Estadísticas

 array:23 [
  "pii" => "S0001731024005830"
  "issn" => "00017310"
  "doi" => "10.1016/j.ad.2024.07.010"
  "estado" => "S300"
  "fechaPublicacion" => "2024-09-01"
  "aid" => "4017"
  "copyrightAnyo" => "2024"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "pgl"
  "cita" => "Actas Dermosifiliogr. 2024;115:T791-T800"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S0001731024004162"
    "issn" => "00017310"
    "doi" => "10.1016/j.ad.2024.04.020"
    "estado" => "S300"
    "fechaPublicacion" => "2024-09-01"
    "aid" => "3956"
    "copyright" => "AEDV"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "pgl"
    "cita" => "Actas Dermosifiliogr. 2024;115:801-13"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "es" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">DOCUMENTO DE CONSENSO</span>"
      "titulo" => "Mejoras en la atenci&#243;n al paciente con psoriasis pustulosa generalizada en Espa&#241;a&#58; recomendaciones de un grupo de expertos"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "801"
          "paginaFinal" => "813"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Improvements in the Management of Patients With Generalized Pustular Psoriasis in Spain&#58; Recommendations From a Group of Experts"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0025"
          "etiqueta" => "Figura 5"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr5.jpeg"
              "Alto" => 1297
              "Ancho" => 2055
              "Tamanyo" => 169124
            ]
          ]
          "descripcion" => array:1 [
            "es" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Seguimiento&#46; Recorrido asistencial actual del paciente con PPG&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "R&#46; Rivera-D&#237;az, J&#46;M&#46; Carrascosa Carrillo, S&#46; Alfonso Zamora, J&#46;P&#46; Navarro Valdivieso, B&#46; Mu&#241;oz Cabello, S&#46; Ros Abarca, J&#46;M&#46; Soria de Francisco, E&#46; Daud&#233;n Tello"
          "autores" => array:8 [
            0 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Rivera-D&#237;az"
            ]
            1 => array:2 [
              "nombre" => "J&#46;M&#46;"
              "apellidos" => "Carrascosa Carrillo"
            ]
            2 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Alfonso Zamora"
            ]
            3 => array:2 [
              "nombre" => "J&#46;P&#46;"
              "apellidos" => "Navarro Valdivieso"
            ]
            4 => array:2 [
              "nombre" => "B&#46;"
              "apellidos" => "Mu&#241;oz Cabello"
            ]
            5 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Ros Abarca"
            ]
            6 => array:2 [
              "nombre" => "J&#46;M&#46;"
              "apellidos" => "Soria de Francisco"
            ]
            7 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "Daud&#233;n Tello"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731024004162?idApp=UINPBA000044"
    "url" => "/00017310/0000011500000008/v1_202409020432/S0001731024004162/v1_202409020432/es/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "S0001731024003387"
    "issn" => "00017310"
    "doi" => "10.1016/j.ad.2024.03.032"
    "estado" => "S300"
    "fechaPublicacion" => "2024-09-01"
    "aid" => "3932"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "pgl"
    "cita" => "Actas Dermosifiliogr. 2024;115:791-800"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "es" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Documento de consenso</span>"
      "titulo" => "Consenso Iberia sobre estrategias de prevenci&#243;n y manejo de la irritaci&#243;n por retinoides t&#243;picos en acn&#233; localizado en cara y tronco"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "791"
          "paginaFinal" => "800"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Iberia Consensus on Strategies to Prevent and Manage Irritation by Topical Retinoids in Facial and Trunk Acne"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figura 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 2953
              "Ancho" => 2341
              "Tamanyo" => 371519
            ]
          ]
          "descripcion" => array:1 [
            "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Recomendaciones del grupo de expertos para prevenir&#47;reducir la irritaci&#243;n de la piel en el tratamiento t&#243;pico del acn&#233; con retinoides&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "V&#46; Aneri, A&#46; Catarino, C&#46; Eguren, I&#46; Hern&#225;ndez, N&#46; Merino, S&#46; Nogu&#233;s, L&#46; Ob&#243;n, M&#46; Salleras"
          "autores" => array:8 [
            0 => array:2 [
              "nombre" => "V&#46;"
              "apellidos" => "Aneri"
            ]
            1 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Catarino"
            ]
            2 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Eguren"
            ]
            3 => array:2 [
              "nombre" => "I&#46;"
              "apellidos" => "Hern&#225;ndez"
            ]
            4 => array:2 [
              "nombre" => "N&#46;"
              "apellidos" => "Merino"
            ]
            5 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Nogu&#233;s"
            ]
            6 => array:2 [
              "nombre" => "L&#46;"
              "apellidos" => "Ob&#243;n"
            ]
            7 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Salleras"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731024003387?idApp=UINPBA000044"
