separate issue). There are other reviews that discuss the relationship between smoking and acne as well and it's not an infrequent question. Regarding the second sentences, I can reword it a bit since looking at the original source I don't see which specific groups are being referred to as skeptics/opponents of such a vaccine. Other would be referring to those who oppose the vaccine (as opposed to those who favor it, which I thought was pretty clear since it's a two-sided issue pro- making a P. acnes vaccine vs anti- making a P.acnes vaccine).

Regarding the other issues you've raised, this has already been discussed (see above discussion) regarding the society & culture section (widely used across various medical articles and I don't know why you're saying it's a poor choice of heading, but if you have a better suggestion, I'm open to it). I agree this section requires further development but it's not a strict requirement for FA (as covered above) and will be continued to be developed. However, a major limiting factor is a lack of high-quality sources discussing it (let alone ones I have access to). Regarding the oral retinoids, it's a pretty strong implication that if they were studied for depression and suicidality, that there were concerns about those issues. It seems redundant to say "concerns have been raised about oral retinoids being linked to an increased risk of psychiatric side effects such as depression and suicidality; however, there is no clear evidence to support such assertions." If other editors agree that this is unclear or necessary, then that's fine (but so far you're the first). Argh, edit conflict! Oh, and the British Journal of Dermatology is a fine source. I changed what the section said that day because I found new information from a newer review. It's never good to stick to old information purely because it's just been there. If new information is found and it contradicts the old information and is high-quality, it should be acknowledged. That's what was done. The current version acknowledges that there is debate as it states in the literature. This isn't an uncommon phenomenon within the medical literature as understanding about a certain topic evolves over time. To say the smoking section "depends heavily" on the Bhate's review seems somewhat misleading to me. It's true that many sentences in that section are cited to that source but two other reviews have also been mentioned and it's only a few sentences. I'm happy to include other reviews if I can find them if you're concerned about a lack of diversity there (though sometimes you have to accept the limitations of the currently available literature) and there are only so many reviews on a topic. TylerDurden8823 (talk) 05:10, 25 February 2017 (UTC)

Re: "I don't think teenagers will interpret these statements as an endorsement of smoking for acne."

If teenagers read on Wikipedia that smoking might make their acne go away, they might start or continue to smoke. Adding "but don't do it; adverse effects, etc" is pointless, because when you're 16, adverse effects lie in the distant future, which is never, whereas acne is now. So if you're going to include that sentence, you will need several sources who are very clear about the existence of a possible positive association between smoking and acne relief. Don't include it because of a passing remark in one source. SarahSV ^(talk) 05:20, 25 February 2017 (UTC)

I'd want to hear other opinions. I don't agree that teenagers are at higher risk of taking it up or not quitting because of that sentence. I also disagree with saying that discussion of adverse effects and that it's not recommended are pointless statements. I meet people every day who have no idea about cigarette's harms (and I also meet many who do and smoke regardless, but that's neither here nor there). There are few reviews that discuss the relationship between acne and smoking. There is one from 2011 that I don't have access to and I'll try to see if someone can get me a copy since that may help with the diversity of included reviews. However, the current version of the article reflects the controversy in the literature. Some reviews say it definitely worsens acne whereas others say the impact is unclear. You say "several sources" will be required, but how many is that? I still disagree with the "passing remark" characterization. @Seppi333:, @CFCF:, @Doc James:, @My Core Competency is Competency:, @Ozzie10aaaa:, @WhatamIdoing:, what do the rest of you think? Does this sentence require modification or removal or is it fine as it is? TylerDurden8823 (talk) 05:36, 25 February 2017 (UTC)

Re: smoking again, you wrote above: "Some reviews say it definitely worsens acne whereas others say the impact is unclear." Yes, but you are saying more than that. You are saying that it might help, and that: "Cigarette smoking is not recommended as an approach to improving the appearance of acne because of its numerous adverse health effects." That's a red flag. I want to know that the sources fully support you on there being an association between smoking and acne disappearing. SarahSV ^(talk) 05:58, 25 February 2017 (UTC)

Wikipedia reflects what high-quality sources say and we have done that. The content does not say acne is improved with cigarette smoking (it says one review says it's unclear whether smoking makes acne worse, better, or doesn't change it at all and that another review says it clearly worsens acne and its relationship with acne is therefore controversial. Your description above sounds to me like a serious misinterpretation to me. We do not say there is an association between smoking and acne disappearing. TylerDurden8823 (talk) 06:08, 25 February 2017 (UTC)

I'm obviously not communicating clearly enough here. Apologies for that. My concern is this. You have written (in an article that will be read by young people): "Cigarette smoking is not recommended as an approach to improving the appearance of acne because of its numerous adverse health effects (bold added)."

That is, there is only one reason not to smoke to improve the appearance of acne, and that reason is the adverse health effects. Other reasons might be that it wouldn't help, or that it would make the acne worse, but those are not the reasons given. Instead only one reason to avoid smoking for acne is offered. Therefore, the implication is that, were it not for those adverse health effects, smoking to improve the appearance of acne might be recommended. SarahSV ^(talk) 06:33, 25 February 2017 (UTC)

I think the preceding sentences clearly demonstrate that cigarettes are not a reliable way to improve acne regardless of its negative health effects so I still disagree with your conclusion. That was a helpful clarification though on what you were trying to communicate though so thank you for that. We'll give DoctorJoeE some time to respond. If he doens't, that sentence can be reworked or removed (it's not essential to the article). TylerDurden8823 (talk) 06:49, 25 February 2017 (UTC)

Adjusted a bit. Doc James (talk · contribs · email) 10:17, 25 February 2017 (UTC)

I have no objection to James' tweak. TylerDurden8823 (talk) 15:58, 25 February 2017 (UTC)

• Re: the "other workers" sentence: DoctorJoeE added it in March 2015. DoctorJoe I was wondering what "other workers" refers to in the sentence: "Other workers have voiced concerns related to creating a vaccine ..." SarahSV ^(talk) 06:22, 25 February 2017 (UTC)
  • SarahSV, I'm not sure I understand your question. The paragraph before the one I added discusses the theoretical possibility of developing a vaccine targeting P. acnes as a treatment for acne; I added (and sourced) the caveat that other workers (specialists and researchers) have pointed out that it may be a very bad idea to neutralize a stable community of normal skin bacteria that is known to protect the skin from more harmful microorganisms. It's an important point, and I would object to removing it. DoctorJoeE ^{review transgressions}/_{talk to me!} 16:04, 25 February 2017 (UTC)

DoctorJoeE, I don't see where in the cited article (https://www.newscientist.com/article/dn20958-in-development-a-vaccine-for-acne/#VRoBMbqL6QY) this claim is made (except perhaps in the author's own words). I don't see anything in the article about a group of skeptics/scientists/etc voicing opposition to the development of such vaccines. This appears to be the pertinent section of the cited article: "This showed that antibodies to P. acnes might reduce pimples. However, a stable community of normal skin bacteria is known to protects the skin from colonisation by nastier germs. A vaccine that encourages the body to indiscriminately attack P. acnes could cause worse trouble than acne." TylerDurden8823 (talk) 17:14, 25 February 2017 (UTC)

"Except perhaps the author's own words"? Really? What else do you need? The concern about immunizing human hosts against normal flora is a widespread concern in the medical community. If you need more cites, I'll provide them, or you can easily find them yourself. DoctorJoeE ^{review transgressions}/_{talk to me!} 22:47, 26 February 2017 (UTC)

DoctorJoeE, yes, really. In this situation, I think plenty more is needed. I see no mention of the author's credentials anywhere near this story (though even a well-credentialed author should not replace critical thinking, but that's an aside). I'm not suggesting that immunizing human beings against their own normal flora isn't a concern, but it's vague in this article who is concerned about it so I do think other sources are needed here for additional specificity (since it seems to be causing confusion for readers who is concerned about the implications of such a vaccination strategy). TylerDurden8823 (talk) 00:23, 27 February 2017 (UTC)

• The article doesn't mention iPLEDGE. Also, again in relation to the sentence: "There is no clear evidence that use of oral retinoids increases the risk of psychiatric side effects such as depression and suicidality", the consent form for isotretinoin refers to these side effects, so that needs to be expressed differently. This is a good source.

The sentence about oral retinoids not having clear evidence of an increased risk of psychiatric side effects is quite well-sourced. Since this is the second time iPLEDGE has come up, I will add a brief mention though I still think this is being belabored a bit in excess since it has its own Wikipedia page already and would be more appropriate on the isotretinoin page. TylerDurden8823 (talk) 18:53, 25 February 2017 (UTC)

That sentence needs to be unpacked. There is a black-box warning, and patients have to sign a consent form saying they've been told of these possible side-effects, yet the article says only "there is no clear evidence that ...". SarahSV ^(talk) 21:08, 25 February 2017 (UTC)

• Should the article not be called Acne, per WP:COMMONNAME?

No, the correct name is acne vulgaris since the term acne is used for various skin conditions (somewhat erroneously). TylerDurden8823 (talk) 18:54, 25 February 2017 (UTC)

The medical name is acne vulgaris. The common name is acne. WP:COMMONNAME: "Wikipedia does not necessarily use the subject's "official" name as an article title; it generally prefers to use the name that is most frequently used to refer to the subject in English-language reliable sources." SarahSV ^(talk) 19:11, 25 February 2017 (UTC)

Sigh, I don't care. Do what you want. Doc James, any thoughts? TylerDurden8823 (talk) 19:47, 25 February 2017 (UTC)

• I agree with My Core Competency is Competency that cosmetics should be discussed. That could be used to build up the "society and culture" section.

This is not a requirement for FA and I found little to no mention in the literature (which I find rather striking). Acne cosmetica has its own page and should be further developed. TylerDurden8823 (talk) 18:54, 25 February 2017 (UTC)

WP:FACR 1(b): "comprehensive: it neglects no major facts or details and places the subject in context". From the title onwards, this article discusses the medical aspects, but it largely ignores the non-medical. There's a billion-dollar global industry devoted to cosmetics to hide acne and other blemishes. SarahSV ^(talk) 19:11, 25 February 2017 (UTC)

Then, present high-quality sources for use. I have yet to find any and have not seen any others recommended. Again, it's still not an FA requirement (I disagree with the above characterization of this lacking in comprehensiveness). I find it odd that not one single review in the medical literature would mention this since many of them discuss the social stigma (at least none that I could see). — Preceding unsigned comment added by TylerDurden8823 (talk • contribs)

Core supplied several medical sources [30] [31][32] [33], and there are lots of non-medical. SarahSV ^(talk) 20:06, 25 February 2017 (UTC)

Slim, only one of the sources you presented here is of adequate quality. [34] is a recent study but a primary source; [35] and [36] are not MEDLINE-indexed (a marker of poor quality). The only one that's okay (and I will review) is this one [37] since it's a MEDLINE-indexed review from a journal with an okay impact factor. That's why I did not use the sources Core presented earlier. I critiqued many of the sources he presented above before and outright stated this but I'll see if the one acceptable source you provided has anything valuable to add. TylerDurden8823 (talk) 20:27, 25 February 2017 (UTC)

You don't need the sources for a cosmetics section to be only MEDRS; you can include others. SarahSV ^(talk) 21:00, 25 February 2017 (UTC)

Ideally, they should be. Where are you proposing this cosmetics section go exactly when the articles you present are from medical journals and yet shouldn't be subject to MEDRS standards? TylerDurden8823 (talk) 21:50, 25 February 2017 (UTC)

• The sentence "One trial found a relationship between acne and obesity" is based on a 12-year-old source. If this is what Core meant, that a discussion of cosmetics for concealment should be included, rather than as a cause for acne (which would be acne cosmetica), then this was unclear from his previous comments and your earlier ones. TylerDurden8823 (talk) 19:47, 25 February 2017 (UTC)

Yes, but other sources have said the same. WP:MEDRS generally favors secondary source within five years, that's true, but it's not an absolute requirement and this sounds a bit like recentism. I'm happy to replace it with a newer review that says the same thing but you'll have to give me a chance to look. TylerDurden8823 (talk) 18:53, 25 February 2017 (UTC)

That's fine, there's no rush. SarahSV ^(talk) 19:11, 25 February 2017 (UTC)

Updated. TylerDurden8823 (talk) 19:37, 25 February 2017 (UTC)

Thank you. You've changed the sentence to "Few studies have examined the relationship between obesity and acne", sourced to [38]. What does the source say? SarahSV ^(talk) 19:51, 25 February 2017 (UTC)

I'll send you a copy so you can see. TylerDurden8823 (talk) 22:16, 25 February 2017 (UTC)

• This sentence could use a tweak: "With increasing [antibiotic] resistance of P. acnes worldwide, antibiotics are becoming less effective." That says they're less effective because they're less effective.

