The DOI matches its Crossref record; 315 of the 358 references it cites were found in a registry or an index; 37 of the 191 sources its claims cite were checked for support.
Guidelines of care for the management of acne vulgaris
Open accessAbstract
Background Acne vulgaris commonly affects adults, adolescents, and preadolescents aged 9 years or older. Objective The objective of this study was to provide evidence-based recommendations for the management of acne. Methods A work group conducted a systematic review and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of evidence and formulating and grading recommendations. Results This guideline presents 18 evidence-based recommendations and 5 good practice statements. Strong recommendations are made for benzoyl peroxide, topical retinoids, topical antibiotics, and oral doxycycline. Oral isotretinoin is strongly recommended for acne that is severe, causing psychosocial burden or scarring, or failing standard oral or topical therapy. Conditional recommendations are made for topical clascoterone, salicylic acid, and azelaic acid, as well as for oral minocycline, sarecycline, combined oral contraceptive pills, and spironolactone. Combining topical therapies with multiple mechanisms of action, limiting systemic antibiotic use, combining systemic antibiotics with topical therapies, and adding intralesional corticosteroid injections for larger acne lesions are recommended as good practice statements. Limitations Analysis is based on the best available evidence at the time of the systematic review. Conclusions These guidelines provide evidence-based recommendations for the management of acne vulgaris.
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Claims the paper makes
37 of 191 cited sources checked · 13 supported · 3 flagged · accuracy not yet measured
Some cited sources support this claim and some don’t — read each source’s verdict below.
In the paper
“The overall RR of IBD between isotretinoin-exposed and unexposed groups is estimated at 1.13 (95% confidence interval, 0.89, 1.43).”
§ Guidelines of care for the management of acne vulgaris > ISOTRETINOIN
What the sources say
- Partly supportedcites [279] 279. Alhusayen RO, Juurlink DN, Mamdani MM, Morrow RL, Shear NH, Dormuth CR. Isotretinoin use and the risk of inflammatory bowel disease: a population-based cohort study. J Invest Dermatol. 2013;133:907-912. sourceExperimental — accuracy not yet measured
The 'Acne therapy and incident IBD' section reports an overall comparison of isotretinoin-treated and untreated participants, but gives a rate ratio of 1.14 (95% CI 0.92–1.41), not 1.13 (0.89–1.43). No page number is available in our copy. (LLM, conf=0.90)
- Not checked — no full text of the sourcecites [280] 280. Bernstein CN, Nugent Z, Longobardi T, Blanchard JF. Isotret- inoin is not associated with inflammatory bowel disease: a population-based case-control study. Am J Gastroenterol. 2009;104:2774-2778. source
- Disputedcites [281] 281. Crockett SD, Porter CQ, Martin CF, Sandler RS, Kappelman MD. Isotretinoin use and the risk of inflammatory bowel disease: a case-control study. Am J Gastroenterol. 2010;105:1986-1993. sourceExperimental — accuracy not yet measured
The Results, under “Results of matched analyses” (page not provided), report an overall IBD odds ratio of 1.68 (95% CI 0.98–2.86) for any isotretinoin use, not the claimed relative risk of 1.13 (95% CI 0.89–1.43). The Methods, under “Statistical analysis,” specify that the study estimated odds ratios rather than relative risks. (LLM, conf=0.90)
Checked by a reasoning model — may be wrong.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Partly supported
Some cited sources support this claim and some don’t — read each source’s verdict below.
In the paper
“Available low certainty evidence from 7 observational studies with substantial heterogeneity do not support a significant association between isotretinoin use and IBD incidence, including ulcerative colitis and Crohn's disease.”
§ Guidelines of care for the management of acne vulgaris > ISOTRETINOIN
What the sources say
- Partly supportedcites [279] 279. Alhusayen RO, Juurlink DN, Mamdani MM, Morrow RL, Shear NH, Dormuth CR. Isotretinoin use and the risk of inflammatory bowel disease: a population-based cohort study. J Invest Dermatol. 2013;133:907-912. sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
- Not checked — no full text of the sourcecites [280] 280. Bernstein CN, Nugent Z, Longobardi T, Blanchard JF. Isotret- inoin is not associated with inflammatory bowel disease: a population-based case-control study. Am J Gastroenterol. 2009;104:2774-2778. source
- Disputedcites [281] 281. Crockett SD, Porter CQ, Martin CF, Sandler RS, Kappelman MD. Isotretinoin use and the risk of inflammatory bowel disease: a case-control study. Am J Gastroenterol. 2010;105:1986-1993. sourceExperimental — accuracy not yet measured
Split into 2 atoms — 0 confirmed, 0 partially supported, 2 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Checked by a reasoning model — may be wrong.
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Partly supported
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“Compared to vehicle at 12 weeks, a greater proportion of patients treated with topical retinoids achieved IGA success in 4 RCTs (risk ratio [RR], 1.57 [1.21, 2.04]).59,63,64,71”
§ Guidelines of care for the management of acne vulgaris > Topical retinoids
What the sources say
- Could not verifycites [59] 59. Thiboutot D, Pariser DM, Egan N, et al. Adapalene gel 0.3% for the treatment of acne vulgaris: a multicenter, random- ized, double-blind, controlled, phase III trial. J Am Acad Dermatol. 2006;54:242-250. sourceExperimental — accuracy not yet measured
Thiboutot’s paper is a randomized controlled trial of a topical retinoid, so it could be cited as one of the four trials rather than as the source of the pooled estimate. However, paper-scoped searches returned no full-text snippets, and the available evidence does not establish its vehicle comparison, 12-week IGA result, or inclusion in the four-trial analysis. The unscoped searches found no reliable match for the stated risk ratio; they do not establish misattribution. (LLM, conf=0.72)
- Not checked — no full text of the sourcecites [63] 63. Webster GF, Sugarman J, Levy-Hacham O, Toledano O. Microencapsulated benzoyl peroxide and tretinoin for the treatment of acne vulgaris: results from a phase 2 multicenter, double-blind, randomized, vehicle-controlled study. Skinmed. 2020;18(6):343-351.
- Could not verifycites [64] 64. Gollnick HP, Draelos Z, Glenn MJ, et al. Adapalene-benzoyl peroxide, a unique fixed-dose combination topical gel for the treatment of acne vulgaris: a transatlantic, randomized, double-blind, controlled study in 1670 patients. Br J Derma- tol. 2009;161:1180-1189. sourceExperimental — accuracy not yet measured
Gollnick (2009) is identified as a randomized acne trial of adapalene–benzoyl peroxide, so citing it as one of four trials is plausible; the pooled RR need not appear in an individual trial. Two searches of its Semantic Scholar record returned no full-text snippets, however, and the other search results do not establish its vehicle-comparator IGA success result at 12 weeks. The available evidence therefore cannot verify this trial’s contribution to the stated comparison; it does not establish misattribution. (LLM, conf=0.62)
- Not checked — no full text of the sourcecites [71] 71. Jarratt MT, Brundage T. Efficacy and safety of clindamycin- tretinoin gel versus clindamycin or tretinoin alone in acne vulgaris: a randomized, double-blind, vehicle-controlled study. J Drugs Dermatol. 2012;11:318-326.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Could not verify
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“In patients who are pregnant, the risk of fetal harm from topical azelaic acid, BP, erythromycin, and clindamycin are not expected based on limited expected systemic absorption.174,175”
§ Guidelines of care for the management of acne vulgaris > Considerations in topical therapies
What the sources say
- Not checked — no full text of the sourcecites [174] 174. Murase JE, Heller MM, Butler DC. Safety of dermatologic medications in pregnancy and lactation: part I. Pregnancy. J Am Acad Dermatol. 2014;70:401.e1-401.e14; quiz 15. source
- Supportedcites [175] 175. Ly S, Kamal K, Manjaly P, Barbieri JS, Mostaghimi A. Treat- ment of acne vulgaris during pregnancy and lactation: a Narrative review. Dermatol Ther. 2023;13:115-130. source
The Topical Treatments section reports minimal skin absorption and no reported adverse fetal effects for azelaic acid. It describes benzoyl peroxide as low risk because of minimal systemic absorption, and says topical erythromycin and clindamycin have minimal or negligible systemic absorption and are considered safe during pregnancy. The supplied passages do not give page numbers. (LLM, conf=0.93)
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Compared to vehicle at 12 weeks, a greater proportion of patients treated with combined BP and topical retinoid achieved IGA success in 3 RCTs (RR, 2.19 [1.77, 2.72]).63,64,109”
§ Guidelines of care for the management of acne vulgaris > Fixed-dose topical combinations
What the sources say
- Not checked — no full text of the sourcecites [63] 63. Webster GF, Sugarman J, Levy-Hacham O, Toledano O. Microencapsulated benzoyl peroxide and tretinoin for the treatment of acne vulgaris: results from a phase 2 multicenter, double-blind, randomized, vehicle-controlled study. Skinmed. 2020;18(6):343-351.