    "url" => "/00017310/0000011500000008/v1_202409020432/S0001731024003387/v1_202409020432/es/main.assets"
  ]
  "asociados" => array:1 [
    0 => array:17 [
      "pii" => "S0001731024003387"
      "issn" => "00017310"
      "doi" => "10.1016/j.ad.2024.03.032"
      "estado" => "S300"
      "fechaPublicacion" => "2024-09-01"
      "aid" => "3932"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "pgl"
      "cita" => "Actas Dermosifiliogr. 2024;115:791-800"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:1 [
        "total" => 0
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Documento de consenso</span>"
        "titulo" => "Consenso Iberia sobre estrategias de prevenci&#243;n y manejo de la irritaci&#243;n por retinoides t&#243;picos en acn&#233; localizado en cara y tronco"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "791"
            "paginaFinal" => "800"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Iberia Consensus on Strategies to Prevent and Manage Irritation by Topical Retinoids in Facial and Trunk Acne"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0010"
            "etiqueta" => "Figura 2"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr2.jpeg"
                "Alto" => 2953
                "Ancho" => 2341
                "Tamanyo" => 371519
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Recomendaciones del grupo de expertos para prevenir&#47;reducir la irritaci&#243;n de la piel en el tratamiento t&#243;pico del acn&#233; con retinoides&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "V&#46; Aneri, A&#46; Catarino, C&#46; Eguren, I&#46; Hern&#225;ndez, N&#46; Merino, S&#46; Nogu&#233;s, L&#46; Ob&#243;n, M&#46; Salleras"
            "autores" => array:8 [
              0 => array:2 [
                "nombre" => "V&#46;"
                "apellidos" => "Aneri"
              ]
              1 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Catarino"
              ]
              2 => array:2 [
                "nombre" => "C&#46;"
                "apellidos" => "Eguren"
              ]
              3 => array:2 [
                "nombre" => "I&#46;"
                "apellidos" => "Hern&#225;ndez"
              ]
              4 => array:2 [
                "nombre" => "N&#46;"
                "apellidos" => "Merino"
              ]
              5 => array:2 [
                "nombre" => "S&#46;"
                "apellidos" => "Nogu&#233;s"
              ]
              6 => array:2 [
                "nombre" => "L&#46;"
                "apellidos" => "Ob&#243;n"
              ]
              7 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Salleras"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731024003387?idApp=UINPBA000044"
      "url" => "/00017310/0000011500000008/v1_202409020432/S0001731024003387/v1_202409020432/es/main.assets"
    ]
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Consensus Document</span>"
    "titulo" => " Iberia Consensus on Strategies to Prevent and Manage Irritation by Topical Retinoids in Facial and Trunk Acne"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "T791"
        "paginaFinal" => "T800"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "V&#46; Aneri, A&#46; Catarino, C&#46; Eguren, I&#46; Hern&#225;ndez, N&#46; Merino, S&#46; Nogu&#233;s, L&#46; Ob&#243;n, M&#46; Salleras"
        "autores" => array:8 [
          0 => array:4 [
            "nombre" => "V&#46;"
            "apellidos" => "Aneri"
            "email" => array:1 [
              0 => "aneriderma@gmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "Catarino"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "C&#46;"
            "apellidos" => "Eguren"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "I&#46;"
            "apellidos" => "Hern&#225;ndez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "N&#46;"
            "apellidos" => "Merino"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "S&#46;"
            "apellidos" => "Nogu&#233;s"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "aff0030"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "L&#46;"
            "apellidos" => "Ob&#243;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">g</span>"
                "identificador" => "aff0035"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Salleras"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">h</span>"
                "identificador" => "aff0040"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:8 [
          0 => array:3 [
            "entidad" => "Consulta Privada-Dermoclinic&#44; M&#225;laga&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Hospital Egas Moniz&#44; Centro Hospitalar de Lisboa Ocidental&#44; Lisboa&#44; Portugal"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Cl&#237;nica Eguren&#44; Madrid&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Centro de especialidades Ricardo Tr&#233;nor&#44; Hospital La Fe&#44; Valencia&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Dermamedicin Cl&#237;nicas&#44; Santa Cruz de Tenerife&#44; Spain"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
          5 => array:3 [
            "entidad" => "Centro M&#233;dico Sanitas Milenium&#44; Tarragona&#44; Spain"
            "etiqueta" => "f"
            "identificador" => "aff0030"
          ]
          6 => array:3 [
            "entidad" => "C&#46;E&#46; Juan Llorens&#44; Valencia&#44; Spain"
            "etiqueta" => "g"