No, that says they're less effective because of antibiotic resistance (which is the how). I think the sentence is fine as it is. TylerDurden8823 (talk) 18:53, 25 February 2017 (UTC)

It needs to be written differently. You could add that they're less effective because they're used so much. SarahSV ^(talk) 19:11, 25 February 2017 (UTC)

The very first sentence of the antibiotic section says: "Antibiotics are **frequently** applied to the skin or taken orally to treat acne and are thought to work due to their antimicrobial activity against P. acnes and their anti-inflammatory properties." TylerDurden8823 (talk) 19:41, 25 February 2017 (UTC)

That has nothing to do with the point I'm making, which is that the sentence in question reduces to tautology. One way you could fix it is by explaining that use/overuse of antibiotics to treat acne has caused resistance, which means they are less effective. That is, I'm suggesting that you unpack the point for the general reader. SarahSV ^(talk) 19:46, 25 February 2017 (UTC)

Fine. TylerDurden8823 (talk) 20:27, 25 February 2017 (UTC)

• Images: the article contains just three images of acne. It would be helpful to have others of varying severity, including on different ethnicities. If there are no good free images on Commons or Flickr, you could ask for help from dermatologists.

SarahSV ^(talk) 18:04, 25 February 2017 (UTC)

This has already been discussed at length above (see the discussion between CFCF & I). We have tried looking and not found great accessible images of varying ethnicities and severities though the article's current illustrations do show some variation in terms of severity and appearance based on skin color. This is also not a requirement for FA but certainly an area that can be further improved over time. That aside, how many images do you think the article really needs? TylerDurden8823 (talk) 18:53, 25 February 2017 (UTC)

It's a bit of a wall of text at the moment. Have you tried writing to dermatologists? Images apart, it would be helpful to reach out to a few for reviews/suggestions. SarahSV ^(talk) 19:11, 25 February 2017 (UTC)

I'm not well-versed in the process of getting images uploaded to, properly copyrighted, etc. that's out of my wheelhouse. As I said before, it's not a requirement for FA but I agree that additional high-quality images would be useful. CFCF and I discussed this at the beginning of his comments. TylerDurden8823 (talk) 19:37, 25 February 2017 (UTC)

Tyler, one thing I've noticed is that, when someone raises an objection, you reply with "this has already been discussed", and refer them to someone who has not objected. There's no point in doing that. You've requested reviews, and here they are. Please use the objections to make the article better, rather than batting them away. Having said that, I do realize that this is very frustrating process for nominators. SarahSV ^(talk) 19:42, 25 February 2017 (UTC)

SlimVirgin, yes, that's because I'm annoyed when someone hasn't read the above conversations before trying to contribute new comments (that's what's needed-fresh blood and fresh comments rather than rehashings). You'll see my responses to the issues raised below are quite different in tone because they're less frustrating/new. Sarastro requested non-medical editors come here but I already thought the article had undergone considerable review but I agree with having multiple perspectives. I hate repeating myself and many of the comments have seemed excessively nitpicky for an FA review (this has also been noted above many times in the previous conversations). You've brought up a few good points, which I've largely addressed, but I disagree with many of the raised suggestions. But to your initial point, it's the repetition that's aggravating and burning me out. That's why I sound exasperated (because I am). So, I would kindly ask that we keep the repetition to a minimum. As a courtesy, please take some time to read the conversations. I recognize it's not a requirement (but it would be nice). TylerDurden8823 (talk) 20:20, 25 February 2017 (UTC)

Perhaps we've read the previous discussions, but we disagree. If a dermatologist says that no mention of cosmetics ia a major omission, then s/he's probably right. I noticed it too, as a non-medical editor (and as a woman). Core also told you there were some problems with the writing, but for every example I've given you of those problems, you've told me that I'm wrong. The examples include a sentence someone else added, which isn't supported by the source.

I completely understand the frustration, because this review has been long. But Core's was a most thorough review, and the issues aren't resolved. And Seppi supported only on images and MoS. Another problem is that the article is overly focused on the medical, with lots of jargon, and isn't really accessible to the general reader, even though the main readership may be teenagers and other young adults. I know that the jargon is unavoidable up to a point, but I wonder whether more could be done to introduce plainer language. I've also wondered how you chose the sources you focus on most. SarahSV ^(talk) 20:51, 25 February 2017 (UTC)

Indeed, we disagree. I do respect the expert opinion of an individual dermatologist but not necessarily above the consensus of major reviews. I disagreed (as have other editors (see above)) with several suggestions Core made including discussion of therapies that they mentioned were once commonplace yet not mentioned in any of the recent literature (even on occasion). As I said above, if Core meant that the mention of cosmetics as a form of disguising acne should be mentioned, that's reasonable but I don't think that was clearly communicated before. I took Core's comments to mean as we should discuss cosmetics as a cause/contributor to acne and that's where I disagreed for aforementioned reasons. I did not get the sense that you had adequately read the above conversations since certain points raised seemed redundant and were fully discussed (i.e., images of acne severity). Core did say he disagreed with how some things were written but other editors have looked it over and didn't seem to agree so we've had new eyes on it. Just because I don't agree with your suggestions doesn't mean I'm ignoring them. I have made adjustments you suggested and I made many of Core's suggested edits, so I don't appreciate the insinuation that I'm somehow being uncooperative. That has also been a significant driver of my frustration. Many of the comments above have not, IMO, focused enough on the content, and have been personal (suggesting I'm ignoring ideas or implying I have ulterior motives or things to that effect with statements (like the one below)) and that's not constructive. I'm allowed to disagree and the issues are largely resolved (and I don't appreciate your suggesting otherwise). Which ideas have I not responded to? (iPLEDGE is on the backburner but I haven't forgotten if that's what you mean but I did address it above). Many of the critiques I see above are vague. You say there's too much medical jargon (Bruce1ee said the same), but you have to consider that perhaps I don't see it. So be specific, where??? And you're right, some level of jargon is unavoidable. You'll have to explain what you mean about "I've also wondered how you chose the sources you focus on most." TylerDurden8823 (talk) 21:48, 25 February 2017 (UTC)

I was asking how you decided which sources to use. Based on the ones I can see, it's often unclear how they were chosen. For example:

You use Bhate and Williams 2013 13 times. That article has a paragraph on chocolate (p. 479). But you use Ferdowsian and Levin 2010 (both from PCRM) as your source on chocolate, although they barely mention it. They say: "No study has established a positive association between acne and chocolate, saturated fat, or salt intake." You use that to support (leaving out saturated fat): "Effects from other potentially contributing dietary factors, such as consumption of chocolate or salt, are not supported by the evidence". Bhate and Williams agree, but they include a study in which chocolate did appear to make a difference, one that postdates Ferdowsian and Levin, so B&W 2013 is a better source.

Ferdowsian and Levin 2010 is one of five sources supporting: "there is weak observational evidence suggesting that dairy milk consumption is positively associated with a higher frequency and severity of acne." But F&L don't say the observational evidence is weak. They describe two prospective cohort studies and say there was a "significant association". It's to be expected that PCRM would stress the link, which is why they're perhaps not the best source for this point. But if you do use them, you have to reflect what they say. SarahSV ^(talk) 01:54, 27 February 2017 (UTC)

That strikes me as a loaded question and one that typically wouldn't be well-received. It's the manner in which it was asked that I find irksome. I would (again) strongly urge you to focus on content rather than critique how I select MEDRS-compliant review articles. Why on Earth are you counting how many times a specific review is used? Talk about nitpicky...sheesh. Also, please keep in mind that Wikipedia articles are collaborative efforts so I didn't add everything and don't own the article. I was unaware of the PCRM ties but don't think it invalidates the sources. The Bhate references used in the article are appropriate and Bhate has authored many of the recent review articles about acne. You're correct that Ferdowsian & Levin in their 2010 article don't describe the observational evidence as weak. The purpose of their citation there is simply to confirm the observational nature of the evidence (not to comment on its strength/weakness). Melnik doesn't describe the evidence as weak either but it's obvious from his reviews that he strongly believes in the hypothesis (his review was only included to really have a comprehensive balance of viewpoints even though the mainstream has yet to accept this association as valid or strong). However, the significant limitations/weakness of the observational evidence is supported by the 2014 JAAD Brosnick review, which is more pointed about just how limited the observational data for that association really is and specifically states it's rather low-level evidence. Therefore, they're being used for what they said. I would even argue for removing the Melnik sources (it seems to be a minority opinion from what I can see and I can't verify the Nestle Nutrition Melnik source, which I didn't add). The use of the Ferdowsian & Levin 2010 review is fine for the claim about chocolate and salt. Saturated fat seems to be less controversial (not popularly discussed in the literature so I would question whether it even merits mention but don't care about that strongly). It verifies the claim regardless of how much they discussed the issue. However, I've added a second review for reinforcement that has more extensive discussion of how weak that evidence is too so your concern should be addressed. TylerDurden8823 (talk) 02:54, 27 February 2017 (UTC)

I'm concerned that the approach to sourcing doesn't have coherence. The article needs to present a coherent account: this is the key secondary literature, and these are the key issues covered by that literature. Dermatologists should be able to read this article and agree on those points. Not to have noticed that one source is PCRM is a concern. Anything about diet in this article needs (ideally) a non-conflicted source.