- Not checked — no full text of the sourcecites [64] 64. Gollnick HP, Draelos Z, Glenn MJ, et al. Adapalene-benzoyl peroxide, a unique fixed-dose combination topical gel for the treatment of acne vulgaris: a transatlantic, randomized, double-blind, controlled study in 1670 patients. Br J Derma- tol. 2009;161:1180-1189. source
- Supportedcites [109] 109. Dreno B, Bissonnette R, Gagne-Henley A, et al. Prevention and reduction of atrophic acne scars with adapalene 0.3%/benzoyl peroxide 2.5% gel in subjects with moderate or severe facial acne: results of a 6-month randomized, vehicle-controlled trial using intra-individual comparison. Am J Clin Dermatol. 2018;19(2):275-286. source
The Discussion (page unavailable) reports that at week 12, more subjects were IGA clear or almost clear with adapalene/benzoyl peroxide than with vehicle (31.4% versus 11.9%). This randomized trial supports the cited direction of effect as one of the three trials; the RR and confidence interval are pooled figures, not results attributed to this individual trial. (LLM, conf=0.90)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Greater reductions in both inflammatory (MD in the percentage change from baseline, À37.34% [À72.49%,À2.18%]) and noninflammatory (MD, À20.47% [À26.31,À14.62]) lesion counts were seen in combined BP and topical antibiotic versus vehicle at 12 weeks in 4 RCTs.66,69,99,101”
§ Guidelines of care for the management of acne vulgaris > Fixed-dose topical combinations
What the sources say
- Not checked — no full text of the sourcecites [66] 66. Eichenfield LF, Alio Saenz AB. Safety and efficacy of clinda- mycin phosphate 1.2%-benzoyl peroxide 3% fixed-dose combination gel for the treatment of acne vulgaris: a phase 3, multicenter, randomized, double-blind, active-and vehicle-controlled study. J Drugs Dermatol. 2011;10:1382- 1396.
- Partly supportedcites [69] 69. Lookingbill DP, Chalker DK, Lindholm JS, et al. Treatment of acne with a combination clindamycin/benzoyl peroxide gel compared with clindamycin gel, benzoyl peroxide gel and vehicle gel: combined results of two double-blind investiga- tions. J Am Acad Dermatol. 1997;37:590-595. sourceExperimental — accuracy not yet measured
Lookingbill et al. (1997) compares clindamycin/benzoyl peroxide gel with vehicle, so it is a relevant trial for the cited four-RCT comparison. A Semantic Scholar snippet from “A comparative study of Acne Vulgaris with special reference to Therapeutic options” also reports that the combination reduced inflammatory lesions more than vehicle. The cited paper has no searchable full-text snippets, however, and the available evidence does not verify its 12-week result or the pooled mean difference of −37.34% (95% CI −72.49% to −2.18%); that estimate is attributed to four trials collectively, not necessarily to Lookingbill alone. (LLM, conf=0.72)
- Supportedcites [99] 99. Stein Gold L, Baldwin H, Kircik LH, et al. Efficacy and safety of a fixed-dose clindamycin phosphate 1.2%, benzoyl peroxide 3.1%, and adapalene 0.15% gel for moderate-to-severe acne: a randomized phase II study of the first triple-combination drug. Am J Clin Dermatol. 2022;23(1):93-104. sourceExperimental — accuracy not yet measured
Stein Gold et al. (2022) is a 12-week randomized trial with both clindamycin/benzoyl peroxide and vehicle arms. Its full-text snippet states that all active two-drug combinations, including clindamycin/benzoyl peroxide, significantly reduced inflammatory lesions versus vehicle at week 12 (score 0.537). The −37.34% mean difference and confidence interval are the citing document’s pooled estimate across four trials, not a result attributed to this individual trial alone. (LLM, conf=0.88)
- Not checked — no full text of the sourcecites [101] 101. Pariser DM, Rich P, Cook-Bolden FE, Korotzer A. An aqueous gel fixed combination of clindamycin phosphate 1.2% and benzoyl peroxide 3.75% for the once-daily treatment of moderate to severe acne vulgaris. J Drugs Dermatol. 2014; 13(9):1083-1089.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Greater reductions in both inflammatory (MD in the percentage change from baseline, À37.34% [À72.49%,À2.18%]) and noninflammatory (MD, À20.47% [À26.31,À14.62]) lesion counts were seen in combined BP and topical antibiotic versus vehicle at 12 weeks in 4 RCTs.66,69,99,101”
§ Guidelines of care for the management of acne vulgaris > Fixed-dose topical combinations
What the sources say
- Not checked — no full text of the sourcecites [66] 66. Eichenfield LF, Alio Saenz AB. Safety and efficacy of clinda- mycin phosphate 1.2%-benzoyl peroxide 3% fixed-dose combination gel for the treatment of acne vulgaris: a phase 3, multicenter, randomized, double-blind, active-and vehicle-controlled study. J Drugs Dermatol. 2011;10:1382- 1396.
- Not checked — no full text of the sourcecites [69] 69. Lookingbill DP, Chalker DK, Lindholm JS, et al. Treatment of acne with a combination clindamycin/benzoyl peroxide gel compared with clindamycin gel, benzoyl peroxide gel and vehicle gel: combined results of two double-blind investiga- tions. J Am Acad Dermatol. 1997;37:590-595. source
- Supportedcites [99] 99. Stein Gold L, Baldwin H, Kircik LH, et al. Efficacy and safety of a fixed-dose clindamycin phosphate 1.2%, benzoyl peroxide 3.1%, and adapalene 0.15% gel for moderate-to-severe acne: a randomized phase II study of the first triple-combination drug. Am J Clin Dermatol. 2022;23(1):93-104. source
The Methods describe a randomized 12-week trial with clindamycin/benzoyl peroxide and vehicle arms. The Results (Fig. 2 caption) report significantly greater reductions in noninflammatory lesions for the combination arm than for vehicle at week 12. This paper supports its citation as one of the four trials; the pooled mean difference and confidence interval are not presented as this trial’s individual result. (LLM, conf=0.90)
- Not checked — no full text of the sourcecites [101] 101. Pariser DM, Rich P, Cook-Bolden FE, Korotzer A. An aqueous gel fixed combination of clindamycin phosphate 1.2% and benzoyl peroxide 3.75% for the once-daily treatment of moderate to severe acne vulgaris. J Drugs Dermatol. 2014; 13(9):1083-1089.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesEvery source the paper cites for this claim was checked and supports it.
In the paper
“Concurrent topical application of BP with either dapsone or sulfacetamide causes an orange-brown skin discoloration, which can be washed off; thus BP should be used at a different time of day than topical dapsone.169”
§ Guidelines of care for the management of acne vulgaris > Topical antibiotics
What the sources say
- Supportedcites [169] 169. Dubina MI, Fleischer AB Jr. Interaction of topical sulfaceta- mide and topical dapsone with benzoyl peroxide. Arch Dermatol. 2009;145:1027-1029. source
The Abstract and Comment report orange-brown discoloration when benzoyl peroxide is combined with either dapsone or sulfacetamide. The Comment says the colored precipitate on skin is easily wiped away and does not stain skin; it also recommends using the medications at different times of day. (LLM, conf=0.93)
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Compared to vehicle at 12 weeks, a greater proportion of patients treated with clascoterone achieved IGA success in 2 RCTs (RR, 2.08 [1.39, 3.11]).93”
§ Guidelines of care for the management of acne vulgaris > Clascoterone
What the sources say
- Partly supportedcites [93] 93. Hebert A, Thiboutot D, Stein Gold L, et al. Efficacy and safety of topical clascoterone cream, 1%, for treatment in patients with facial acne: two phase 3 randomized clinical trials. JAMA Dermatology. 2020;156(6):621-630. sourceExperimental — accuracy not yet measured
The Results > Efficacy table reports greater IGA-defined treatment success with clascoterone than vehicle at week 12 in both trials. It does not report the cited pooled risk ratio of 2.08 (95% CI 1.39–3.11); the Methods > Statistical Analysis section instead describes adjusted odds ratios, and the table gives separate estimates for each trial. Page numbers are unavailable in our copy. (LLM, conf=0.88)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“COC use is associated with small increases in myocardial infarction and stroke risks, particularly in patients above age 35 years who smoke tobacco or patients who have hypertension, diabetes mellitus, or migraines.”