            "identificador" => "aff0035"
          ]
          7 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital Sagrat Cor&#44; Grupo Quironsalud&#44; Barcelona&#44; Spain"
            "etiqueta" => "h"
            "identificador" => "aff0040"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Consenso Iberia sobre estrategias de prevenci&#243;n y manejo de la irritaci&#243;n por retinoides t&#243;picos en acn&#233; localizado en cara y tronco"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 2956
            "Ancho" => 2340
            "Tamanyo" => 491220
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Recommendations from the expert group to prevent&#47;reduce skin irritation in the topical treatment of acne with retinoids&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Acne is a highly prevalent chronic inflammatory disease worldwide&#44; affecting approximately 80&#37; of adolescents &#40;from 13 to 18 years old&#41;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">1</span></a> that usually grows into adulthood&#46; In its most severe or persistent forms&#44; it leads to a series of psychosocial effects that can negatively impact the patient&#39;s quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Currently&#44; retinoids &#40;both oral and topical&#41; are the gold standard to treat acne as first-line therapy according to the main national and international clinical practice guidelines&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">3&#8211;6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The first topical retinoid for acne therapy was tretinoin&#44; also known as retinoic acid&#44; which was approved by the U&#46;S&#46; Food and Drug Administration &#40;FDA&#41; in the 1970s&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">7</span></a> Since then&#44; other retinoids such as isotretinoin&#44; adapalene&#44; and trifarotene have also been approved and are currently marketed in Spain and Portugal to treat acne&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Retinoids work by activating nuclear retinoic acid receptors in the skin&#46; These receptors regulate gene expression&#44; which in turn can improve cell turnover&#44; reduce sebum production&#44; and increase collagen production&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">9</span></a> However&#44; this process can also cause skin irritation&#46; Retinoids can increase the production of enzymes that degrade collagen and skin proteins&#44; leading to dryness&#44; peeling&#44; and redness&#46; Additionally&#44; retinoids can alter the skin lipid barrier&#44; making it more susceptible to water loss and&#44; therefore&#44; drier&#44; more sensitive&#44; and more prone to irritation&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">10&#44;11</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Although skin irritation is considered a sign that treatment is working&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">12</span></a> as it indicates that the skin is experiencing faster cell turnover&#44; excessive irritation can be counterproductive and cause the patient to abandon the treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">13</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In our routine dermatological clinical practice&#44; we are used to managing the tolerability issues associated with retinoids&#44; using different strategies to minimize potential irritation&#46; These include&#58; 1&#41; training the patient on the correct application of treatment&#44; especially within the first few weeks&#44; and 2&#41; using cosmetics as adjuncts to maintain proper hygiene and hydration of the affected area&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">However&#44; literature supporting these strategies is scarce&#44; as well as information on how to properly prevent or efficiently treat tolerability issues associated with topical retinoids in facial and truncal acne&#46; This knowledge and these skills should become part of the expertise of all health professionals involved in the management of acne&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The objective of this consensus document was to validate a series of recommendations aimed at improving the approach to patients with acne and the tolerability of topical retinoid therapies&#46; We consider these recommendations of great interest to health professionals often dealing with acne patients&#44; including dermatologists&#44; general practitioners&#44; and pediatricians&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Method</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Selection of participants</span><p id="par0045" class="elsevierStylePara elsevierViewall">One scientific committee for the project was established&#44; including 8 dermatologists &#40;7 Spanish and 1 Portuguese&#41; focused on facial and truncal acne&#46; The committee&#44; with methodological assistance&#44; defined the objectives&#44; scope&#44; and sections of the document&#46; Four major topic groups were addressed&#58; 1&#41; preferences for topical acne treatment&#59; 2&#41; skin irritation and topical acne treatment with retinoids&#59; 3&#41; recommendations&#47;guidelines to prevent&#47;reduce skin irritation in topical acne treatment with retinoids&#59; and 4&#41; extreme weather conditions and skin irritation and topical acne treatment with retinoids&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Literature review and preliminary recommendations</span><p