Re: "collaborative efforts so I didn't add everything and don't own the article", FAC nominators are expected to be able to vouch for everything in the article. SarahSV ^(talk) 03:20, 27 February 2017 (UTC)

• Oppose, mainly 1(b). Tyler, I'm sorry, but I'm going to oppose. I think this is an excellent GA, but I agree with Core that it needs more for FA. Several reasons:

• The "society and culture" section, or whatever you prefer to call the non-medical, needs to be developed. This isn't only a medical issue. In particular, cosmetics are important. I'm not suggesting you write a lot, just something like—these ingredients will make it worse; these won't; this is how to conceal it. You don't need medical sources to discuss the make-up and the industry. As it stands, the article is written from a purely medical perspective, and perhaps from a male perspective.
• The epidemiology section seems under-developed.
• There's a lot of jargon. I don't like simplifying vocabulary unnecessarily, but quite a bit of this is limited to a specialist readership, e.g. "Activation of TLR2 and TLR4 by P. acnes leads to increased secretion of IL-8, TNF-α, and IL-1α." Sometimes it would be easy to explain. For example: "Notable adverse effects of microneedling include ... tram track scarring." "Tram track scarring" isn't a blue link, so the reader would have to google it. You could add a brief explanation in brackets (ditto with anything similar; even when blue-linked it can be helpful to do that, so that readers don't have to keep clicking).
• This sentence needs to be introduced by explaining why you're mentioning it: "There is no clear evidence that use of oral retinoids increases the risk of psychiatric side effects such as depression and suicidality."
• Two examples have been given in the last couple of days of sentences added by others that weren't supported by the sources, so the article needs a final check. One is still in the research section: "Other workers have voiced concerns related to creating a vaccine designed to neutralize a stable community of normal skin bacteria that is known to protect the skin from colonization by more harmful microorganisms" (source). Not clear who "other workers" refers to.
• The following and anything similar could use a copy edit: "Azelaic acid is thought to be an effective acne treatment ... Additionally, azelaic acid has a slight skin-lightening effect ... Azelaic acid may cause skin irritation but is otherwise very safe." and "Salicylic acid is a topically applied beta-hydroxy acid ... Additionally, salicylic acid opens obstructed skin pores ... Salicylic acid is known to be less effective than retinoid therapy ..."
• It could use a terminology section, or at least a sentence in the first section. Neither acne nor vulgaris are explained, although earlier versions of the article had a terminology section.
• It needs something about bullying and social exclusion. There is nothing on the social consequences. I can find one sentence in the body (in Prognosis) about the psychological aspect: "There is good evidence to support the idea that acne has a negative psychological impact, and that it worsens mood, lowers self-esteem, and is associated with a higher risk of anxiety disorders, depression, and suicidal thoughts." (Also, that should be tightened to "Acne worses mood, etc.") Given that the first paragraph of the lead includes this, apparently as a major issue, the article should say more about it.
• The conclusion of the smoking section makes no sense:

• "Some reviews have found that cigarette smoking worsens acne[7] whereas others have found unclear effects.[3][8] Cigarette smoking is not recommended as an approach to improving the appearance of acne because of its adverse health effects.[3]

The last sentence is a non sequitur. It implies that smoking might help acne, but this is the first hint of that. If there's evidence to that effect, it should be explained, referring to multiple, high-quality sources (and written very carefully). Either that or the final sentence should be removed.

Other suggestions (not reasons for the oppose):

• The title should be Acne, per COMMONNAME.
• It needs more images. Dermatologists will almost certainly help. You could write to the authors of your main sources, and perhaps they'd agree to read the article too.

You're obviously not happy about this, and I'm sorry for that. You've done tremendous work on the article, and you're very close to getting it to the next level. SarahSV ^(talk) 03:25, 27 February 2017 (UTC) (expanded SarahSV ^(talk) 21:55, 1 March 2017 (UTC))

Slim, respectfully, you're wrong, your oppose is premature, and I'm really rubbed the wrong way by your conduct. It very clearly demonstrates an abrasive lack of listening and thus forces me to repeat myself (again). You say you're sorry but it comes across as insincere when you ignore multiple requests to solely focus on content rather than my editing approach. The issues you rehashed are still being *actively* addressed (i.e., active discussion on the Newscientist source) and thus the oppose is premature (just as Core's was before he struck it out, which you should do as well). My approach has been quite systematic and your concerns are unwarranted. Not knowing that two authors of one review article in this entire article are affiliated with PCRM is hardly grounds for an oppose or concern about my approach to entering articles (the very idea is laughable). As I said above, I don't care if the article is renamed acne vs acne vulgaris (and this was addressed above). Your implication that dermatologists couldn't read this article and agree on it (controversies aside) is unfounded (citing an n=1 in Core is inadequate). I still disagree with you about the smoking. Other editors seem to as well (i.e., Doc James adjusted it and didn't see the need to adjust it the way you're suggesting).

The point about jargon is invalid (at least for the toll like receptors bit since they're explained earlier in the section with simpler terminology). There's really not a good way to simplify TNF alpha, interleukins 1 and 8. It already says inflammatory chemical signals. I don't know what more you want there. If you look at other medical FAs, you will still encounter some medical jargon (and I did ask you before for specific examples but received none until now though Bruce1ee provided some examples which have been addressed). 'll see if I can figure out a simpler way to say tram track scarring but it's likely going to be quite wordy to describe it (and only occurs 1-2x in the whole article so that's a very minor point). And, second time I'm asking how *many* images, in your opinion? Please be specific. Slim, you presented medical articles for use for the cosmetic issues, but then say medical articles don't need to be used and MEDRS need not apply. That seems very inconsistent to me. WAID just presented her suggestions yesterday. How about giving someone a chance to review & incorporate them, hmm? I've been working on the article a lot but I don't have 24 hours a day to do so, so I would request some patience while changes are being introduced before arriving at a conclusion about the overall nomination since you've raised new unique concerns every single day. If you're asking me to write to dermatologists for additional photos and reviews, that's not going to be an overnight process. "The epidemiology section seems underdeveloped." Very helpful specific feedback. I have no idea why male vs female issues are coming up. There are entire sections dedicated to acne care specifically in pregnant women and paragraphs about the use of oral contraceptives for acne. I'll also add I've been working well with other female and male editors. It's really just been you. This is absolutely ridiculous. At this juncture, I cannot take your suggestions seriously Sarah and I do not think I can work with you any longer. TylerDurden8823 (talk) 06:09, 27 February 2017 (UTC)

Comments from WhatamIdoing

A few comments:

• Concealer is, in Western societies, a gendered product, which may account for its relative lack of prominence in articles like this and in academic sources. This article should mention the type of product and link to the page. Depending upon the content, a trade rag might be a perfectly acceptable source (e.g., for "sold X million in Europe last year" claims). OTOH, I think that should be considered ===Self-care=== rather than ==Society and culture==.
• Acne cosmetica should probably be mentioned and linked in the article, under ===Differential diagnosis===.
• If you want to expand ==Society and culture==, then see the notes that I left at Talk:Acne vulgaris#History and culture. (Tyler doesn't have access to the book [a geolocation restriction?], so you'd have to add the material yourself.
• On the question of isotretinoin, I'm not feeling the need for a discussion of psychiatric side effects. I don't doubt the statement – "clear evidence" isn't required for product labels (when the effect is a preventable death, you want to warn people now and perfect your evidence later), and evidence that seemed clear when the label was approved may become murky later – but I don't think it's obviously relevant to this article.
• This page reminds me why I never encourage anyone to submit an article to FAC.

WhatamIdoing (talk) 04:58, 26 February 2017 (UTC)

Hi WhatamIdoing, thank you for your terrific suggestions. You are correct that I don't have access to that book (I have no idea why). Since multiple editors have now suggested the addition of acne medicamentosa (although you're the first to have a specific recommendation as to where it might go), a brief mention is reasonable. I have no objection to adding a self-care subsection or something similar under society & culture. I agree with you that no further discussion of the lack of clear evidence for isotretinoin is needed. I don't have a strong objection to adding a brief background sentence (i.e., that these concerns were raised but that does seem rather obvious if it was studied since no one studies whether isotretinoin makes you laugh at inappropriate times since that's never been a concern). I agree that if there's even a hint of a possible signal when it comes to something so important that pharmaceutical companies would have a warning for liability/medicolegal reasons even if high-quality evidence to support such an association is lacking. And yeah, amen to that last point. I may never do it again after this terrible experience. Truly awful. TylerDurden8823 (talk) 06:18, 27 February 2017 (UTC)

Comments by Bruce1ee

These are drive-by comments from a non-medical editor (as requested by Sarastro1 above):

• Classification section: the statements "Large nodules were previously referred to as cysts" & "the term severe nodular acne is now the preferred terminology" give no indication when these changes occurred – when were nodules no longer referred to as cysts, and when did severe nodular acne become the preferred terminology?

It's often very, very difficult to find a precise time when such a change happened. It's usually a gradual process so I highly doubt I'll find a reliable source that says it changed in year X or after event Y. TylerDurden8823 (talk) 19:49, 25 February 2017 (UTC)

• Infections section: is the statement "One particularly virulent strain has been circulating in Europe for at least 87 years." with reference to the date of the source? If so, perhaps that date should be mentioned.

I don't understand the question/requested edit. TylerDurden8823 (talk) 19:49, 25 February 2017 (UTC)

In the source of that statement (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2924382/) 87 years appears to have been calculated from "London 1920", giving 2007 (1920+87). Am I reading that correctly? My question is, was the source written in 2007, and should the 87 years not be referenced to 2007? If I'm completely off course, please ignore this point :) —Bruce1ee^talk 22:31, 25 February 2017 (UTC)

I see what you mean. I'll look into that. TylerDurden8823 (talk) 23:10, 25 February 2017 (UTC)

After looking at the article more closely, it's not entirely clear to me how this 87 year figure was derived. I do see the London 1920 figure you mean but I see nothing about 2007 and the review article was published in 2010. I see mention of London 1920 and Norway 1997 (which would be 77 years and perhaps they made a mistake but that's only speculation). So, it's hard for me to say, but the article itself was not written in 2007. TylerDurden8823 (talk) 03:08, 27 February 2017 (UTC)

The article may have been published in 2010, but is it not possible it was written in 2007. Regardless, as it stands the source doesn't support that figure, and my feeling is that unless the figure is adjusted to match the source, or another source is found, that statement should be removed. —Bruce1ee^talk 06:44, 27 February 2017 (UTC)

Maybe, but I don't have any hard proof that it was written in 2007. It's speculative on our part. I don't feel strongly about keeping it in since it is a little bit nebulous which specific time frame that 87 years figure refers to. TylerDurden8823 (talk) 06:51, 27 February 2017 (UTC)

Bruce1ee, once that issue is addressed, what do you think about the nomination? TylerDurden8823 (talk) 06:55, 27 February 2017 (UTC)

I'm leaning towards a support. I'd like to see a reduction in "medical jargon", but I said below, to cover this topic in sufficient detail, some jargon is necessary. —Bruce1ee^talk 07:15, 27 February 2017 (UTC)

I'm working on reducing the jargon. Will need 24-48 hours. Additional specific examples would help expedite that. TylerDurden8823 (talk) 07:31, 27 February 2017 (UTC)

I've done another run through the article and simplified it further in a few spots so it should be better. If you see any other areas that you think are able to be simplified that I've missed, let me know. As you said before, there will be some jargon that can't be simplified (I can't simplify complicated sounding names of certain cytokines) but I have also added a visual aid to the pathophysiology section which should also be helpful. TylerDurden8823 (talk) 07:12, 1 March 2017 (UTC)

Support the prose as a non-medical layreader – I think your simplifications have helped. I see you've also removed the "87 years" statement, thank you. Good luck with the nomination. —Bruce1ee^talk 14:40, 1 March 2017 (UTC)

• References: the link in ref.no. 33 ("Frequently Asked Questions: Acne") is dead.