§ Guidelines of care for the management of acne vulgaris > Combined oral contraceptives
What the sources say
- Not checked — no full text of the sourcecites [193] 193. Arrington EA, Patel NS, Gerancher K, Feldman SR. Combined oral contraceptives for the treatment of acne: a practical guide. Cutis. 2012;90:83-90.
- Partly supportedcites [194] 194. Harper JC. Should dermatologists prescribe hormonal con- traceptives for acne? Dermatol Ther. 2009;22:452-457. sourceExperimental — accuracy not yet measured
The “Risks of combination oral contraceptive pills” section (page not provided) reports increased myocardial infarction and stroke risks associated with COC use and identifies smoking, age, hypertension, diabetes, and migraines as relevant risk factors. It does not characterize the increases in myocardial infarction or stroke risk as small, so that magnitude is unsupported. (LLM, conf=0.86)
- Not checked — no full text of the sourcecites [211] 211. Katsambas AD, Dessinioti C. Hormonal therapy for acne: why not as first line therapy? facts and controversies. Clin Dermatol. 2010;28:17-23. source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
- It may state two separate claims as one. 46
- Probably not a substantial claim. 8
At least one cited source doesn’t support this claim or points to a different paper, and none confirmed it — see the verdicts below.
In the paper
“Current data show no consistent difference in acne responses based on COC formulations or dosages and do not support the superiority of one COC over another for acne treatment”
§ Guidelines of care for the management of acne vulgaris > Combined oral contraceptives
What the sources say
- Not checked — no full text of the sourcecites [199] 199. Kelly S, Davies E, Fearns S, et al. Effects of oral contraceptives containing ethinylestradiol with either drospirenone or levo- norgestrel on various parameters associated with well-being in healthy women: a randomized, single-blind, parallel- group, multicentre study. Clin Drug Investig. 2010;30:325-336. source
- Disputedcites [200] 200. Palatsi R, Hirvensalo E, Liukko P, et al. Serum total and unbound testosterone and sex hormone binding globulin (SHBG) in female acne patients treated with two different oral contraceptives. Acta Derm Venereol. 1984;64:517-523. sourceExperimental — accuracy not yet measured
The Improvement of acne section (p. 4) reports that acne responded better to desogestrel/ethinyloestradiol than to levonorgestrel/ethinyloestradiol (p<0.05), contrary to the claim of no formulation difference or superiority. Patients and Methods (p. 2) shows that both groups received the same ethinyloestradiol dose, so this study does not compare dosages. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
- Not checked — no full text of the sourcecites [201] 201. Rosen MP, Breitkopf DM, Nagamani M. A randomized controlled trial of second-versus third-generation oral contraceptives in the treatment of acne vulgaris. Am J Obstet Gynecol. 2003;188:1158-1160. source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“In addition to concerns about antibiotic resistance, oral tetracycline-class antibiotic use has been associated with inflammatory bowel disease (IBD), 114 pharyngitis, 179 Clostridium difficile infection, 180,181 and Candida vulvovaginitis.”
§ Guidelines of care for the management of acne vulgaris > SYSTEMIC ANTIBIOTICS
What the sources say
- Not checked — no full text of the sourcecites [114] 114. Margolis DJ, Fanelli M, Hoffstad O, Lewis JD. Potential association between the oral tetracycline class of antimicro- bials used to treat acne and inflammatory bowel disease. Am J Gastroenterol. 2010;105:2610-2616. source
- Supportedcites [179] source
Citation 179 is attached to pharyngitis, not to the other listed conditions. The Introduction identifies tetracyclines as commonly used oral antibiotics for acne, and the Results report an association between oral antibiotic use for acne and pharyngitis (odds ratio 4.34 in the cohort study). The study does not establish causation. (LLM, conf=0.90)
- Not checked — no full text of the sourcecites [180] 180. Bartlett JG, Chang TW, Gurwith M, Gorbach SL, Onderdonk AB. Antibiotic-associated pseudomembranous colitis due to toxin-producing clostridia. N Engl J Med. 1978;298:531-534. source
- Not checked — no full text of the sourcecites [181] 181. Carroll KC, Bartlett JG. Biology of Clostridium difficile: implications for epidemiology and diagnosis. Annu Rev Microbiol. 2011;65:501-521. source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
Every source the paper cites for this claim was checked and supports it.
In the paper
“The Centers for Disease Control and Prevention recommend outpatient antibiotic stewardship programs to include (1) commitment to optimizing antibiotic prescribing and patient safety, (2) implementation action for stewardship policy or practice, (3) tracking prescribing practices through clinician feedback or self-assessment, and (4) access to educational resources and expertise.182”
§ Guidelines of care for the management of acne vulgaris > SYSTEMIC ANTIBIOTICS
What the sources say
- Supportedcites [182] 182. Sanchez GV, Fleming-Dutra KE, Roberts RM, et al. Core elements of outpatient antibiotic stewardship. MMWR Re- comm Rep. 2016;65(6):1-12. 183. 102. Nast A, Dr eno B, Bettoli V, et al. European evidence-based (S3) guideline for the treatment of acne -update 2016 - short version. J Eur Acad Dermatol Venereol. 2016;30: 1261-1268. source
The “Core Elements of Outpatient Antibiotic Stewardship” section lists the four elements the citing sentence attributes to CDC: commitment to prescribing and patient safety, action for policy and practice, tracking and reporting through feedback or self-assessment, and education and expertise. The citing sentence accurately paraphrases that list. (LLM, conf=0.95)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Menstrual irregularities were commonly reported (40.6% vs 0%; RR, 10.89 [1.54, 77.08]), 140,141 may be dose-dependent, 232 and are less common among those using COC.233”
§ Guidelines of care for the management of acne vulgaris > Spironolactone
What the sources say
- Not checked — no full text of the sourcecites [140] 140. Patiyasikunt M, Chancheewa B, Asawanonda P, Noppakun N, Kumtornrut C. Efficacy and tolerability of low-dose spirono- lactone and topical benzoyl peroxide in adult female acne: a randomized, double-blind, placebo-controlled trial. J Derma- tol. 2020;47:1411-1416. source
- Not checked — no full text of the sourcecites [141] 141. Goodfellow A, Alaghband-Zadeh J, Carter G, et al. Oral spironolactone improves acne vulgaris and reduces sebum excretion. Br J Dermatol. 1984;111:209-214. source
- Supportedcites [232] 232. Layton AM, Eady EA, Whitehouse H, Del Rosso JQ, Fedorowicz Z, van Zuuren EJ. Oral spironolactone for acne vulgaris in adult females: a hybrid systematic review. Am J Clin Dermatol. 2017;18:169-191. source
Citation 233 is attached to the claim that menstrual irregularities are less common with combined oral contraceptive (COC) use, not to the earlier numerical comparison. In Results > Side Effects Reported in RCTs and Case Series (page not provided), the review reports a significantly lower incidence with concomitant COC use: 6/112 versus 32/146 without a COC. (LLM, conf=0.94)
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“COCs have been associated with small increases in breast cancer and cervical cancer risks and decreases in endometrial, ovarian, and colorectal cancer risks in systematic reviews.”