id="par0050" class="elsevierStylePara elsevierViewall">A literature review &#40;PUBMED and COCHRANE&#41; on recommendations and strategies to improve the tolerability of topical retinoids in acne treatment was conducted&#46; With the information obtained&#44; the scientific committee created a series of preliminary recommendations&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Scientific committee meetings</span><p id="par0055" class="elsevierStylePara elsevierViewall">The scientific committee met twice to review and confirm the objectives&#44; scope&#44; and sections of the document&#46; Subsequently&#44; the results of the literature review and the provisional recommendations were presented and discussed&#46; This led to the definition of 34 final recommendations&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Delphi</span><p id="par0060" class="elsevierStylePara elsevierViewall">The 34 final recommendations were subjected to consensus using the Delphi method<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">14</span></a> to establish the level of agreement on such recommendations&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">This was done online through Google Forms and&#44; in addition to the scientific committee&#44; these recommendations were submitted to 125 dermatologists &#40;108 Spanish and 17 Portuguese&#41;&#46; Votes were cast on a Likert scale<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">15</span></a> from 1 &#40;totally agree&#41; to 5 &#40;totally disagree&#41;&#46; Consensus was defined when&#44; at least&#44; 85&#37; of participants voted &#8804; 2 &#40;totally agree and agree&#41;&#44; and majority when&#44; at least&#44; 70&#37; of participants voted &#8804; 2&#46; Recommendations with a level of agreement &#60;<span class="elsevierStyleHsp" style=""></span>85&#37; in the 1<span class="elsevierStyleSup">st</span> round of voting were voted in a 2<span class="elsevierStyleSup">nd</span> Delphi round &#40;the cutoff values did not change from the 1<span class="elsevierStyleSup">st</span> to the 2<span class="elsevierStyleSup">nd</span> Delphi round&#41;&#46; This methodology was selected due to its common and recent use in the field of acne&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">16&#44;17</span></a></p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0070" class="elsevierStylePara elsevierViewall">Consensus was reached on 22 recommendations &#40;64&#46;70&#37;&#41;&#44; 19 in the 1<span class="elsevierStyleSup">st</span> round and 3 in the 2<span class="elsevierStyleSup">nd</span> round&#46; A total of 6 recommendations &#40;17&#46;65&#37;&#41; achieved a majority consensus&#44; as opposed to another 6 &#40;17&#46;65&#37;&#41; which did not &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; The results of the 2 rounds of voting on the 34 recommendations are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">table 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Block A&#46; On the preferences for topical acne therapy</span><p id="par0075" class="elsevierStylePara elsevierViewall">When prescribing a topical treatment for facial and truncal acne&#44; what experts value most is its efficacy and tolerability&#44; with a 95&#46;5&#37; and 90&#46;2&#37; level of agreement respectively reached in the 1<span class="elsevierStyleSup">st</span> round&#46; Simplicity in the routine&#47;dosage achieved a 75&#46;9&#37; level of agreement in the 1<span class="elsevierStyleSup">st</span> round and majority consensus in the 2<span class="elsevierStyleSup">nd</span> round with a 82&#46;7&#37; level of agreement&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Recommendation &#35;4&#46;</span> Skin irritation is a barrier to prescribing a topical treatment&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Since only 64&#46;7&#37; of participants agreed with this statement in the 2<span class="elsevierStyleSup">nd</span> round&#44; it did not reach consensus&#46; That skin irritation is a barrier to prescribing a topical treatment is a debatable and nuanced issue&#44; as experts consider it a limiting factor only if appropriate measures to prevent or treat irritation are not taken&#44; such as prescribing specific non-comedogenic moisturizers or spacing out applications if necessary&#46; With proper precautions&#44; skin irritation should not be an obstacle to prescribing topical retinoids for facial or truncal acne&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Recommendation &#35;5&#46;</span> The waiting time to obtain results is a barrier to prescribing a topical treatment&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">This statement received a &#60;<span class="elsevierStyleHsp" style=""></span>50&#37; &#40;47&#46;10&#37;&#41; level of agreement in the 2<span class="elsevierStyleSup">nd</span> round&#44; and was&#44; therefore&#44; unable to reach consensus&#46; The lack of agreement on this issue created some controversy within the group&#44; as&#8211;a priori&#8211;the waiting time to see the first results was considered a relevant variable since patients usually prefer quick results&#46; Any retinoid &#40;whether oral or topical&#41; takes time before the first results are noticeable&#44; being a common thing for oral retinoids to cause an initial worsening of acne within the first weeks of treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">18</span></a> One expert recommended starting with topical&#8212;before oral&#8212;retinoid