Good catch, I've fixed the link and it should work now. Thanks! TylerDurden8823 (talk) 19:52, 25 February 2017 (UTC)

As a layperson I found it an interesting and largely accessible article – it does tend to become a little bogged down with medical jargon, but I guess that's what's to be expected in articles of this nature. —Bruce1ee^talk 19:04, 25 February 2017 (UTC)

Bruce1ee, which medical jargon do you mean? I'll simplify it if I can but there's only so much I can do. TylerDurden8823 (talk) 19:49, 25 February 2017 (UTC)

For example in parts of the Pathophysiology section ("Dihydrotestosterone (DHT) is the main driver of androgen-induced sebum production in the skin.[2] Another androgenic hormone responsible for increased sebaceous gland activity is DHEA-S ..."). I understand that to cover this topic in sufficient detail, "medical jargon" is necessary. But I must add that the lead section summarizes the article nicely and I believe is quite accessible to laypeople. —Bruce1ee^talk 22:31, 25 February 2017 (UTC)

I'll see if I can come up with a way to simplify that further without sacrificing meaning. But yes, there is going to be some language that will be difficult to simplify and some medical jargon is necessary. TylerDurden8823 (talk) 23:09, 25 February 2017 (UTC)

Comments by Hanif Al Husaini

• Comments: When I look for ref 97 (Eby, Myra Michelle. Return to Beautiful Skin. Basic Health Publications. p. 275.) to find its ISBN, if exist, I found it in Google Books and it says there are only 184 pages but how can it cite p. 275? Perhaps the Google Books link is not the cited book. If no, please add ISBN, year and other citation details so others can find that book. Hanif Al Husaini (talk) 03:52, 26 February 2017 (UTC)

Hi Husain, that's a really good point. I actually didn't add that content and it's been there for a while. When I searched for the same book I encountered the same discrepancy you did regarding the page count. I'll see if I can track down the editor who added the content to clarify. If I can't, I may just have to replace that with a better source (probably should anyway). TylerDurden8823 (talk) 23:14, 26 February 2017 (UTC)

Binko100, it looks like you added this content [39] a while back. Can you comment on this, please? Thank you! TylerDurden8823 (talk) 23:19, 26 February 2017 (UTC)

On second thought, this user does not appear to be terribly active (no edits since 2015) so I'll just look into obtaining a better source for citation. TylerDurden8823 (talk) 23:20, 26 February 2017 (UTC)

The information has been corrected and now has a better source to support it. Thanks for bring it to my attention Hanif. TylerDurden8823 (talk) 00:32, 27 February 2017 (UTC)

Coordinator note: Just a note to say that, with quite a lot of support, there is no danger of this being archived any time soon. It is quite safe for everyone to take their time. Sarastro1 (talk) 19:47, 28 February 2017 (UTC)

Thank you for clarifying that point, Sarastro. I appreciate that. I'm perhaps slightly edgy after the first review was closed a bit prematurely but I'm glad to know the time pressure isn't on quite as strongly. TylerDurden8823 (talk) 07:13, 1 March 2017 (UTC)

Comments from Victoria

Moved to talk page.

Comments by Sandbh

I was prompted to review this article by the commentary on the use of the word "however".

Based on a quick scan, the article appears to be close to FA standard. Upon reading it closely I noticed several prose issues and a few presentation issues. Now, I do agree with an early reviewer's comment that "None of our FA's are anywhere near perfect, and if we expect perfection we will simply get nothing". Even so, I feel the prose in this article, and some aspects of its presentation, don't yet reach the standard I would expect of an FA article.

Bumps aside, I have so far found the article relatively easy to read, which is a good sign.

General

• Please review the frequency of the words "also" and "however". The article has 20 of the former, and 13 of the latter. This is too many.

The use of the term "also" has been addressed. TylerDurden8823 (talk) 02:41, 6 March 2017 (UTC)

The count is down to 6x also and 7x however, which is much more tolerable. Sandbh (talk) 10:06, 6 March 2017 (UTC)

Sounds good. TylerDurden8823 (talk) 18:18, 6 March 2017 (UTC)

• Please explain what Latin terms such as vulgaris, inversa, and rosacea etc mean.

I think the etymology of rosacea and inversa are outside the scope of this article. Vulgaris is reasonable since the medical term is acne vulgaris. I still have yet to hear why the word however is not suitable for encyclopedic prose (this was the primary purpose of Victoria's ping). TylerDurden8823 (talk) 02:29, 6 March 2017 (UTC)

I meant vulgaris (L. 'common') or something like that. No etymology required. I like Latin but like to know what the words means without having to look them up.

Yes, I understood what you meant. I think that's fine for vulgaris. TylerDurden8823 (talk) 18:18, 6 March 2017 (UTC)

Lead

• I looked briefly at this article a little while ago and frankly, as a general reader, was put off by so many citations in the lead. There is nothing in the lead that I can see that is controversial or so complex that it would necessitate a cite. Wikipedia is an encylopedia for the general reader; it is not a medical encyclopedia.

Yes, I understand that Wikipedia not a medical encyclopedia but there are guidelines/stylistic points for how to write a medical article specifically and many medical FAs have citations in the lead (omission of citations in the lead (on my read) is also not an FA criterion though I understand if it doesn't agree with you (but this is often controversial based on who is asked).

MOS:MED does not require citations in the lead (from what I could see). MOS:LEAD suggests citations in the lead may be required for complex, current, or controversial subjects. The great majority of FA articles have no or only a few citations in the lead. I don't care what other medical FAs have in their leads. This is your article and I'm reviewing it. There is nothing in the lead that I can see that warrants a cite. What cites there are are unnecessary. I contend that the article does not currently follow the style guidelines, which is an FA requirement. (I'm not as grumpy as what I've just written may come over as). Sandbh (talk) 10:22, 6 March 2017 (UTC)

Yes, I know MEDMOS doesn't require lead citations. As I said before, this has been controversial and preference has varied widely in the community. I personally don't feel strongly about citations in the lead but saying there are no controversial remarks in the lead is something many users would disagree with (e.g., many readers out there have strong beliefs about the relationship between acne and diet, sunlight, hygiene, etc-addressed in more detail in causes, but who knows if they'll scroll that far). I won't characterize this as "my article" Wikipedia:Ownership of content and I think it's relevant that multiple other medical FAs have citations in the lead. If that's a true failure of meeting FA criteria, then those other articles are not true FAs and are not being held to the same standard or it's not a true criterion. I think additional opinions regarding the absence/presence of citations in the lead would be important to this point. I'll follow whatever the consensus may be. TylerDurden8823 (talk) 18:18, 6 March 2017 (UTC)

I suspect none of the other reviewers would mind if the mundane, non-controversial citations in the lead were removed. I worry that it's a bit late in the FAC process to seek to obtain consensus and then follow that. In the absence of other reviewer views on this point and noting my objections, I'd take that---if I may be so bold---as consensus, and remove 'em. On the other medical FAs the lead citations in some of these may be justified; others may have gotten through simply because none of the reviewers thought it was important. I happen to think it's important. Sandbh (talk) 04:25, 7 March 2017 (UTC)

• "The role of diet and cigarette smoking is unclear and neither cleanliness nor sunlight appear to be involved." Prose needs refining here. You appear to be saying that the status of all four items is unclear but expressing this in different ways. The contrast between diet and smoking, and cleanliness is jarring. Is the sentence saying cleanliness may or may not cause or prevent acne?

No, the sentence is saying that cleanliness and sunlight do not appear to be involved (obviously, science is an evolving field so wiggle room is reasonable here but the acne/diet and acne/smoking relationships are relatively controversial. Stating the prose requires further refinement is a broad statement that doesn't really help me. Specific recommendations are more helpful. TylerDurden8823 (talk) 02:29, 6 March 2017 (UTC)

Please check my edit. Sandbh (talk) 10:53, 6 March 2017 (UTC)

Yes, that's not exactly how I would've written it. TylerDurden8823 (talk) 18:18, 6 March 2017 (UTC)

• "Treatments applied directly to the affected skin, such as azelaic acid, benzoyl peroxide, and salicylic acid, are commonly used. Antibiotics and retinoids are available in formulations that are applied to the skin and taken by mouth for the treatment of acne." The bit that goes "and taken by mouth" is clumsy; the bit that goes "for the treatment of acne" is redundant given the previous sentence.

I agree but that was not my decision. Other medical editors have felt strongly that the phrasing "by mouth" is needed for simplicity rather than the term oral. Other editors have raised similar concerns about that particular phrasing. TylerDurden8823 (talk) 02:29, 6 March 2017 (UTC)

OK but please be consistent in the rest of the article and replace all the "oral"s with "by mouth's. Sandbh (talk) 10:53, 6 March 2017 (UTC)

This discrepancy came about due to extra emphasis on simplified language in the lead. This was per Doc James' preference. As I said, multiple editors have objected to use of the phrasing "by mouth" as awkward. If I consistently use that throughout the article, it's awkward and if I change it to oral in the lead, then it's not simple enough. This is a damned if I do/don't situation. TylerDurden8823 (talk) 18:18, 6 March 2017 (UTC)

OK then. Sandbh (talk) 04:25, 7 March 2017 (UTC)

• "Several types of birth control pills help against acne in women." The source appears to say that oral contraceptives can result in drug-induced acne (Table 1).

This is covered in the management section. Oral contraceptives are generally thought to decrease acne severity in women who take them. Which source are you referring to that says OCs may cause drug-induced acne? TylerDurden8823 (talk) 02:29, 6 March 2017 (UTC)

The cited article. Table 1, row 2, "Drug-induced acne".

Hmm, after taking another look you're right that it says that though I find it interesting that I don't see a specific source cited within the AAFP article for that claim. This may reflect differences between older generations of oral contraceptives and be less common with newer ones (e.g., combination 3rd/4th gen contraceptives). We have plenty of references in the management section verifying that combination OCs are helpful for acne in women. TylerDurden8823 (talk) 18:18, 6 March 2017 (UTC)

Googling around I can see quite a few references to OC's causing acne, as a side effect:

Manual of Dermatologic Therapeutics - Page 6

https://books.google.com.au/books?isbn=0781760585

Kenneth A. Arndt, ‎Jeffrey T. S. Hsu - 2007 - ‎Preview - ‎More editions

Acne may be associated with oral contraceptive pills if recently started or discontinued and if composed of an androgenic progesterone. During the first ...

Classification

• "…closed (whiteheads) clogged skin follicles (comedones)…". Eh?

I'm still working on rephrasing that sentence. I know it's clumsy but I'm reworking that sentence per Victoria's earlier suggestions. Please be patient (note her comments were left within the last 24 hours and many edits have been made). TylerDurden8823 (talk) 02:29, 6 March 2017 (UTC)

Okie-dokie. Sandbh (talk) 10:53, 6 March 2017 (UTC)

• "Moderate severity acne is defined as a higher number of inflammatory papules and pustules occurring on the face compared to mild cases of acne and also involves the trunk of the body." The words "of acne" aren't needed. Where you say, "and also involves the trunk of the body", what involvement is being referred to? Presumably that same as what's going on with the face?

That's correct, the same types of skin lesions affect the trunk. I can clarify that if it really seems ambiguous to you (no one else has seemed to think so though). TylerDurden8823 (talk) 02:29, 6 March 2017 (UTC)

Please clarify. I acknowledge that no one else has seemed to think so. Looking through the rest of my feedback, and my associated copyediting, I am puzzled that no one else has picked up on what seem like basic ce things, for an FA calibre article. The press of time, I suppose. Sandbh (talk) 10:53, 6 March 2017 (UTC)

I clarified. It's the same type of inflammatory lesions affecting both the face and trunk. TylerDurden8823 (talk) 18:18, 6 March 2017 (UTC)

• "Lastly, severe acne is said to occur when nodules (the painful 'bumps' lying under the skin) are the characteristic facial lesions and involvement of the trunk is extensive." In a short para like this, "lastly" isn't required.

Fine, I don't feel strongly about that. TylerDurden8823 (talk) 02:29, 6 March 2017 (UTC)

• "Large nodules were previously referred to as cysts, and the term nodulocystic has been used in the medical literature to describe severe cases of inflammatory acne.[21] However, true cysts are rare in those with acne and the term severe nodular acne is now the preferred terminology." I find the first sentence to be confusing as it mixes what used to happen with something that has happened, and I don't understand the reason for the mixing.