§ Guidelines of care for the management of acne vulgaris > Combined oral contraceptives
What the sources say
- Not checked — no full text of the sourcecites [212] 212. Gierisch JM, Coeytaux RR, Urrutia RP, et al. Oral contraceptive use and risk of breast, cervical, colorectal, and endometrial cancers: a systematic review. Cancer Epidemiol Biomarkers Prev. 2013;22:1931-1943. source
- Not checked — no full text of the sourcecites [213] 213. Havrilesky LJ, Moorman PG, Lowery WJ, et al. Oral contra- ceptive pills as primary prevention for ovarian cancer: a systematic review and meta-analysis. Obstet Gynecol. 2013; 122:139-147. source
- Supportedcites [214] 214. Iversen L, Sivasubramaniam S, Lee AJ, Fielding S, Hannaford PC. Lifetime cancer risk and combined oral contraceptives: the Royal College of general practitioners' oral contraception study. Am J Obstet Gynecol. 2017;216:580.e1-580.e9. source
The Introduction (page unavailable) reports increased breast and cervical cancer risk in current or recent combined oral contraceptive users and reduced endometrial, ovarian, and colorectal cancer risk. The Comment calls the breast-cancer increase modest, and the References identify a systematic review and pooled analyses addressing these associations. The paper qualifies the increases by recency of use. (LLM, conf=0.88)
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Progestin-only oral contraceptive pills, intramuscular injections, intrauterine devices, or subcutaneous implants may worsen acne.196,197”
§ Guidelines of care for the management of acne vulgaris > Combined oral contraceptives
What the sources say
- Partly supportedcites [196] 196. Barbieri JS, Mitra N, Margolis DJ, Harper CC, Mostaghimi A, Abuabara K. Influence of contraception class on incidence and severity of acne vulgaris. Obstet Gynecol. 2020;135:1306-1312. sourceExperimental — accuracy not yet measured
The Results report more acne encounters after switching from combined pills to progestin-only pills, levonorgestrel IUDs, or an etonogestrel implant. The Introduction also reports a prior survey suggesting that injections, implants, and hormonal IUDs worsened acne. However, this paper's new-user analysis found fewer incident acne encounters with DMPA injections and implants, and switching to DMPA was not associated with a significant increase; the blanket claim is therefore not supported by its findings for every listed method. (LLM, conf=0.86)
- Not checked — no full text of the sourcecites [197] 197. Lortscher D, Admani S, Satur N, Eichenfield LF. Hormonal contraceptives and acne: a retrospective analysis of 2147 patients. J Drugs Dermatol. 2016;15:670-674.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Partly supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“COC treat acne through their overall anti-androgenic properties, which decrease ovarian androgen production, increase sex hormone-binding globulin, and reduce free testosterone that would otherwise activate the androgen receptor.”
§ Guidelines of care for the management of acne vulgaris > Combined oral contraceptives
What the sources say
- Not checked — no full text of the sourcecites [192] 192. Arowojolu AO, Gallo MF, Lopez LM, Grimes DA. Combined oral contraceptive pills for treatment of acne. Cochrane Database Syst Rev. 2012;6:CD004425. source
- Not matchedcites [193] 193. Arrington EA, Patel NS, Gerancher K, Feldman SR. Combined oral contraceptives for the treatment of acne: a practical guide. Cutis. 2012;90:83-90.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Supportedcites [194] 194. Harper JC. Should dermatologists prescribe hormonal con- traceptives for acne? Dermatol Ther. 2009;22:452-457. source
The mechanism passage under “Abstract” states that COCs have an overall anti-androgenic effect: they block LH-induced ovarian androgen production and increase SHBG, which binds free testosterone and prevents it from binding the androgen receptor. The Conclusion also states that their anti-androgenic effects improve acne. (LLM, conf=0.95)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“Localized skin atrophy, systemic absorption of steroids, and possible adrenal suppression may occur.247”
§ Guidelines of care for the management of acne vulgaris > Intralesional corticosteroid
What the sources say
- Could not verifycites [247] 247. Kwon HH, Yoon JY, Hong JS, Jung JY, Park MS, Suh DH. Clinical and histological effect of a low glycaemic load diet in treatment of acne vulgaris in Korean patients: a randomized, controlled trial. Acta Derm Venereol. 2012;92:241-246. sourceExperimental — accuracy not yet measured
The Materials and Methods (p. 1) describe a dietary intervention for acne, and the Discussion (pp. 4–5) addresses its effects. Searches for intralesional corticosteroid injections, skin atrophy, systemic steroid absorption, and adrenal suppression found no passage in our copy addressing those risks. (LLM, conf=0.78)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Could not verify
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Data from 2 isotretinoin cohort studies estimated the risk of mild normocytic anemia as 0.4%, abnormal platelet level at 1.2% to 2.9%, and abnormal white blood cell count at 7.0% to 10.8%”
§ Guidelines of care for the management of acne vulgaris > ISOTRETINOIN
What the sources say
- Partly supportedcites [269] 269. Evaristo L, Bagatin E. Use of oral isotretinoin to treat acne in the public system: a hospital-based retrospective cohort. Sao Paulo Med J. 2019;137:363-368. sourceExperimental — accuracy not yet measured
The Results (page unavailable) report one case of mild normocytic anemia among 257 followed patients, approximately 0.4%. They report no leukopenia or thrombocytopenia and do not provide the claimed 1.2%–2.9% platelet or 7.0%–10.8% white-blood-cell abnormality rates. This paper is one cohort, not both studies referred to in the citing sentence. (LLM, conf=0.88)
- Could not verifycites [270] 270. Barbieri JS, Shin DB, Wang S, Margolis DJ, Takeshita J. The clinical utility of laboratory monitoring during isotretinoin therapy for acne and changes to monitoring practices over time. J Am Acad Dermatol. 2020;82:72-79. sourceExperimental — accuracy not yet measured
The Results (Frequency of laboratory abnormalities; page unavailable) report no significant white blood cell or platelet abnormalities in this cohort, but do not give the claimed rates for mild normocytic anemia, abnormal platelets, or abnormal white blood cell counts. Searches for the percentages and anemia terms found no passage reporting those estimates or combining two cohorts. (LLM, conf=0.77)
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Many global acne experts have agreed that isotretinoin is the most appropriate treatment option for those with severe or scarring acne.183,184,[257][258][259][260][261][262]”
§ Guidelines of care for the management of acne vulgaris > ISOTRETINOIN
What the sources say
- Partly supportedcites [183] sourceExperimental — accuracy not yet measured
In §5.4.4 (pp. 37–38), the guideline says that many experts support isotretinoin as a first-choice treatment for specified severe forms of acne and cites prevention of scarring as a reason. It does not separately recommend isotretinoin as the most appropriate treatment for scarring acne regardless of severity. (LLM, conf=0.84)
- Not checked — no full text of the sourcecites [184] 184. Oon HH, Wong SN, Aw DCW, Cheong WK, Goh CL, Tan HH. Acne management guidelines by the Dermatological Society of Singapore. J Clin Aesthet Dermatol. 2019;12:34-50.
- Not checked — no full text of the sourcecites [257] 257. Asai Y, Baibergenova A, Dutil M, et al. Management of acne: Canadian clinical practice guideline. CMAJ. 2016;188: 118-126. source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Multiple studies indicate that isotretinoin may improve quality of life and decrease symptoms of anxiety and depression in patients with moderate to severe acne”
§ Guidelines of care for the management of acne vulgaris > ISOTRETINOIN
What the sources say
- Partly supportedcites [292] 292. Secrest AM, Hopkins ZH, Frost ZE, et al. Quality of life assessed using Skindex-16 scores among patients with acne receiving isotretinoin treatment. JAMA Dermatol. 2020;156: 1098-1106. sourceExperimental — accuracy not yet measured
The Results (page not specified) report improved quality-of-life and Emotional domain scores during isotretinoin treatment in patients with moderate to severe acne. The Methods describe these as measures of how skin disease affects quality of life; the paper does not establish a decrease in anxiety or depression symptoms specifically. (LLM, conf=0.88)
- Not checked — no full text of the sourcecites [293] 293. Bray AP, Kravvas G, Skevington SM, Lovell CR. Is there an association between isotretinoin therapy and adverse mood changes? A prospective study in a cohort of acne patients. J Dermatolog Treat. 2019;30:796-801. source
- Partly supportedcites [294] 294. Paljarvi T, McPherson T, Luciano S, Herttua K, Fazel S. Isotretinoin and adverse neuropsychiatric outcomes: retro- spective cohort study using routine data. Br J Dermatol. 2022; 187:64-72. sourceExperimental — accuracy not yet measured
The Discussion (page not provided) says the results add to evidence suggesting improvement in anxiety and depression symptoms, and reports reduced incidence of both compared with patients prescribed oral antibiotics. The paper does not report an improvement in quality of life; its Outcome measurement section lists neuropsychiatric diagnoses and related proxies, not quality-of-life measures. (LLM, conf=0.87)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Partly supported
In the paper
“Existing comparative effectiveness data do not suggest superiority of one topical retinoid against another, with efficacy and tolerability differing by specific concentrations and formulations.153,[156][157][158][159]”
§ Guidelines of care for the management of acne vulgaris > Topical retinoids
What the sources say
- Not matchedcites 153,[156][157][158][159]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Not matched
None of the sources cited for this claim have been checked yet.