treatment to avoid the usual initial worsening associated with oral retinoids&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">There are patients for whom topical retinoid treatment would be indicated regardless of the time it takes to achieve results&#44; such as patients who do not meet criteria for oral treatment&#44; patients who need combined therapies &#40;oral and topical&#41;&#44; and those requiring maintenance with topical retinoids after finishing oral retinoid treatment&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Recommendation &#35;6&#46;</span> Photosensitivity is a barrier to prescribing a topical treatment&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">With only 30&#46;10&#37; agreement in the 2<span class="elsevierStyleSup">nd</span> round&#44; this statement received the lowest level of agreement of all consensus statements&#46; It is well-known that sun exposure should be avoided while on topical retinoids&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">7</span></a> which is why it was particularly notable that there was no agreement on this issue&#46; After analyzing the results&#44; the expert committee explained this lack of agreement by considering that photosensitivity is not a barrier <span class="elsevierStyleItalic">per se</span> since there are easily accessible and applicable tools &#40;photoprotectors&#41; for patients&#46; None of the experts&#44; from the Iberian Peninsula or the Balearic and Canary Islands&#44; would refrain from prescribing a topical treatment due to photosensitivity&#46; Even in some cases with a high risk of photosensitivity&#44; topical retinoid treatment might be preferred over full-dose oral retinoids&#44; which can have more side effects of irritation and photosensitivity than a properly applied topical treatment&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Block B&#46; On skin irritation and topical acne treatment with retinoids</span><p id="par0115" class="elsevierStylePara elsevierViewall">The 6 recommendations voted in this block reached consensus &#40;level of agreement &#8805; 85&#37;&#41; in the 1<span class="elsevierStyleSup">st</span> round&#44; making it the block with the highest level of agreement among all those evaluated&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Recommendation &#35;8&#46;</span> Mild and controllable skin irritation frequently occurs at the beginning of treatment&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Recommendation &#35;10&#46;</span> It is important to tell the patient that temporary irritation is normal and expected and&#44; therefore&#44; treatment should not be discontinued&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">These 2 recommendations achieved consensus with a 98&#46;5&#37; level of agreement&#46; Consensus was unanimous regarding irritation being associated with topical retinoid treatment as an expected&#44; mild&#44; and controllable side effect at the beginning of treatment that tends to decrease over time&#46; The entire expert committee agreed on the importance of explaining how retinoids work to avoid treatment discontinuation due to a lack of results within the first few days of treatment or poor tolerability&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Recommendation &#35;7&#46;</span> I consider that irritation is an expected reaction at the start of treatment and not an undesirable side effect&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Recommendation &#35;12&#46;</span> Patients who follow the application recommendations&#47;guidelines properly tend to have fewer skin irritation problems than those who do not&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">These 2 issues reached consensus with a 94&#46;7&#37; level of agreement in the 1<span class="elsevierStyleSup">st</span> round&#46; The experts showed a high level of agreement on the importance of explaining patients that if they apply the guidelines&#47;recommendations properly&#44; they will have fewer tolerability issues&#44; and that they should not discontinue treatment despite initial irritation since it is not an undesirable side effect &#40;except for very sensitive skin&#41;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Recommendation &#35;11&#46;</span> Skin irritation can be prevented and&#47;or reduced by following correct application guidelines&#47;recommendations&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">A total of 97&#37; of participants considered that skin irritation treated with topical retinoids can be prevented&#47;reduced if the proper guidelines&#47;recommendations are followed&#46; The expert committee summarized the main recommendations in <a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Block C&#46; On recommendations&#47;guidelines to prevent&#47;reduce skin irritation in topical acne treatment with retinoids</span><p id="par0160" class="elsevierStylePara elsevierViewall">In this block&#44; a total of 7 recommendations were evaluated&#44; 4 of which reached consensus in the 1<span class="elsevierStyleSup">st</span> round&#46; Specifically&#44; <span class="elsevierStyleItalic">recommendation &#35;16</span>&#44; &#8220;spacing the applications of topical retinoids helps prevent and&#47;or reduce skin irritation&#44;&#8221; with a 99&#46;2&#37; level of agreement&#44; was the recommendation that obtained the highest level of agreement among all the issues on which votes were cast&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Recommendation &#35;13&#46;</span> Applying topical retinoid correctly at night helps prevent and&#47;or reduce skin irritation&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Recommendation &#35;17&#46;</span> Combining treatment with specific non-comedogenic moisturizers and SPF helps prevent and&#47;or reduce skin irritation&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">These 2 recommendations achieved broad consensus&#44; with 91&#37; and 94&#37; levels of agreement&#44; respectively in the 1<span class="elsevierStyleSup">st</span> round as strategies to improve the tolerability of topical retinoid treatment&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Recommendation &#35;14&#46;</span> Washing the face with specific products in the morning to remove retinoid residues helps prevent and&#47;or reduce skin irritation&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Recommendation &#35;15&#46; Drying the skin by patting &#40;without rubbing&#41; helps prevent and&#47;or reduce skin irritation&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">These 2 recommendations reached consensus in the 2<span class="elsevierStyleSup">nd</span> round with a nearly 90&#37; level of agreement in both cases &#40;see detailed results in <a class="elsevierStyleCrossRef" href="#tbl0005">table 1</a>&#41;&#46; The expert committee considers these 2 measures of paramount importance regarding good tolerability associated with topical retinoids&#58; washing the face in the morning to remove the residues of the treatment applied the night before with specific non-comedogenic products and doing so carefully without rubbing the skin when drying&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Recommendation &#35;18&#46;</span> The wash-off technique &#40;applying treatment&#44; waiting 30 to 60<span class="elsevierStyleHsp" style=""></span>minutes&#44; and washing the face with a specific product&#41; is a measure that helps prevent and&#47;or reduce skin irritation&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">In the 2<span class="elsevierStyleSup">nd</span> round&#44; &#8220;the wash-off technique &#40;applying treatment&#44; waiting 30 to 60<span class="elsevierStyleHsp" style=""></span>minutes&#44; and washing the face with a specific product&#41; is a measure that helps prevent and&#47;or reduce skin irritation&#8221; that obtained a majority level of agreement with 76&#37;&#46; Although this technique can slow down the process of applying treatment&#44; it is an interesting technique for very sensitive skins&#44; especially within the first few days of treatment&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Recommendation &#35;19&#46;</span> I find the following standard administration protocol for initiating topical retinoid treatment for acne to be correct &#40;see <a class="elsevierStyleCrossRef" href="#fig0010">figure 2</a>&#41;&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">A total of 88&#37; of voters found the standard administration protocol for initiating topical retinoid treatment for acne presented in <a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a> to be correct in the 1<span class="elsevierStyleSup">st</span> round&#46; Having a validated schedule to start a topical retinoid treatment was a requirement that the expert committee considered necessary when sharing these recommendations with other medical professionals&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Block D&#46; On extreme weather conditions and skin irritation and topical acne treatment with retinoids</span><p id="par0215" class="elsevierStylePara elsevierViewall">With 15 recommendations&#44; this block was the most extensive of the 4 and generally obtained the lowest level of agreement&#58; 8 issues reached consensus &#40;7 in the 1<span class="elsevierStyleSup">st</span> round and 1 in the 2<span class="elsevierStyleSup">nd</span> round&#41;&#44; 4 issues achieved a majority consensus&#44; and 3 did not reach any levels of agreement&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Recommendation &#35;20&#46;</span> It is preferable to START a topical retinoid treatment for acne when the weather is not extreme&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Recommendation &#35;21&#46;</span> The time of year does not matter when starting a topical retinoid treatment for acne&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Neither of these 2 issues&#44; with 67&#46;7&#37; and 39&#46;8&#37; levels of agreement&#44; respectively&#44; in the 2<span class="elsevierStyleSup">nd</span> round&#44; reached consensus or a majority consensus either&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Starting topical retinoid treatment during extreme weather conditions&#44; i&#46;e&#46;&#44; periods of high sun exposure &#40;summer months in the Iberian Peninsula&#41; or intense cold &#40;winter months in the Iberian Peninsula&#41;&#44; were the issues that generated the most controversy within this block&#46; The expert group concluded that&#44; considering that the use of topical retinoids in extreme weather conditions is closely related to irritation &#40;cold&#41; and photosensitization &#40;heat&#47;sun&#41;&#44; it seems logical that these issues did not reach consensus &#40;which is consistent with recommendations &#35;4 and &#35;6 from block A&#44; which also did not reach consensus&#41;&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Recommendation &#35;26&#46;</span> During