The reason is because the nomenclature has evolved over time and misuse of the proper terminology remains (unfortunately) prevalent. I think that's very clear from how it's written when it says that due to the lack of true cysts that nodular acne is the preferred terminology (since "nodulocystic" is something of a misnomer). TylerDurden8823 (talk) 02:29, 6 March 2017 (UTC)

No need to give me the reason; I understand that. I was referring to the grammatical construction of the sentences, which remains clumsy. Sandbh (talk) 10:53, 6 March 2017 (UTC)

If you say you don't understand the reason for the mixing, that sounds like a request for further explanation (that's why I provided one). I trimmed the word "however" here but otherwise I don't see what issues you have with these two sentences. Please clarify. TylerDurden8823 (talk) 18:18, 6 March 2017 (UTC)

Pls see my small ce. Sandbh (talk) 04:25, 7 March 2017 (UTC)

• The lead sentence of the last paragraph makes me think the para is going to talk about acne inversa, but then mentions acne rosacea. This paragraph would start better as something like, "Acner inversa and acne rosacea are not true forms of the condition. Acnea inversa…"

These sentences are simply (and briefly) included due to comments on the FAC and were recently added. A full discussion of these separate conditions is found on their respective Wikipedia pages and is outside of the scope of this article. This is, yet again, another example of misnomers coming in to the nomenclature, which is why these sentences were added. TylerDurden8823 (talk) 02:29, 6 March 2017 (UTC)

No need for a full discussion, just better paragraph construction. Topic sentence introduces the topic, rest of the paragraph elaborates. You have all the words already it's just a matter of rearranging them. Sandbh (talk) 10:53, 6 March 2017 (UTC)

Well, I think proper discussion is essential to communication. I'm fine with rearranging this now that you've clarified your proposed edit but the terms acne inversa and rosacea have to be defined before explaining that they're not true forms of acne (otherwise the reader lacks context). TylerDurden8823 (talk) 18:18, 6 March 2017 (UTC)

Signs and symptoms

• "Typical features of acne include increased secretion of oily sebum by the skin, microcomedones, comedones, papules, nodules (large papules), pustules, and in many cases scarring." Scarring isn't a feature of acne is it? Isn't it a result of acne?

That seems like splitting hairs to me. TylerDurden8823 (talk) 02:29, 6 March 2017 (UTC)

FA standard: "A featured article exemplifies our very best work and is distinguished by professional standards of writing." Sandbh (talk) 10:53, 6 March 2017 (UTC)

I maintain it's splitting hairs. TylerDurden8823 (talk) 18:18, 6 March 2017 (UTC)

The way it's written now, "Typical features of acne include increased secretion of oily sebum by the skin, microcomedones, comedones, papules, nodules (large papules), pustules, and often results in scarring" hits the mark nicely. Sandbh (talk) 04:25, 7 March 2017 (UTC)

Scars

• "Scarring is most likely to take place with severe nodular acne, but may occur with any form of acne vulgaris." What is "severe nodular acne"?

Severe nodular acne is exactly what was described in the classification immediately above this. "severe acne is said to occur when nodules (the painful 'bumps' lying under the skin) are the characteristic facial lesions and involvement of the trunk is extensive.[17][21]" TylerDurden8823 (talk) 02:29, 6 March 2017 (UTC)

Check my ce. Sandbh (talk) 10:53, 6 March 2017 (UTC)

That's fine since we've defined severe acne as synonymous with severe nodular acne so I have no objection. TylerDurden8823 (talk) 18:18, 6 March 2017 (UTC)

• "Acne scars are classified based on whether the abnormal healing response following dermal inflammation leads to excess collagen deposition or loss at the site of the acne lesion." Opening "Acne" is redundant.

That's fair. TylerDurden8823 (talk) 02:29, 6 March 2017 (UTC)

• "Atrophic acne scars are the most common type of acne scar and have lost collagen from this healing response." What healing response is being referred to here?

I do not understand your question. The healing of the acne lesion (the only thing discussed). TylerDurden8823 (talk) 02:29, 6 March 2017 (UTC)

Check my ce. Sandbh (talk) 10:53, 6 March 2017 (UTC)

• "Atrophic scars may be further classified as ice-pick scars, boxcar scars, and rolling scars." The opening "Atrophic" is redundant.

I disagree. If the sentence simply started with "scars", this could be ambiguous and lead the reader to misinterpret this as referring broadly to all acne scars (which would be inaccurate). TylerDurden8823 (talk) 02:29, 6 March 2017 (UTC)

Nonsense. The topic sentence of the paragraph is, "Atrophic acne scars have lost collagen from the healing response and are the most common type of acne scar (account for approximately 75% of all acne scars)." Why is it necessary to start the next sentence in the same paragraph with, "Atrophic acne scars…" What other kind of scars could possibly be being referred to? Sandbh (talk) 10:53, 6 March 2017 (UTC)

Whoa, chill. It was unclear from your initial comment that you were referring to the second sentence (you said "opening atrophic" which led me to think you were referring to the first mention in that paragraph rather than the second). This has been fixed. TylerDurden8823 (talk) 18:18, 6 March 2017 (UTC)

Cool! Sandbh (talk) 04:25, 7 March 2017 (UTC)

• "Hypertrophic scars are uncommon, and are characterized by increased collagen content after the abnormal healing response." The words "after the abnormal healing response" are redundant.

Sure, I guess. TylerDurden8823 (talk) 02:29, 6 March 2017 (UTC)

• "Hypertrophic scars remain within the original margins of the wound, whereas keloid scars can form scar tissue outside of these borders." Since the sentence and paragraph are talking about hypertrophic scars, where have keloid scars come from? What are they and their characteristics?

They are a type of hypertrophic scar and they are different from hypertrophic scars exactly as described (the main differentiating factor being whether the scar remains within the margins of the original wound or not). TylerDurden8823 (talk) 02:29, 6 March 2017 (UTC)

So why isn't this in the paragraph? Sandbh (talk) 10:53, 6 March 2017 (UTC)

I should revise what I said before. Keloids are on the spectrum of hypertrophic scars but are considered distinct (it seems) by derm authorities. Keloids are one of the two ways in which a scar can form with excessive collagen deposition. If it's really confusing, I can add a brief sentence that keloids can result from acne. TylerDurden8823 (talk) 18:18, 6 March 2017 (UTC)

That would be good if you could do that. Sandbh (talk) 04:25, 7 March 2017 (UTC)

Pigmentation

• "Postinflammatory hyperpigmentation (PIH) is usually the result of nodular acne lesions." Please start this paragraph with plain English, and then introduce the terminology, rather than the other way around.

Also seems nitpicky but sure. Other readers have not pointed to this sentence as a source of confusion from medical jargon. TylerDurden8823 (talk) 02:29, 6 March 2017 (UTC)

Yep, its a mystery to me. I'm just looking for a professional writing standard in your article (mostly it is, apart from what I notice).

Sure. TylerDurden8823 (talk) 18:18, 6 March 2017 (UTC)

• "These nodular lesions often leave behind an inflamed darkened mark after the original acne lesion has resolved." The word "Nodular" is redundant.

Fixed. TylerDurden8823 (talk) 02:29, 6 March 2017 (UTC)

• "Inflammation from acne lesions stimulates specialized pigment-producing skin cells (known as melanocytes) to produce more melanin pigment which leads to the skin's darkened appearance with PIH." The "acne" is redunant, as is "with PIH".

Just saying "inflammation from lesions" seems awkward to me and like it might confuse readers. I'm fine with removing a redundant PIH mention. TylerDurden8823 (talk) 02:29, 6 March 2017 (UTC)

Well, the first two setences of the paragraph each use the word "acne lesion/s." Is it really necessary to do this again? Sandbh (talk) 10:53, 6 March 2017 (UTC)

After rereading it, I suppose not. I'm trying to keep things as simple as possible so I don't lose lay medical readers in the process but it's difficult to see it through their eyes sometimes. Regardless, this has been fixed. TylerDurden8823 (talk) 18:18, 6 March 2017 (UTC)

My lay eyes thank thee. Sandbh (talk) 04:25, 7 March 2017 (UTC)

• "Even minimal skin exposure to the sun's ultraviolet rays can sustain hyperpigmentation. Daily use of SPF 15 or higher sunscreen can minimize acne-associated hyperpigmentation." Ending both sentences with hyperpigmentation is awkward.

Do you have a specific suggestion to reword this? If so, I'm listening. TylerDurden8823 (talk) 02:29, 6 March 2017 (UTC)

Let me have a closer look at this.

See my ce/trim.

Hope my responses so far are helpful. It's mostly small stuff, making sure the diamond is finely cut. Sandbh (talk) 10:53, 6 March 2017 (UTC)

Thanks, I appreciate the clarification since many earlier comments (not yours for the most part) have seemed unnecessarily harsh/not constructive in nature (as noted in my discussion with Victoria and SV earlier). I think the revision you put in place re: risk is fine. I had similar misgivings about ending two consecutive sentences with hyperpigmentation. TylerDurden8823 (talk) 18:18, 6 March 2017 (UTC)

-- Sandbh (talk) 01:13, 6 March 2017 (UTC)

Causes

Genes

• "The predisposition to acne for specific individuals is likely explained by a genetic component, a theory which is supported by twin studies and studies examining the rates of acne among first-degree relatives." Two uses of the word "studies" are redundant. How about, "The predisposition to acne for specific individuals is likely explained by a genetic component, a theory which is supported by studies examining the rates of acne among twins and first-degree relatives."

Sounds good. I've adjusted this. This was helpful feedback. TylerDurden8823 (talk) 18:18, 6 March 2017 (UTC)

• "Acne susceptibility is likely due to the influence of multiple genes, as the disease does not follow a classic Mendelian inheritance pattern." I know that Mendelian inheritance pattern is wikilinked however I don't think I should have to click on this to work out what it is.

If we explain everything in full, there's not much point in having the blue links. I think an elaborate discussion of a Mendelian inheritance pattern will detract from the article's focus on acne. TylerDurden8823 (talk) 18:41, 6 March 2017 (UTC)

Please see my ce. I placed "Mendelian" in parentheses, so as to focus the eye more on "inheritance pattern" since that's the key concept, and even I can get what that is.

• "Multiple gene candidates have been proposed to increase acne susceptibility including certain variations in tumor necrosis factor-alpha (TNF-alpha), IL-1 alpha, and CYP1A1 genes, among others." The phrase "to increase acne susceptibility: is redundant.

Sure, that's adjusted. TylerDurden8823 (talk) 18:18, 6 March 2017 (UTC)

• "The 308 G/A single nucleotide polymorphism variation in the gene for TNF is associated with increased acne risk." Please turn this around so that the terminology comes last: "Increased risk is associated with the 308 G/A single nucleotide polymorphism variation in the gene for TNF."

This seems very minor and I don't really see the reason for this rearrangement but done. TylerDurden8823 (talk) 21:40, 6 March 2017 (UTC)

• Is TNF the same as TNF-alpha?

TNF refers to tumor necrosis factor (the blue link will help you there). TNF-alpha is one specific member of the tumor necrosis factor family. Why should the risk sentence be rearranged that way? I'm not opposed but do not understand the reason for the proposal. Please clarify. TylerDurden8823 (talk) 18:18, 6 March 2017 (UTC)

Here's part of the paragraph: "Acne susceptibility is likely due to the influence of multiple genes, as the disease does not follow a classic (Mendelian) inheritance pattern. Multiple gene candidates have been proposed including certain variations in tumor necrosis factor-alpha (TNF-alpha), IL-1 alpha, and CYP1A1 genes, among others.[16] Increased risk is associated with the 308 G/A single nucleotide polymorphism variation in the gene for TNF.[34]" I more or less get everything up to the last sentence. When I get to TNF at the end of the last sentence I'm confused as to wether that's the same as TNF-alpha (I presume not as I would've expect it to say TNF-alpha if it was) or if it's the same concept---I can't tell as I can't clearly grasp the connection between the two terms. They must be related in some way, but how? Sandbh (talk) 04:25, 7 March 2017 (UTC)

Hormones

• The opening para is hard to follow as it starts off with mentioning hormonal activity during menstrual cycles and puberty and elaborates this, and then mixes the two concepts with growth hormone and insulin-like growth factor. The first time I read this I thought that it was saying that growth hormone and insulin-like growth factor were being counted as sex hormones. It was only when I went back and reread the section that I could see what was happening. Prose needs some work.