In the paper
“BP use is limited by concentration and formulation-dependent burning sensation, stinging, dryness, erythema, pain, peeling, irritation, fabric staining and bleaching, and uncommon contact allergy.”
§ Guidelines of care for the management of acne vulgaris > Benzoyl peroxide
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“The association between acne severity and androgen levels remains unclear, with some studies showing positive associations while others showed no associations.48,49”
§ Guidelines of care for the management of acne vulgaris > METHODS
What the sources say
- Not checked — no full text of the sourcecites [48] 48. Franik G, Bizo n A, W1och S, Kowalczyk K, Biernacka-Bartnik A, Madej P. Hormonal and metabolic aspects of acne vulgaris in women with polycystic ovary syndrome. Eur Rev Med Pharmacol Sci. 2018;22:4411-4418. source
- Not checked — no full text of the sourcecites [49] 49. Kiayani AJ, Rehman FU. Association of serum testosterone and sex hormone binding globulin levels in females with acne based on its severity. J Ayub Med Coll Abbottabad. 2016; 28:357-359.
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Doxycycline may cause gastrointestinal disturbances (15.7% vs 5.9%; RR, 2.56 [1.05, 6.25]),”
§ Guidelines of care for the management of acne vulgaris > Doxycycline
What the sources say
- Not checked — no full text of the sourcecites [115] 115. Skidmore R, Kovach R, Walker C, et al. Effects of subantimicrobial-dose doxycycline in the treatment of mod- erate acne. Arch Dermatol. 2003;139:459-464. source
- Not checked — no full text of the sourcecites [116] 116. Leyden JJ, Bruce S, Lee CS, et al. A randomized, phase 2, dose-ranging study in the treatment of moderate to severe inflammatory facial acne vulgaris with doxycycline calcium. J Drugs Dermatol. 2013;12:658-663.
- Not checked — no full text of the sourcecites [117] 117. Moore A, Ling M, Bucko A, Manna V, Rueda MJ. Efficacy and safety of subantimicrobial dose, modified-release doxycy- cline 40 mg versus doxycycline 100 mg versus placebo for the treatment of inflammatory lesions in moderate and severe acne: a randomized, double-blinded, controlled study. J Drugs Dermatol. 2015;14:581-586.
Strength:hedged· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Available evidence is insufficient to develop a recommendation on the use of topical glycolic acid, sulfur, sodium sulfacetamide, and resorcinol for acne treatment or to make recommendations that compare topical BP, retinoids, antibiotics, and their combinations directly against each other (Supplementary Tables XXVII-XXXV, available via Mendeley at https://data.mendeley.com/datasets/ z2bmdwwdf9/2)”
§ Guidelines of care for the management of acne vulgaris > Considerations in topical therapies
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“There is a lack of active comparator studies to suggest if any one topical antibiotic is superior to another.”
§ Guidelines of care for the management of acne vulgaris > Topical antibiotics
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“In 2021, dermatologists prescribed more oral antibiotics per clinician than all other specialties, with the majority of antibiotics used for acne treatment.177,178”
§ Guidelines of care for the management of acne vulgaris > SYSTEMIC ANTIBIOTICS
What the sources say
- Not checked — no full text of the sourcecites [177] 177. Barbieri JS, Bhate K, Hartnett KP, Fleming-Dutra KE, Margolis DJ. Trends in oral antibiotic prescription in dermatology, 2008 to 2016. JAMA Dermatol. 2019;155: 290-297. source
- Not matchedcites [178] 178. Centers for Disease Control and Prevention. Outpatient Antibiotic Prescriptions d United States, 2022. Updated November 15, 2025.. Accessed January 18, 2024. https:// www.cdc.gov/antibiotic-use/data/report-2022.html 179. 101. Margolis DJ, Fanelli M, Kupperman E, et al. Association of pharyngitis with oral antibiotic use for the treatment of acne: a cross-sectional and prospective cohort study. Arch Derma- tol. 2012;148:326-332.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“In a RCT of 925 patients comparing standard isotretinoin with lidoseisotretinoin, 81.0% of patients treated with standard isotretinoin experienced a 90% reduction in lesion count and 88.9% of patients treated with standard isotretinoin achieved treatment success after 20 weeks of treatment.151”
§ Guidelines of care for the management of acne vulgaris > ISOTRETINOIN
What the sources say
- Not checked — no full text of the sourcecites [151] 151. Webster GF, Leyden JJ, Gross JA. Results of a phase III, double-blind, randomized, parallel-group, non-inferiority study evaluating the safety and efficacy of isotretinoin- Lidose in patients with severe recalcitrant nodular acne. J Drugs Dermatol. 2014;13:665-670.
Strength:plain· not yet calibratedn = 925Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“In addition, TMP-SMX may be associated with severe adverse reactions such as Stevens-Johnson syndrome/toxic epidermal necrolysis and acute respiratory failure.”
§ Guidelines of care for the management of acne vulgaris > Considerations in systemic antibiotics
Strength:hedged· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“COC confers benefits beyond contraception and acne treatment, including regulating menstrual cycles, induction of amenorrhea, prevention of menstrual migraines, and treatment of conditions such as dysmenorrhea, hirsutism, menorrhagia, endometriosis-associated pelvic pain, premenstrual syndrome, among others.217”
§ Guidelines of care for the management of acne vulgaris > Combined oral contraceptives
What the sources say
- Not checked — no full text of the sourcecites [217] 217. ACOG practice bulletin no. 110: noncontraceptive uses of hormonal contraceptives. Obstet Gynecol. 2010;115: 206-218. source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“in a small RCT of 9 patients, most acne cysts injected with triamcinolone resolved within 3-7 days of the treatment, and those injected with triamcinolone resolved faster than those with saline control.239”
§ Guidelines of care for the management of acne vulgaris > Intralesional corticosteroid
What the sources say
- Not checked — no full text of the sourcecites [239] 239. Levine RM, Rasmussen JE. Intralesional corticosteroids in the treatment of nodulocystic acne. Arch Dermatol. 1983;119: 480-481. source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim could be matched to a paper in Crossref, so there is nothing to check it against.
In the paper
“Estimated VTE incidence per 10,000 person-years are estimated at approximately 1-5 in nonpregnant women who do not use COCs, 3-9 in COC users, 10 in drospirenone-containing COC users, 5-20 in pregnancy, and 40-65 in the 12-week postpartum period.208,210”
§ Guidelines of care for the management of acne vulgaris > Combined oral contraceptives
What the sources say
- Not matchedcites [208] 208. ACOG Committee Opinion Number 540. Risk of Venous Thromboembolism Among Users of Drospirenone- Containing Oral Contraceptive Pills. American College of Obstetricians and Gynecologists; 2012.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites [210] 210. Food and Drug Administration. Combined Hormonal Con- traceptives (CHCs) and the Risk of Cardiovascular Disease Endpoints. 2011. Accessed January 18, 2024. https://www. fda.gov/media/82335/download
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Not matched
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Available evidence is insufficient to develop a recommendation on the use of oral corticosteroids, flutamide, or metformin for acne treatment”
§ Guidelines of care for the management of acne vulgaris > Considerations in hormonal agents
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“Common side effects also include diuresis, breast tenderness, breast enlargement, gynecomastia, fatigue, headache, and dizziness.234”
§ Guidelines of care for the management of acne vulgaris > Spironolactone
What the sources say
- Not checked — no full text of the sourcecites [234] 234. Shaw JC, White LE. Long-term safety of spironolactone in acne: results of an 8-year followup study. J Cutan Med Surg. 2002;6:541-545. source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Sarecycline is dosed by weight at 1.5 mg/kg and is generally well tolerated with low incidence of gastrointestinal, photosensitivity, and Candida infection side effects.”