extreme weather conditions&#44; I prefer my patients to space out the applications of topical retinoids&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">This recommendation received a 59&#46;4&#37; level of agreement in the 2<span class="elsevierStyleSup">nd</span> round&#44; not reaching a majority consensus or consensus for that matter&#46; The expert committee clarified that the need to space out applications does not depend so much on the time of year but on the tolerability and the phase of the treatment the patient is in&#46; Spacing out applications is a recommended and widely used measure at the beginning of the treatment or when the patient experiences a high level of irritation&#44; regardless of the weather&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Recommendation &#35;32&#46;</span> I avoid topical retinoid treatment in patients with fair skin types during periods of high sun exposure&#46;</p><p id="par0255" class="elsevierStylePara elsevierViewall">A majority disagreement was reached &#40;81&#46;2&#37; in the 2<span class="elsevierStyleSup">nd</span> round&#41; that&#44; in patients with fair skin phototypes&#44; it is not necessary to avoid topical retinoid treatment during periods of high sun exposure&#46; In fact&#44; although it can occur in any patient&#44; post-inflammatory hyperpigmentation in acne patients is more common in darker skin types&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">19</span></a> The expert committee emphasized that in any patient&#44; the proper application of photoprotection provides protection regardless of the patient&#39;s skin type&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Recommendation &#35;33&#46;</span> Irritation due to photosensitization by topical retinoids is a very common issue in my clinical practice&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">There was a majority disagreement &#40;80&#46;50&#37; in the 2<span class="elsevierStyleSup">nd</span> round of voting&#41; that irritation due to photosensitization induced by topical retinoids is a very common issue in the dermatologists&#8217; office&#46; Some experts acknowledged not having seen any patients with photosensitization due to topical retinoids&#44; but some with photosensitization due to oral retinoids&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0270" class="elsevierStylePara elsevierViewall">This document presents a series of strategies and practical recommendations on how to reduce or prevent tolerability issues of topical retinoids to treat facial and truncal acne&#46; The Delphi methodology was followed and followed by a large group of dermatologists from Spain and Portugal&#44; thereby reinforcing the validity of the recommendations&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">Notably&#44; a high level of agreement was reached on the recommendations &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#58; 82&#46;3&#37; of them&#44; 28 out of 34&#44; achieved some level of agreement &#40;22 reached consensus with a &#8805; 85&#37; level of agreement and 6 reached a majority consensus with a &#8805; 70&#37; level of agreement&#41;&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">Consensus was almost unanimous &#40;94&#46;7&#37;&#41; that patients who properly follow the application recommendations&#47;guidelines &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41; tend to have fewer tolerability issues than those who do not&#46; These recommendations are simple and very easy to apply&#44; so it is essential to disseminate them widely both to the medical community and to patients&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">Based on the consensus results and its own experience&#44; the expert committee concluded that topical retinoid-related skin irritation is an expected&#44; mild&#44; and controllable reaction if correct prevention and management guidelines are followed&#46; Therefore&#44; it should not be a reason to discontinue treatment&#44; which is why the expert committee emphasized the importance of dedicating part of the consultation to explaining the various strategies to the patient and recommended providing supporting materials for the patient&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall">With this consensus&#44; the expert committee fulfills the objective of this project&#58; to provide recommendations endorsed by a large panel of dermatologists&#44; helping other health care professionals treating acne improve topical retinoid treatments for facial and truncal acne&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Funding</span><p id="par0295" class="elsevierStylePara elsevierViewall">Galderma has collaborated in the funding of the project&#46; However&#44; this sponsoring laboratory did not participate in the drafting of the article&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicts of interest</span><p id="par0300" class="elsevierStylePara elsevierViewall">None of the authors declared any conflicts of interest on the topics covered in this article&#44; which they have defended solely based on their clinical experience&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">Dr&#46; Alexander Catarino has received support from Galderma to attend the AEDV 2021 congress&#46; Dr&#46; Cristina Eguren has received support for attending meetings and&#47;or travel expenses from Galderma&#46; Dr&#46; Cristina Eguren is president of DERMUS &#40;Association of Private Dermatology Clinics&#41;&#44; a member of