Specific recommendations are always preferable (i.e., "prose needs some work" doesn't really help me). The mention of menstrual cycles is only meant to be illustrative. I can see how you might have linked IGF and GH as sex hormones I guess but that seems like a strained interpretation to me since they're in separate sentences (it seems like a clear demarcation to me) but I'll try to make that clearer. TylerDurden8823 (talk) 18:18, 6 March 2017 (UTC)

• "Medical conditions that commonly cause a high-androgen state, such as polycystic ovary syndrome, congenital adrenal hyperplasia, and androgen-secreting tumors, can cause acne in affected individuals." This is good example of starting off with a general term and concluding with the specifics.

Infections

• "Propionibacterium acnes (P. acnes) is the anaerobic bacterial species that is widely suspected to contribute to the development of acne, but its exact role in this process is not entirely clear." Please don't start with jargon: "It is widely suspected that the anaerobic bacterial species that contributes to the development of acne is Propionibacterium acnes (P. acnes) but its exact role in this process is not entirely clear."

Sure. TylerDurden8823 (talk) 18:18, 6 March 2017 (UTC)

• "There are specific sub-strains of P. acnes associated with normal skin and others with moderate or severe inflammatory acne." The words, "others with" are redundant. Perhaps add a comma after "skin".

Sure, I guess. TylerDurden8823 (talk) 18:18, 6 March 2017 (UTC)

• "It is unclear whether these undesirable strains evolve on-site or are acquired, or possibly both depending on the person." The words after "aquired" are redundant.

Why is that redundant? There was no prior mention that both of these processes could be occurring simultaneously. TylerDurden8823 (talk) 18:18, 6 March 2017 (UTC)

Well, as I understand it, "or" in the way you've used it means one or the other or both. So, there is no need to say "or possibly both" since the first or has already capture this possibility. Sandbh (talk) 04:25, 7 March 2017 (UTC)

• "These strains have the capability of either changing, perpetuating, or adapting to the abnormal cycle of inflammation, oil production, and inadequate sloughing of dead skin cells from acne pores." The use of "either" means that a single strain can do only one of these things ie changing, prepetuating, or adpating. Is that right? No multi-role strains?

No, that is not what is intended. P. acnes is involved in multiple steps of acne's pathogenesis. I've trimmed the word either. TylerDurden8823 (talk) 18:18, 6 March 2017 (UTC)

• "Infection with the parasitic mite Demodex is associated with the development of acne.[26][45] However, it is unclear whether eradication of these mites improves acne." The "however" is not required. Rather than "these mites", the singular "the mite" will suffice.

Sure, I've adjusted this. TylerDurden8823 (talk) 18:18, 6 March 2017 (UTC)

Diet

• "The relationship between diet and acne is unclear, as there is no high-quality evidence which establishes any definitive link." The words after "unclear" are redundant.

Why? Because we elaborate on this later in the paragraph? TylerDurden8823 (talk) 18:36, 6 March 2017 (UTC)

That wasn't so much what I had in mind. Rather, I presume that if there was high quality evidence then the relationship would be clear. Since there isn't, it's not. To me it seem like a statement of the obvious. Sandbh (talk) 05:06, 7 March 2017 (UTC)

• "High-glycemic-load diets have been found to have different degrees of effect on acne severity by different studies." The words after "severity" are not required.

Sure, that's fine. TylerDurden8823 (talk) 18:36, 6 March 2017 (UTC)

• "Additionally, there is weak observational evidence suggesting that dairy milk consumption is positively associated with a higher frequency and severity of acne." Since this sentence is about an increase in acne rather than the reduction in acne referred to in the previous sentence, the word "Additionally" is not required, as well as being confusing. The word "observational" is not required.

I think removing the word additionally is fine but I do think it's important to be specific about the type of evidence so I think observational should stay. TylerDurden8823 (talk) 18:36, 6 March 2017 (UTC)

Sold. Sandbh (talk) 05:06, 7 March 2017 (UTC)

• "These milk components are hypothesized to promote the effects of insulin and IGF-1 and thereby increase the production of androgen hormones, sebum, and promote the formation of comedones." The word "milk" is redundant as is the word "thereby".

I think removing milk here is fine. The term thereby is meant to illustrate linkage between these events (i.e., increased insulin and IGF-1 --> increased production of androgen hormones, sebum, promotes comedone formation, etc). TylerDurden8823 (talk) 18:36, 6 March 2017 (UTC)

• "Chocolate does contain varying amounts of sugar, which can lead to a high glycemic load, and it can be made with or without milk." Whole sentence can be deleted. It's hard to grasp its link with the previous sentence.

The link is glycemic load and milk. That's really not clear from that sentence? I thought it was very straightforward. The whole first half of the paragraph discusses how glycemic load and milk have been investigated as possible dietary risk factors for acne. Chocolate has been under suspicion as well (though available evidence doesn't support this) due to its higher glycemic load and milk content (if it's milk chocolate). TylerDurden8823 (talk) 18:36, 6 March 2017 (UTC)

Well, at one point the article say, "Multiple randomized controlled trials and nonrandomized studies have found a lower-glycemic-load diet to be effective in reducing acne." But then it says, "Effects from other potentially contributing dietary factors, such as consumption of chocolate or salt, are not supported by the evidence" followed by "Chocolate does contain varying amounts of sugar, which can lead to a high glycemic load". One part says chocolate no worries; the other part say chocolate = risk factor. Is that right? Even your reply above contradicts what the article says i.e., "There is weak observational evidence suggesting that dairy milk consumption is positively associated with a higher frequency and severity of acne." So how can you say, "available evidence doesn't support this) due to its higher glycemic load and milk content (if it's milk chocolate)"? I'm confused. Sandbh (talk) 05:06, 7 March 2017 (UTC)

Smoking

• "The relationship between cigarette smoking and acne severity is unclear and remains controversial.[3] The observational nature of the evidence between smoking and acne severity has raised concerns that bias and confounding may have influenced the results.[3] Some reviews have found that cigarette smoking worsens acne[7] whereas others have found unclear effects." A lot of overlap across these three sentences. Don't need to say much more than, "The relationship between cigarette smoking and acne severity is unclear and remains controversial due to concerns about biased or statistically questionable evidence, or inconsistent results."

This has been adjusted but I still think it's important to give brief mention to the fact that reviews on this topic have reached different conclusions. TylerDurden8823 (talk) 18:36, 6 March 2017 (UTC)

• "Cigarette smoking is not recommended as an approach to improving the appearance of acne because of its adverse health effects." What an odd sentence. It has no introductory context. Why even mention it?

It's mentioned because there have been controversies over whether smoking helps, hurts, or has no effect on acne (that's what was previously said instead of "unclear effects" on acne in the preceding sentence but SlimVirgin was extremely concerned that teenagers would take up smoking after reading the article (which I maintain is ridiculous) to improve their acne. TylerDurden8823 (talk) 18:36, 6 March 2017 (UTC)

Tyler has misrepresented my concerns. The smoking sentences need to be rewritten for several reasons. First, the sentence Sandbh highlighted (the third and final sentence in the smoking section) is a non-sequitur, as I pointed out in my oppose. Second, any claim that smoking helps acne needs to be unpacked, not mentioned in passing, and sourced to multiple high-quality sources, so that we know the article gets it right. That it might encourage teenagers to smoke is one reason it needs extra care. Another is simply that it's surprising, so it shouldn't be thrown in as though it isn't. SarahSV ^(talk) 20:00, 6 March 2017 (UTC)

I'll let the above comments speak for themselves. They're quite clear and I have not misrepresented anything. TylerDurden8823 (talk) 21:25, 6 March 2017 (UTC)

I agree with SarahSV. The third and final sentence is a non-sequitur: "A conclusion or statement that does not logically follow from the previous argument or statement." This will not do for a FA. It's Ok to mention it but it needs an introductory context along the lines of your response e.g. "Despite urban myths to the contrary, there is no evidence that cigarette smoking will improve the appearance of acne; such a practice is not recommended because of its adverse health effects." That's not so good prose but I hope you get my meaning. (I would word it stronger than that, as the Wikipedia equivalent of a complete crock).

Sandbh, an earlier version (e.g. here) suggested that smoking did help, supported by one or two sources.

One of the them (Bhate and Williams 2012) says: "An earlier case series suggested an inverse relationship between acne and smoking, suggesting an anti-inflammatory effect of a component found in cigarettes" and "A large-scale, questionnaire study of 27 083 military men between 1983 and 2003 found the prevalence of acne to be lower in active smokers, with a dose-dependent inverse relationship between severe acne prevalence and cigarette consumption from 21 cigarettes per day and higher."

But the same source also cites a study that shows the opposite.

Because this is so surprising, I requested mutiple high-quality sources and a careful summary of them. In response Tyler removed the implication that smoking might help, but left the "Cigarette smoking is not recommended as an approach to improving" sentence. Hence the non-sequitur. SarahSV ^(talk) 06:03, 7 March 2017 (UTC)

SlimVirgin, thank you, and how very peculiar (the studies)! I do like the earlier version. Let me have a little think about this. Sandbh (talk) 06:25, 7 March 2017 (UTC)

I'd be inclined to have an introductory para at the start of the Causes section, delete the Smoking section, and add to the end of the Causes section intro para: "Studies as to the impact of smoking on the incidence of acne have been inconclusive.[3]" Sandbh (talk) 07:26, 7 March 2017 (UTC)

Please see my ce to this end. Sandbh (talk) 08:24, 7 March 2017 (UTC)

Sandbh, your removal of the smoking section is an improvement, but if smoking is now mentioned only in passing in the body, it should be removed from the lead. My concern is that an earlier version of the smoking section said the opposite. Tyler changed it in February 2016 and swapped the sources. Previously it said: "Cigarette smoking is known to increase the risk of developing acne. Additionally, acne severity worsens as the number of cigarettes per day a person smokes increases." Sourced to Knutsen-Larson et al. 2012 (full text). That source says:

Cigarette smoking and dietary factors increase acne risk and disease severity ... The link between smoking and acne is well established. Even though smoking avoidance and cessation should be encouraged in all patients, this preventive message is especially important for patients suffering from acne. Practitioners should emphasize not only that smoking increases acne risk but also that a dose-dependent relationship exists between daily cigarette use and acne disease severity.

I asked Tyler why he swapped the source for Bhate and Williams 2013, then used it to say the opposite. He replied: "I changed what the section said that day because I found new information from a newer review." But there is only one year difference between the sources. This has made me wonder how the sources were chosen, and whether the article reflects the preponderance of sources.

I've removed smoking from the lead, as you requested, and adjusted the words to do with causes. Sandbh (talk) 22:22, 7 March 2017 (UTC)

Sarastro1, you asked what my concerns were. This is one of them, namely to what extent the article reflects the secondary literature on acne. Would dermatologists find anything surprising, anything important missing? We've had one review from a dermatologist. He initially opposed but withdrew it, possibly because he was fed up with the comments rather than happy with the article. He suggested that Tyler write to some of his sources and ask them to read the article. I think this is an excellent idea. SarahSV ^(talk) 20:36, 7 March 2017 (UTC)

Sandbh, I wrote: "if smoking is now mentioned only in passing in the body, it should be removed from the lead" (if, then). But should it be mentioned only in passing in the body? The 2012 source says: "The link between smoking and acne is well established. ... Practitioners should emphasize not only that smoking increases acne risk but also that a dose-dependent relationship exists ...". If that's the mainstream view, the article should make that clear. But is it the mainstream view? We can't respond to every point of confusion by removing text. SarahSV ^(talk) 22:35, 7 March 2017 (UTC)

SlimVirgin: Based on my superficial reading it appears that the influence of smoking is contested/unclear. If there's anything more to it, I'll have to leave this to TylerDurden8823 to ferret out and incorporate into the article. A possible hornets' nest. Sandbh (talk) 22:50, 7 March 2017 (UTC)

Stress

• "Overall, few high-quality studies have been performed which demonstrate that stress causes or worsens acne." The word "Overall" is not required.