§ Guidelines of care for the management of acne vulgaris > Sarecycline
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“In a large cohort study of 108,547 patients with acne who received spironolactone for $30 days, 0.22% received a hyperkalemia diagnosis and 0.03% discontinued spironolactone within 30 days after hyperkalemia diagnosis.”
§ Guidelines of care for the management of acne vulgaris > Spironolactone
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Despite the remarkable effectiveness of isotretinoin observed in routine dermatology practice, clinical trial data regarding its efficacy are limited and of low quality.”
§ Guidelines of care for the management of acne vulgaris > ISOTRETINOIN
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“In a RCT of 33 patients with treatment-resistant cystic and conglobate acne, mean number of cystic lesions decreased by 17% and 33% at 1 and 2 months of isotretinoin treatment, but increased by 33% and 58% at 1 and 2 months of placebo”
§ Guidelines of care for the management of acne vulgaris > ISOTRETINOIN
What the sources say
- Not checked — no full text of the sourcecites [252] 252. Peck GL, Olsen TG, Butkus D, et al. Isotretinoin versus placebo in the treatment of cystic acne. A randomized double-blind study. J Am Acad Dermatol. 1982;6:735-745. source
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Clinicians should counsel patients about expected time to acne improvement with COCs, usually notable within 3-6 months”
§ Guidelines of care for the management of acne vulgaris > Combined oral contraceptives
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“data from 5 isotretinoin cohort studies estimated that risks of abnormal liver function tests above reference limits ranged from 0.8% to 10.4%, with 0.9% to 4.7% requiring treatment discontinuation”
§ Guidelines of care for the management of acne vulgaris > ISOTRETINOIN
What the sources say
- Not checked — no full text of the sourcecites [266] 266. Amichai B, Shemer A, Grunwald MH. Low-dose isotretinoin in the treatment of acne vulgaris. J Am Acad Dermatol. 2006;54: 644-646. source
- Not checked — no full text of the sourcecites [267] 267. Kızılyel O, Metin MS, Elmas € O F, C ¸ayır Y, Aktas ¸A. Effects of oral isotretinoin on lipids and liver enzymes in acne patients. Cutis. 2014;94:234-238.
- Not checked — no full text of the sourcecites [268] 268. Ghaffarpour G, Mazloomi S, Soltani-Arabshahi R, Seyed KS. Oral isotretinoin for acne, adjusting treatment according to patient's response. J Drugs Dermatol. 2006;5:878-882.
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Data from 6 isotretinoin cohort studies estimated that the risks of abnormal triglycerides ranged from 7.1% to 39.0% and abnormal cholesterol levels ranged from 6.8% to 27.2%”
§ Guidelines of care for the management of acne vulgaris > ISOTRETINOIN
What the sources say
- Not checked — no full text of the sourcecites [266] 266. Amichai B, Shemer A, Grunwald MH. Low-dose isotretinoin in the treatment of acne vulgaris. J Am Acad Dermatol. 2006;54: 644-646. source
- Not checked — no full text of the sourcecites [267] 267. Kızılyel O, Metin MS, Elmas € O F, C ¸ayır Y, Aktas ¸A. Effects of oral isotretinoin on lipids and liver enzymes in acne patients. Cutis. 2014;94:234-238.
- Not checked — no full text of the sourcecites [268] 268. Ghaffarpour G, Mazloomi S, Soltani-Arabshahi R, Seyed KS. Oral isotretinoin for acne, adjusting treatment according to patient's response. J Drugs Dermatol. 2006;5:878-882.
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“Common adverse effects associated with isotretinoin involve the mucocutaneous, musculoskeletal, and ophthalmic systems and generally resolve following isotretinoin discontinuation with standard treatment courses. 3”
§ Guidelines of care for the management of acne vulgaris > ISOTRETINOIN
What the sources say
- Not checked — no full text of the sourcecites [3] 3. Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74:945-973.e33. source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“In an RCT of 782 patients, lidose-isotretinoin showed non-inferiority in reducing facial and truncal nodular lesions and in the proportion of patients achieving $90% reduction of total lesions at 20 weeks (76.9% vs 81.0%; RR, 0.95 [0.88, 1.02]).”
§ Guidelines of care for the management of acne vulgaris > ISOTRETINOIN
What the sources say
- Not checked — no full text of the sourcecites [151] 151. Webster GF, Leyden JJ, Gross JA. Results of a phase III, double-blind, randomized, parallel-group, non-inferiority study evaluating the safety and efficacy of isotretinoin- Lidose in patients with severe recalcitrant nodular acne. J Drugs Dermatol. 2014;13:665-670.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“Among sexually active patients who reported non-adherence, 29% did not comply with consistent condom use and 39% missed 1 or more contraceptive pills in the previous month.”
§ Guidelines of care for the management of acne vulgaris > ISOTRETINOIN
What the sources say
- Not checked — no full text of the sourcecites [277] 277. Collins MK, Moreau JF, Opel D, et al. Compliance with pregnancy prevention measures during isotretinoin therapy. J Am Acad Dermatol. 2014;70:55-59. source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Population-based studies have not identified increased risk of neuropsychiatric conditions or IBD in patients with acne undergoing isotretinoin treatment”
§ Guidelines of care for the management of acne vulgaris > ISOTRETINOIN
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“Staphylococcus epidermidis, Staphylococcus aureus, and Malassezia species have also been identified in acne lesions, although causal relationships remain to be demonstrated.[41][42][43][44][45]”
§ Guidelines of care for the management of acne vulgaris > METHODS
What the sources say
- Not matchedcites [41][42][43][44][45]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Topical retinoids may cause photosensitivity; concurrent daily sunscreen use can reduce sunburn risks.”
§ Guidelines of care for the management of acne vulgaris > Topical retinoids
Strength:hedged· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“BP is an over-the-counter topical antimicrobial agent that releases free oxygen radicals and is mildly comedolytic.164,165”
§ Guidelines of care for the management of acne vulgaris > Benzoyl peroxide
What the sources say
- Not checked — no full text of the sourcecites [164] 164. Cunliffe WJ, Dodman B, Ead R. Benzoyl peroxide in acne. Practitioner. 1978;220:479-482.
- Not checked — no full text of the sourcecites [165] 165. Fulton JE Jr, Farzad-Bakshandeh A, Bradley S. Studies on the mechanism of action to topical benzoyl peroxide and vitamin A acid in acne vulgaris. J Cutan Pathol. 1974;1:191-200. source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“Clascoterone is a topical antiandrogen that directly binds the androgen receptor and inhibits androgen-mediated lipid and inflammatory cytokine synthesis from sebocytes.172”
§ Guidelines of care for the management of acne vulgaris > Clascoterone
What the sources say
- Not matchedcites [172] 172. Rosette C, Agan FJ, Mazzetti A, Moro L, Gerloni M. Cortex- olone 17alpha-propionate (clascoterone) is a novel androgen receptor antagonist that inhibits production of lipids and inflammatory cytokines from sebocytes in vitro. J Drugs Dermatol. 2019;18:412-418.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Not matched
In the paper
“Tetracycline-class antibiotics exhibit antibiotic properties by binding the 16S ribosomal RNA of the bacterial ribosome 30S subunit to inhibit protein synthesis, as well as anti-inflammatory properties by inhibiting neutrophil chemotaxis and matrix metalloproteinases and down-regulating inflammatory cytokines.176”
§ Guidelines of care for the management of acne vulgaris > SYSTEMIC ANTIBIOTICS
What the sources say
- Not checked — no full text of the sourcecites [176] 176. Perret LJ, Tait CP. Non-antibiotic properties of tetracyclines and their clinical application in dermatology. Australas J Dermatol. 2014;55:111-118. source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Azelaic acid is a topical comedolytic, antibacterial, and anti-inflammatory agent, which may be particularly helpful for patients with sensitive skin or darker skin types due to its lightening effect on dyspigmentation.96,97,173”
§ Guidelines of care for the management of acne vulgaris > Azelaic acid
What the sources say
- Not checked — no full text of the sourcecites [96] 96. Cunliffe WJ, Holland KT. Clinical and laboratory studies on treatment with 20% azelaic acid cream for acne. Acta Derm Venereol Suppl. 1989;143:31-34.