Sure, that's fine. TylerDurden8823 (talk) 18:36, 6 March 2017 (UTC)

• "While the connection between acne and stress has been debated, some research indicates that increased acne severity is associated with high stress levels in certain contexts (e.g., in association with the hormonal changes seen in premenstrual syndrome). The phrase, "While the connection between acne and stress has been debated" is redundant.

Why? I think it's important to comment that it's still actively debated. Simply stating that some evidence finds this may not be clear enough to a lay reader that this remains a controversial topic. TylerDurden8823 (talk) 18:36, 6 March 2017 (UTC)

If it's still actively debated that's fine. But that's not how it reads. It says the connect has been debated (past tense). Suggest changing it to something line, "While the connection between acne and stress continues to be debated..." Sandbh (talk) 05:06, 7 March 2017 (UTC)

• "…(e.g., in association with the hormonal changes seen in premenstrual syndrome)." The "the" is redundant.

Adjusted. TylerDurden8823 (talk) 18:36, 6 March 2017 (UTC)

-- Sandbh (talk) 03:01, 6 March 2017 (UTC)

Pathophysiology

• "Dihydrotestosterone (DHT) is the main hormonal driver of oily sebum production in the skin." Pls turn this sentence around.

I have no objection to this but I sense a common theme with this suggestion and a few others but don't see why you're making this suggestion. Please explain why. TylerDurden8823 (talk) 18:36, 6 March 2017 (UTC)

"Dihydrotestosterone (DHT)" is too much of a jargon-whopper to start a sentence with. "Testosteone", sure. Benzol peroxide (excuse spelling) OK. Dihydrotestosterone (DHT)? Nope. Sandbh (talk) 05:06, 7 March 2017 (UTC)

• "A major mechanism of acne-related skin inflammation is mediated by P. acnes's ability to bind and activate a class of immune system receptors known as toll-like receptors, especially toll-like receptor 2 (TLR2) and toll-like receptor 4 (TLR4)." This sentence would read better as "…a class of immune system receptors known as toll-like receptors (TLR), especially TLR2 and TLR4."

I have no objection to this change. Fixed. TylerDurden8823 (talk) 18:36, 6 March 2017 (UTC)

• "Squalene oxidation activates NF-κB…". What is NF-κB? A wikilink won't do here.

There's no simple way to explain this. The wikilink will have to do. Some jargon in the pathophysiology section of a medical article is inevitable. TylerDurden8823 (talk) 18:36, 6 March 2017 (UTC)

Please see my ce. It now read, "Squalene oxidation activates NF-κB (a protein complex)..." That's all I'm looking for, really simple stuff. Sandbh (talk) 05:06, 7 March 2017 (UTC)

• "LTB4 promotes skin inflammation by acting on peroxisome proliferator-activated receptor alpha (PPARα)." It'd be helpful to mention that PPARα is a protein.

Sure, that's reasonable. TylerDurden8823 (talk) 21:25, 6 March 2017 (UTC)

• "This inflammatory cascade…" Nice!

Thank you :) TylerDurden8823 (talk) 21:25, 6 March 2017 (UTC)

Diagnosis

• "Comedones (blackheads and whiteheads) must be present to diagnose acne and the absence of comedones suggests a different skin disorder with an appearance similar to that of acne." Awkward phrasing, and missing enough context. Suggest: "Comedones (blackheads and whiteheads) must be present to diagnose acne. In their absence, an appearance similar to that of acne would would suggest a different skin disorder." I haven't got this right but even looking at the sentence leaves me confused. I though the distinctive appearance of acne was due to blackheads and whiteheads. How could a skin disorder look like acne without these present? I'm confused.

I don't know that I agree. There's plenty of earlier context (immediately above within the pathophysiology section) and description of comedones and microcomedones throughout the article. And yes, the distinctive appearance of acne IS due to whiteheads and blackheads (which are informal/colloquial terms for closed and open comedones, respectively). If whiteheads and blackheads (comedones) are absent, that's inconsistent with acne. TylerDurden8823 (talk) 21:25, 6 March 2017 (UTC)

I boldly ce'd it as suggested, since the ce says the same thing, as far as I can see, and it's easier to read. Sandbh (talk) 05:06, 7 March 2017 (UTC)

• "This scale was the first to use a standardized photographic protocol to assess acne severity; since its creation in 1979, Cook's grading scale has undergone several revisions." The phrase "Cook's grading scale" is redunant---replace with "the".

Sure, that's fine. TylerDurden8823 (talk) 21:25, 6 March 2017 (UTC)

• "Leeds acne grading technique counts acne lesions on the face, back, and chest and categorizes them as inflammatory or non-inflammatory." Suggest, "The Leeds" to make it clear that Leeds is a proper noun.

Sure, that's fine. TylerDurden8823 (talk) 21:25, 6 March 2017 (UTC)

Differential diagnosis

• "Such skin conditions include angiofibromas, epidermal cysts, flat warts, folliculitis, keratosis pilaris, milia, perioral dermatitis, and rosacea, among others." Aiieee! Kill the "skin". And trim the redundant "among others".

I'm still actively adding diagnoses to that section. And others is currently valid since the list is not yet comprehensive but stay tuned. TylerDurden8823 (talk) 21:25, 6 March 2017 (UTC)

I trimmed the "skin". The word "include" (a constituent part of a whole) is necessarily incomplete; ergo adding "among others" is not required, and redundant. Sandbh (talk) 05:06, 7 March 2017 (UTC)

-- Sandbh (talk) 05:47, 6 March 2017 (UTC)

Management

• "Many different treatments exist for acne, including alpha hydroxy acid, anti-androgen medications, antibiotics, antiseborrheic medications, azelaic acid, benzoyl peroxide, hormonal treatments, keratolytic soaps, nicotinamide, retinoids, and salicylic acid." Too long. Suggest: "Many different treatments exist for acne. These include alpha hydroxy acid, anti-androgen medications, antibiotics, antiseborrheic medications, azelaic acid, benzoyl peroxide, hormonal treatments, keratolytic soaps, nicotinamide, retinoids, and salicylic acid."

That's fixed. TylerDurden8823 (talk) 21:25, 6 March 2017 (UTC)

• "They are believed to work in at least four different ways, including the following: anti-inflammatory effects, hormonal manipulation, killing P. acnes, and normalizing skin cell shedding and sebum production in the pore to prevent blockage." The words "the following" are redundant. Replace "anti-inflammatory effects" with "reducing inflammation".

Sure, this doesn't seem like something that would really confuse a lay reader (IMO) but no objection since it means the same thing. TylerDurden8823 (talk) 21:25, 6 March 2017 (UTC)

• "Commonly used medical treatments include topical therapies such as antibiotics, benzoyl peroxide, and retinoids, and systemic therapies including antibiotics, hormonal agents, and oral retinoids." Replace "Commonly used medical" with "Common treatments".

Sure, that's fine. TylerDurden8823 (talk) 21:25, 6 March 2017 (UTC)

Diet

• "As of 2014, evidence is insufficient to recommend milk restriction for this purpose." Hmmm. "As of 2014, evidence was insufficient?"

That's correct. TylerDurden8823 (talk) 21:25, 6 March 2017 (UTC)

Benzoyl peroxide

• At this point I capitulated and engaged in some copy editing and trimming.

That's fine. I've reviewed each diff. No objections. TylerDurden8823 (talk) 21:25, 6 March 2017 (UTC)

-- Sandbh (talk) 06:12, 6 March 2017 (UTC)

Retinoids

• "Retinoids are medications structurally related to vitamin A,[9] which possess anti-inflammatory properties, normalize the follicle cell life cycle, and reduce sebum production." The vitamin A connection is not that important. Suggest: "Retinoids are medications that possess anti-inflammatory properties, normalize the follicle cell life cycle, and reduce sebum production. They are structurally related to vitamin A."

I'm not sure I agree that the vitamin A connection is not as important since it's a defining characteristic of the medication class but I'm fine with this simple rearrangement for emphasis. Fixed. TylerDurden8823 (talk) 21:25, 6 March 2017 (UTC)

• "The retinoids appear to influence the cell life cycle in the follicle lining." The "The" is not needed.

Which instance of "the" do you mean? TylerDurden8823 (talk) 21:25, 6 March 2017 (UTC)

The first one. Sandbh (talk) 06:17, 7 March 2017 (UTC)

• At this point I did some ce and trimming
• What's the introductory context for this sentence(?): "There is no clear evidence that use of oral retinoids increases the risk of psychiatric side effects such as depression and suicidality."

Sigh, this was a concern from a few others too. It's a very well-known concern that has been raised about oral retinoids. It's on my list of to-dos for this article to add a very brief contextual sentence (i.e., this has been a concern. The evidence doesn't support it blah blah blah, etc. Discussed a few times above.). TylerDurden8823 (talk) 21:25, 6 March 2017 (UTC)

Excellent. Sandbh (talk) 06:17, 7 March 2017 (UTC)

Antibiotics

• ce and trim done
• "It is recommended that oral antibiotics be stopped after three months and used in combination with benzoyl peroxide if their use is thought to be necessary for adequate treatment. The use of topical or oral antibiotics alone is discouraged due to concerns surrounding antibiotic resistance, but their use is recommended in combination with topical benzoyl peroxide or a retinoid. Dapsone is not a first-line topical antibiotic due to higher cost and lack of clear superiority over other antibiotics. Topical dapsone is not recommended for use with benzoyl peroxide due to yellow-orange skin discoloration with this combination."
  
  

A bit of jumble here. I don't understand the first sentence. It seems to overlap the first part of the second sentence. The use of "but" in the second sentence is awkward. The third sentence is odd because it's a "not" sentence and it introduces a new subject (Dapsone) without any introductory context. It makes sense when you get to sentence four, but the reader shouldn't have to wait that long.

Please clarify what you don't understand about the first sentence (it seems straightforward to me). Oral antibiotics are not recommended for prolonged use due to concerns about antibiotic resistance and side effects (this is discussed clearly). Why is the "but" awkward for you? What do you recommend in its place? Dapsone is simply another antibiotic which is stated in the first sentence in which it is mentioned. That's very straightforward. No further introduction is needed. It's a less commonly used antibiotic because of the listed disadvantages and lack of clear superiority to other (more commonly) used antibiotics. TylerDurden8823 (talk) 21:25, 6 March 2017 (UTC)

1. I gather the first sentence means: If you need to use oral antibiotics after 3 months you will need to also take benzoyl peroxide? The way the sentence is written now does not make this very clear, on first reading. The word "stopped" is such a strong word that it tends to swamp the rest of the sentence. 2. The start of the second sentence has a negative sense, (which is fine) but is then followed by a "but", which I find to be an unusual, hard to navigate combination. I'd be inclined to say something like (this will be rough; ignore the bolding):

If oral antibiotics need to be take for more than three months then it is recommended you take benzoyl peroxide at the same time. Otherwise there is a risk of developing antibiotic resistance.