- Not checked — no full text of the sourcecites [97] 97. Katsambas A, Graupe K, Stratigos J. Clinical studies of 20% azelaic acid cream in the treatment of acne vulgaris. Com- parison with vehicle and topical tretinoin. Acta Derm Venereol Suppl. 1989;143:35-39.
- Not checked — no full text of the sourcecites [173] 173. Kircik LH. Efficacy and safety of azelaic acid (AzA) gel 15% in the treatment of post-inflammatory hyperpigmentation and acne: a 16-week, baseline-controlled study. J Drugs Dermatol. 2011;10:586-590.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“isotretinoin reduces the size and secretion of sebaceous glands, decreases surface and ductal level of sebumdependent C. acnes indirectly, inhibits comedogenesis by normalizing keratinocyte keratinization, and possesses anti-inflammatory properties. 251”
§ Guidelines of care for the management of acne vulgaris > ISOTRETINOIN
What the sources say
- Not checked — no full text of the sourcecites [251] 251. Villani A, Nastro F, Di Vico F, Fabbrocini G, Annunziata MC, Genco L. Oral isotretinoin for acne: a complete overview. Expert Opin Drug Saf. 2022;21:1027-1037. source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Spironolactone crosses the placenta and exposure in utero in animal studies may cause feminization of a male fetus.”
§ Guidelines of care for the management of acne vulgaris > Spironolactone
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Spironolactone is not FDA-approved for the treatment of acne.”
§ Guidelines of care for the management of acne vulgaris > Spironolactone
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Oral doxycycline, minocycline, and sarecycline are FDA-approved for the management of acne.”
§ Guidelines of care for the management of acne vulgaris > Considerations in systemic antibiotics
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Prednisone 0.5-1 mg/kg/day has been used to treat acne fulminans, isotretinoin-induced acne fulminans and to prevent isotretinoin-induced acne flares in at-risk patients.249,250”
§ Guidelines of care for the management of acne vulgaris > Considerations in hormonal agents
What the sources say
- Not checked — no full text of the sourcecites [249] 249. Jansen T, Plewig G. Acne fulminans. Int J Dermatol. 1998;37: 254-257. source
- Not checked — no full text of the sourcecites [250] 250. Karvonen SL. Acne fulminans: report of clinical findings and treatment of twenty-four patients. J Am Acad Dermatol. 1993; 28:572-579. source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Spironolactone is an aldosterone receptor antagonist that decreases testosterone production and competitively inhibits testosterone and dihydrotestosterone binding to androgen receptors in the skin.”
§ Guidelines of care for the management of acne vulgaris > Spironolactone
What the sources say
- Not checked — no full text of the sourcecites [225] 225. Boisselle A, Dionne FT, Tremblay RR. Interaction of spirono- lactone with rat skin androgen receptor. Can J Biochem. 1979; 57:1042-1046. source
- Not checked — no full text of the sourcecites [226] 226. Menard RH, Martin HF, Stripp B, Gillette JR, Bartter FC. Spironolactone and cytochrome P-450: impairment of steroid hydroxylation in the adrenal cortex. Life Sci. 1974;15:1639- 1648. source
- Not checked — no full text of the sourcecites [227] 227. Menard RH, Stripp B, Gillette JR. Spironolactone and testic- ular cytochrome P-450: decreased testosterone formation in several species and changes in hepatic drug metabolism. Endocrinology. 1974;94:1628-1636. source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“A recent Delphi consensus study of 22 acne experts reached agreement on checking alanine aminotransferase and triglycerides prior to initiation and at peak isotretinoin dose and on not checking complete blood count, low-density lipoprotein or highdensity lipoprotein.”
§ Guidelines of care for the management of acne vulgaris > ISOTRETINOIN
What the sources say
- Not checked — no full text of the sourcecites [273] 273. Xia E, Han J, Faletsky A, et al. Isotretinoin laboratory monitoring in acne treatment: a Delphi consensus study. JAMA Dermatol. 2022;158:942-948. source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Notably, the US Preventive Service Task Force recommends screening for depression in adults 291 and in adolescents aged 12-18 years 295 and recommends screening for anxiety in adolescents aged 8-18 years, 296 regardless of exposure to isotretinoin, each with grade B recommendations that concludes with moderate certainty that such screening yields moderate net benefits.”
§ Guidelines of care for the management of acne vulgaris > ISOTRETINOIN
What the sources say
- Not checked — no full text of the sourcecites [291] 291. Siu AL, , US Preventive Services Task Force (USPSTF), Bibbins- Domingo K, Grossman DC, et al. Screening for depression in adults: US preventive services task force recommendation statement. JAMA. 2016;315:380-387. source
- Not checked — no full text of the sourcecites [295] 295. US Preventive Services Task Force, Mangione CM, Barry MJ, Nicholson WK, et al. Screening for depression and suicide risk in children and adolescents: US preventive services task force recommendation statement. JAMA. 2022;328:1534-1542. source
- Not checked — no full text of the sourcecites [296] 296. US Preventive Services Task Force, Mangione CM, Barry MJ, Nicholson WK, et al. Screening for anxiety in children and adolescents: US preventive services task force recommenda- tion statement. JAMA. 2022;328:1438-1444. source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Full-face dermabrasion, mechanical dermabrasion with rotary devices, and ablative laser treatment of the entire face or non-facial regions are not recommended within 6 months of isotretinoin use due to increased risks of adverse events.”
§ Guidelines of care for the management of acne vulgaris > ISOTRETINOIN
What the sources say
- Not checked — no full text of the sourcecites [298] 298. Waldman A, Bolotin D, Arndt KA, et al. ASDS guidelines task force: consensus recommendations regarding the safety of lasers, dermabrasion, chemical peels, Energy devices, and skin surgery during and after isotretinoin use. Dermatol Surg. 2017;43:1249-1262. source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“Expert consensus from the American Society of Dermatologic Surgery concluded that there is insufficient evidence to justify delaying treatment with superficial chemical peels and nonablative lasers, including hair removal lasers and lights, vascular lasers, and nonablative fractional devices for patients currently receiving or recently received isotretinoin.”
§ Guidelines of care for the management of acne vulgaris > ISOTRETINOIN
What the sources say
- Not checked — no full text of the sourcecites [298] 298. Waldman A, Bolotin D, Arndt KA, et al. ASDS guidelines task force: consensus recommendations regarding the safety of lasers, dermabrasion, chemical peels, Energy devices, and skin surgery during and after isotretinoin use. Dermatol Surg. 2017;43:1249-1262. source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“Long-acting reversible contraceptives, including intrauterine devices and contraceptive implants, should be considered as the primary contraceptive method whenever clinically appropriate since they have higher effectiveness than COCs and condoms in reducing the risk of unintended pregnancy and do not depend on ongoing patient efforts.”
§ Guidelines of care for the management of acne vulgaris > ISOTRETINOIN
What the sources say
- Not matchedcites [278] 278. Committee on Practice Bulletins-Gynecology, Long-Acting Reversible Contraception Work Group. Practice bulletin No. 186: long-acting reversible contraception: implants and intrauterine devices. Obstet Gynecol. 2017;130:e251-e269.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Not matched
The paper relies on this without support.
Cutibacterium acnes has specific culture requirements that prevent growth in routine bacterial culture.
“C. acnes has specific culture requirements that prevent growth in routine bacterial culture.”
The paper relies on this without support.
Routine microbiologic and/or antibiotic susceptibility testing does not affect acne management.
“routine microbiologic and/or antibiotic susceptibility testing is not indicated for patients with acne since it does not affect management.”
The paper relies on this without support.
Androgens such as testosterone and dehydroepiandrosterone sulfate have central roles in acne pathogenesis.
“Androgens, such as testosterone and dehydroepiandrosterone sulfate, have central roles in the pathogenesis of acne.”
The paper relies on this without support.
Polycystic ovarian syndrome is a common cause of hyperandrogenism, characterized by ovulatory dysfunction or polycystic ovaries on ultrasonography.
“Polycystic ovarian syndrome is a common cause of hyperandrogenism, characterized by ovulatory dysfunction or polycystic ovaries on ultrasonography.”
The paper relies on this without support.
Topical retinoids are comedolytic and anti-inflammatory, improve dyspigmentation, and enable maintenance of acne clearance.