3. When Dapsone is mentioned, at the start of sentence 3, that is its first mention in the article. Hence my comment about it lacking introductory context, a concern which remains. Sandbh (talk) 06:17, 7 March 2017 (UTC)

Hormonal agents

• ce and trim done

Reviewed performed copyedits/trims without major objections. TylerDurden8823 (talk) 21:25, 6 March 2017 (UTC)

Azelaic acid

• ce and trim done

Reviewed performed copyedits/trims without major objections. TylerDurden8823 (talk) 21:25, 6 March 2017 (UTC)

Salicylic acid

• ce and trim done

Reviewed performed copyedits/trims without major objections. TylerDurden8823 (talk) 21:25, 6 March 2017 (UTC)

Other medications

• ce and trim done
• Please add a plain English summary of what exogenous ochronosis is.

Yeah, I've been mulling that over but there's not a particularly simple way to explain that. TylerDurden8823 (talk) 21:25, 6 March 2017 (UTC)

I gather it's a form of dermatitis? Thus, "exogenous ochronosis (a form of dermatitis)"?

Combination therapy

• Is good.

Glad to hear it. TylerDurden8823 (talk) 21:25, 6 March 2017 (UTC)

Pregnancy

• ce and trim done
• the (category C) (B) etc thing is introduced here without any explanation

This is pretty well-known and ubiquituous (and blue-linked for additional information. A full explanation of medication safety categories is definitely outside the scope of this article and I think its inclusion would cause the article to lose focus). TylerDurden8823 (talk) 21:25, 6 March 2017 (UTC)

I don't know it :( A footnote would be helpful for people like me. -- Sandbh (talk) 06:17, 7 March 2017 (UTC)

• a lot of technical jargon here: oligohydramnios; ductus arteriosus; occlusive dressings---what are these?

These are other medical terms that are not easily explained in lay terms (hence, they are blue linked for further information). Oligohydramnios I can probably simplify but ductus arteriosus is a bit more challenging as is occlusive dressing. TylerDurden8823 (talk) 21:25, 6 March 2017 (UTC)

Something like this would do: "oligohydramnios (amniotic fluid deficiency); ductus arteriosus (fetal blood vessel); occlusive (sealed) dressings

(sealed)". Sandbh (talk) 06:17, 7 March 2017 (UTC)

• "In studies examining the effects of topical retinoids during pregnancy, fetal harm has not been seen in the second and third trimesters." So, safe to use during the first trimester?

I will have to look back at the cited sources. They may not have commented on it. Stay tuned. TylerDurden8823 (talk) 21:25, 6 March 2017 (UTC)

-- Sandbh (talk) 07:52, 6 March 2017 (UTC)

Procedures; Alternative medicine

• ce and trim done

Reviewed performed copyedits/trims without major objections. TylerDurden8823 (talk) 21:25, 6 March 2017 (UTC)

-- Sandbh (talk) 09:03, 6 March 2017 (UTC)

Prognosis; Epidemiology

• ce and trim done

Reviewed performed copyedits/trims without major objections. TylerDurden8823 (talk) 21:25, 6 March 2017 (UTC)

More to follow -- Sandbh (talk) 09:12, 6 March 2017 (UTC)

History

• ce and trim done -- Sandbh (talk) 09:39, 6 March 2017 (UTC)

Reviewed performed copyedits/trims without major objections. TylerDurden8823 (talk) 21:25, 6 March 2017 (UTC)

Society and culture

• OK -- Sandbh (talk) 09:40, 6 March 2017 (UTC)

Glad to hear it. TylerDurden8823 (talk) 21:25, 6 March 2017 (UTC)

Research

• "The aim of this research is to develop medications targeting hormones known to increase sebum production…" Eh? Increase or decrease?
• ce otherwise done

This is correct. The target of medications under development will be sebum-promoting hormones (i.e., hormones that increase sebum production and therefore worsen acne) to interfere with this process. Is that really unclear? It seems straightforward on my read (and many others I've asked). TylerDurden8823 (talk) 21:25, 6 March 2017 (UTC)

¡Ay, caramba!, I get it now! Pls see my ce. Sandbh (talk) 06:17, 7 March 2017 (UTC)

Taking a little bit of a break since I'm getting annoyed and burnt out. TylerDurden8823 (talk) 21:56, 6 March 2017 (UTC)

I hear you. FAC's are very hard work. Sandbh (talk) 06:17, 7 March 2017 (UTC)

My conclusion

• Lean support, at this time. My concerns (mainly to do with prose) have mostly been addressed. I believe the following are outstanding, as detailed in the main body of my comments:

1. I've requested a trimming of citations in the lead so that the only ones left are for items that are truly contentious, so current that they're still developing, or horrendously complex. (I can't see anything in the lead that qualifies.)
2. Concerns about the potential for oral contraceptives causing acne
3. Concerns about the chocolate discussion
4. Hoping that my ce to the smoking para was OK
5. Concerns about the construction of the antibiotic subsection
6. Another ten or so minor items.

I enjoyed the opportunity to review this interesting article.

-- Sandbh (talk) 11:36, 7 March 2017 (UTC)

Lingzhi

• This is a big article with many refs. I'll try to spot check a representative sample, but it's gonna take a few days.  Lingzhi ♦ (talk) 11:15, 6 March 2017 (UTC)
  • OK, I've been informed that another reviewer checked 25% of the refs. Kudos.  Lingzhi ♦ (talk) 11:46, 6 March 2017 (UTC)

John

Leaning oppose. I share Sandbh's concerns. This is a good article and the minor problems with prose and image formatting would be easy to fix. There are problems of coverage which are harder to fix. The article at present over-emphasises the medical aspects of the condition over the cultural ones. The smoking thing bothers me. There are a bunch of minor things that added together tilt me in this direction. --John (talk) 17:12, 7 March 2017 (UTC)

Coordinator comments

• I'd appreciate it if everyone could take a deep breath here. If we are not careful, this FAC is going to run aground very quickly.
• TylerDurden8823, I know and understand that you are a little frustrated with FAC at the moment, but could I ask you to tone down the comments about the reviews? "As I said before, I did not find your tone collaborative" and an "abrasive manner" does not encourage reviewers to revisit this article, and without reviewers it is not going to pass. Victoriaearle is one of the best FAC reviewers out there and I guarantee if you work with her, this will be a better article at the end of it, whatever the outcome of this FAC. I'm not seeing anything abrasive or un-collaborative in her comments; she is simply trying to make this article reach what she considers to be FA standards.

I would have to disagree. I have found her comments extremely abrasive and inappropriate in tone. TylerDurden8823 (talk) 22:06, 6 March 2017 (UTC)

• Similarly Sarah is an outstanding reviewer and someone who many would be delighted to see at their FACs. You mentioned (some time ago) that you were "really rubbed the wrong way by your conduct", but again I'm not seeing anything in the review at which you should take offence. She is, like you, trying to make the best article possible. Sandbh also seems to be trying to work with you, and giving a very in-depth review; try not to be so defensive. Please work with the reviewers!

I'm working with them but I do not like how Victoria & Sarah talk to me. Sand, WAID, CFCF, Core, Seppi, Opabinia, Bruce1ee, and Hanif have all been just fine. I have found Victoria and Sarah's respective conducts outright inappropriate and have felt they have been very disrespectful toward me. That's not something I will tolerate. I'm really not being defensive except for comments that seem personally oriented or abrasive to me. (e.g., saying things like "that's bad writing" is not nice and just inappropriate. There are nicer/more tactful ways to offer constructive criticism that will not alienate the nominator). When reviewers have been offering feedback in a specific and constructive way (listed above), my responses are quite pleasant. TylerDurden8823 (talk) 22:06, 6 March 2017 (UTC)

• Perhaps Victoria and Sarah could summarise their current positions about what they think this article needs to do to meet the criteria?
• There is a long threat on WT:FAC at the moment at least part of which is about reviewers being driven away, and trying to encourage new reviewers. Any reviewer is within their rights to simply say "oppose on 1a", give a few samples and then walk away if they wish. There is no requirement at FAC to give line-by-line reviews, and in fact these were, once-upon-a-time strongly discouraged. That you are getting so much feedback is unusual, in a good way, and even if you don't agree with the comments (and there is no requirement that you do: this is about working towards a consensus) it is best not to take them too much to heart, or to see them as an attempt to derail this FAC. For better or worse (and I think the former), this is how FAC works. Nominating an article comes with the possibility of disagreement, but the end result is almost always a better article, and with the FA star at the top.

I'm not saying reviewers can't say that, but I will voice my disagreement with them if I think their reasoning is incorrect. I do think some of the earlier opposes or implications of oppose were meant as a derailment due to their earlier disagreeable comments. I understand your dilemma about not wanting to dissuade FAC reviewers but this process is so tedious/burdensome and when faced with some reviewers who offer feedback in a manner that is not constructive, it dissuades editors from wanting to be nominators. That's bad for the process too. It's a two-way street. TylerDurden8823 (talk) 22:06, 6 March 2017 (UTC)

• I've said something similar to this elsewhere, but I wanted to formally note this here on the FAC page.
• This FAC is getting very bogged down and hard to follow at the moment. I'm very tempted to move some of the commentary to the talk page so that any new reviewers can see where we are and are not discouraged by the wall of text. Sarastro1 (talk) 21:54, 6 March 2017 (UTC)

I agree. It's being dragged out because there is a flood of review going on. So far, Sand's has been the most helpful recent review. I don't 100% agree with everything he suggests but agree with most of it and when we disagree we've had little difficulty in resolving disputes through civil discussion. I wish I could say the same of a few other reviewers. TylerDurden8823 (talk) 22:06, 6 March 2017 (UTC)

Closing comment: I think we need to stop now. This FAC is horribly long, and there is a vanishingly small chance of finding a consensus to promote in amongst all this. Therefore there is little point in continuing. I think that it would benefit everyone to take some deep breaths and step away from this for two weeks. After that it can be renominated, but my suggestion would be to work with ALL the reviewers who have commented here and try to reach some compromises.

But I have to place on record that I consider the attitude of the nominator towards Sarah and Victoria to be unhelpful at best, and no matter your opinion of their reasoning, or your disagreement with them (which as I have said before, is perfectly permissible). These are some of your comments: "It's really just been you. This is absolutely ridiculous. At this juncture, I cannot take your suggestions seriously Sarah and I do not think I can work with you any longer", "I did not find your tone collaborative", "when I find that their comments are delivered in an abrasive manner" and "that would have been my advice to you. Any "baiting" exists only in your mind. Your warning is unwarranted. Therefore, I'm disregarding it. We can cease with any further discussion. The comments I'm seeing are not productive/helpful". To be blunt, it's a surprise that anyone has reviewed after this. I would suggest (and by all means disregard this) that you need to encourage reviewers, not drive them away, and if you really want this article to be a FA, I would advise a more collaborative attitude. Note that I am NOT saying that you have to agree with them, or to implement their recommendations.

If you want my detailed reasoning for archiving: we have one outright oppose from SlimVirgin, two leaning opposes (Victoriaearle and John, and Victoria's views still count even though she has moved them to the talk page) and some concerns from My Core Competency is Competency, who has not been on WP since January. Set against that, we have supports from CFCF, Opabinia regalis (both of which I consider to support the accuracy and content), an image and MoS support from Seppi333, a prose support from Bruce1ee and a leaning support (albeit with issues still to address) from Sandbh. This FAC has been open for over 2 months, and in that time we still do not have a consensus and therefore this needs to be archived. It can be renominated after two weeks, as usual, but I would recommend working on this away from FAC before renominating. Sarastro1 (talk) 23:36, 7 March 2017 (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. Sarastro1 (talk) 23:37, 7 March 2017 (UTC)

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