“Topical retinoids are vitamin A derivatives and serve as the cornerstone of acne treatment since they are comedolytic and anti-inflammatory, improve dyspigmentation, and enable maintenance of acne clearance.”
The paper relies on this without support.
Each retinoid binds to a different set of retinoic acid receptors and confers modest differences in activity, tolerability and efficacy.
“Each retinoid binds to a different set of retinoic acid receptors and confers modest differences in activity, tolerability and efficacy.”
The paper relies on this without support.
Combining topical antibiotics with benzoyl peroxide enhances efficacy and may prevent antibiotic resistance development.
“Combining topical antibiotics with BP enhances efficacy and may prevent antibiotic resistance development.”
The paper relies on this without support.
Potential adverse effect profiles of fixed-dose combinations generally reflect those of the individual agents in summation.
“Potential adverse effect profiles of the fixed-dose combinations generally reflect those of the individual agents in summation.”
The paper relies on this without support.
Salicylic acid is a topical comedolytic agent available over the counter, with concentration ranging in 0.5% to 2%.
“Salicylic acid is a topical comedolytic agent that is available over the counter, with concentration ranging in 0.5% to 2%.”
The paper relies on this without support.
Tetracycline-class antibiotics are contraindicated in pregnancy, lactation, and childhood below age 9 years during tooth development, since repeated exposure may cause permanent teeth enamel hypoplasia or discoloration.
“Notably, tetracycline-class antibiotics are contraindicated in pregnancy, lactation, and childhood below age 9 years during tooth development, since repeated exposure may cause permanent teeth enamel hypoplasia or discoloration.”
The paper relies on this without support.
Increasing azithromycin use could increase antibiotic resistance.
“increasing azithromycin use could increase antibiotic resistance.”
The paper relies on this without support.
Tetracycline-class antibiotics can cause permanent teeth discoloration and inhibit bone growth in a fetus or nursing infant.
“tetracyclineclass antibiotics should be avoided due to potential for permanent teeth discoloration and bone growth inhibition in the fetus or nursing infant.”
The paper relies on this without support.
The high current cost of sarecycline may affect equitable access to acne treatment.
“concerns about the high current cost of sarecycline treatment that may impact equitable acne treatment access.”
The paper relies on this without support.
Rare potential adverse effects of minocycline, including vertigo, autoimmune hepatitis, skin hyperpigmentation, drug-induced lupus, and hypersensitivity syndrome, are concerns that justify a conditional recommendation.
“concerns about rare potential adverse effects of minocycline, which include vertigo, autoimmune hepatitis, skin hyperpigmentation, drug-induced lupus, and hypersensitivity syndrome.”
The paper relies on this without support.
Patient values and preferences regarding contraception vary.
“variability in patient values and preferences related to contraception”
The paper relies on this without support.
Broad use of antibiotics for acne can select for antibiotic-resistant bacteria.
“broad use for acne should be discouraged to avoid selection of antibiotic-resistant bacteria.”
The paper relies on this without support.
Depression, anxiety, and suicidal ideation/suicide are highly prevalent in the general population, especially among adolescents who may be candidates for isotretinoin therapy.
“given high prevalence of depression, anxiety and suicidal ideation/suicide in the general population, and especially the adolescent population who may be candidates for isotretinoin therapy”
The paper relies on this without support.
Standard isotretinoin has better bioavailability when taken with a high-fat meal, whereas lidose-isotretinoin bioavailability is less affected by food intake.
“Standard isotretinoin has better bioavailability when taken with a high fat meal, whereas the bioavailability of lidose-isotretinoin is less affected by whether it is taken with food.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Salicylic-acid evidence is graded two ways
MajorThe treatment section calls the evidence moderate certainty, while Table III grades the same recommendation as low certainty.
“We conditionally recommend salicylic acid for acne treatment based on moderate certainty evidence from 1 RCT”
“1.6 For patients with acne, we conditionally recommend salicylic acid.Conditional Low 95”
COC effect estimate falls outside its confidence interval
MajorThe reported noninflammatory-lesion estimate is −19.45%, but its stated interval runs from −9.9% to −9.0%. The interval's midpoint is −9.45%, so it cannot contain the reported estimate.
Reported -19.45 · recomputed -9.45
“noninflammatory (MD, À19.45% [À9.9, À9.0]) lesion counts”
Citations
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Self-citationFrequency of Pregnancy in Acne Patients Taking Oral Antibiotics and Oral Contraceptives
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Self-citationTOPICAL RETINOIC ACID IN ACNE VULGARIS
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Flagged first, then by citations
43 of the 358 references couldn’t be matched to a known paper.
Research works printed but not linked: 5
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Cited by
Sorted by citations
Ludwig, R. J., Anson, M., Zirpel, H., Thaçi, D., Olbrich, H., Bieber, K., Kridin, K., Dempfle, A., Curman, P., Zhao, S. S., et al. (2025) · Frontiers in Pharmacology · doi:10.3389/fphar.2025.1516126 · Cited by 299
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“The accurate assessment of acne severity through standardized grading and classi-fication systems is pivotal for guiding treatment strategies and evaluating therapeutic outcomes [337].”
BackgroundMethodZhou, Z., Zhong, X., Luo, Z., Liu, M., Zhang, H., Zheng, H., & Li, J. (2024) · British Journal of Dermatology · doi:10.1093/bjd/ljae352 · Cited by 81
Third-Generation Tetracyclines: Current Knowledge and Therapeutic Potential
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“Therefore, it will not be discussed further in this review article [10].”
BackgroundThe Role of the Skin Microbiome in Acne: Challenges and Future Therapeutic Opportunities
Niedźwiedzka, A., Micallef, M. P., Biazzo, M., & Podrini, C. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms252111422 · Cited by 77
Metadata
- Authors
- Reynolds, R. V., Yeung, H., Cheng, C. E., Cook-Bolden, F., Desai, S. R., Druby, K. M., Freeman, E. E., Keri, J. E., Stein Gold, L. F., Tan, J. K. L., Tollefson, M. M., Weiss, J. S., Wu, P. A., Zaenglein, A. L., Han, J. M., & Barbieri, J. S.
- Affiliations
- Beth Israel Deaconess Medical Center (US)
- Emory University (US)
- University of California, Los Angeles (US)
- Weill Cornell Medicine (US)
- The University of Texas Southwestern Medical Center (US)
- Pennsylvania State University (US)
- Massachusetts General Hospital (US)
- University of Miami (US)
- Western University (CA)
- Mayo Clinic (US)
- University of California Davis Medical Center (US)
- American Academy of Dermatology (US)
- Brigham and Women's Hospital (US)
- Corresponding author
- Han, Jung Min
- ORCID
- Venue
- Journal of the American Academy of Dermatology
- Publisher
- Elsevier BV
- Published
- 2024-05
- Volume
- 90
- Issue
- 5
- Pages
- 1006.e1-1006.e30
- ISSN
- 0190-9622 (ISSN-L)
- OpenAlex
- W4391339756
- Cited by
- 518
- References
- 358
- Citations by year
- 2026: 224 · 2025: 211 · 2024: 82
- FWCI
- 209.33
- Type
- journal article
- Language
- en
- Update notices
- Open access
- bronze
- doi.org
- Locations
- Journal of the American Academy of Dermatology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Academy of Dermatology
- Topics
- Health Sciences › Medicine › Dermatology › Acne and Rosacea Treatments and Effects
- Health Sciences › Medicine › Dermatology › Dermatologic Treatments and Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- acne, acne treatment, benzoyl peroxide, topical retinoids, topical antibiotics, oral doxycycline, oral isotretinoin, clascoterone, salicylic acid, azelaic acid, minocycline, sarecycline, combined oral contraceptives, spironolactone, intralesional corticosteroids, scar formation, psychosocial burden
- MeSH terms
- Acne Vulgaris, Administration, Cutaneous, Administration, Oral, Adrenal Cortex Hormones, Anti-Bacterial Agents, Benzoyl Peroxide, Contraceptives, Oral, Combined, Cortodoxone, Dermatologic Agents, Dicarboxylic Acids, Doxycycline, Drug Therapy, Combination, Humans, Minocycline, Propionates, Retinoids, Spironolactone, Tetracyclines, Isotretinoin, Injections, Intralesional, Evidence-Based Medicine, Salicylic Acid
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-09-30, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-09-30 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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