the AEDV &#40;Spanish Association of Dermatology and Venereology&#41; board of trustees&#44; and a member of the international council of dermatologists for L&#8217;Oreal Paris&#46; Dr&#46; M&#46; Isabel Hern&#225;ndez Jurado declared to have received payments or fees for lectures&#44; presentations&#44; speaker bureaus&#44; manuscript drafting&#44; or educational events&#46; Dr&#46; Montse Salleras has received consulting fees from Galderma&#44; Lilly&#44; LEO Pharma&#44; and ISDIN&#59; payments or fees for lectures&#44; presentations&#44; speaker bureaus&#44; manuscript drafting&#44; or educational events from Galderma&#44; Lilly&#44; LEO Pharma&#59; payment for expert testimony from Galderma and ISDIN&#59; support for attending meetings and&#47;or travel expenses from Lilly&#44; LEO Pharma&#44; ABBVIE&#44; UCB Pharma&#44; Almirall&#44; Janssen&#44; and ISDIN&#46; Dr&#46; Susanna Nogueras has received consulting fees from Galderma&#46; Dr&#46; Nayra Merino has received payments or fees for lectures&#44; presentations&#44; speaker bureaus&#44; manuscript drafting&#44; or educational events from Galderma&#44; as well as medical materials from Galderma&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:3 [
          "identificador" => "xres2231428"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Objective"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Method"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1868510"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres2231429"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Objetivo"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "M&#233;todo"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1868511"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Method"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Selection of participants"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Literature review and preliminary recommendations"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Scientific committee meetings"
            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Delphi"
            ]
          ]
        ]
        6 => array:3 [
          "identificador" => "sec0035"
          "titulo" => "Results"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Block A&#46; On the preferences for topical acne therapy"
            ]
            1 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Block B&#46; On skin irritation and topical acne treatment with retinoids"
            ]
            2 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Block C&#46; On recommendations&#47;guidelines to prevent&#47;reduce skin irritation in topical acne treatment with retinoids"
            ]
            3 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Block D&#46; On extreme weather conditions and skin irritation and topical acne treatment with retinoids"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Funding"
        ]
        9 => array:2 [
          "identificador" => "sec0070"
          "titulo" => "Conflicts of interest"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2023-11-02"
    "fechaAceptado" => "2024-03-13"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1868510"
          "palabras" => array:4 [
            0 => "Facial and trunk acne"
            1 => "Consensus"
            2 => "Topical retinoids"
            3 => "Irritation"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1868511"
          "palabras" => array:4 [
            0 => "Acn&#233; facial y troncal"
            1 => "Consenso"
            2 => "Retinoides t&#243;picos"
            3 => "Irritaci&#243;n"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To assess the level of agreement on various prevention and management strategies for irritation caused by topical retinoids in facial and trunk acne in an attempt to alleviate it and minimize treatment discontinuations as much as possible&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">After reviewing the scientific medical literatura currently available&#44; 4 different areas of uncertainty in the management of irritation caused by topical retinoids in acne were identified&#46; A questionnaire with 34 recommendations was created and evaluated by a group of 133 dermatologists &#40;Delphi methodology&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In 82&#46;3&#37; of the recommendations &#40;28 out of 34&#41;&#44; some level of agreement was reached &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>85&#37; agreement in 22 recommendations and<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>70&#37; agreement in 6&#41;&#46; The results with the highest level of agreement focused on specific patient education strategies &#40;explaining that irritation is an expected reaction at the beginning of treatment and tends to decrease over time&#41;&#44; gradual and&#47;or spaced application of topical retinoids &#40;at night time to prevent and&#47;or reduce skin irritation&#41;&#44; and the importance of using adjuvant products&#44; specific for acne-prone skin&#44; hydration&#44; photoprotection&#44; and skin cleansing&#46; These recommendations reflect a comprehensive approach to managing irritation associated with topical retinoids and promoting long-term adherence&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Skin irritation caused by topical retinoids in facial and trunk acne is an expected&#44; mild&#44; and controllable reaction if proper prevention and management guidelines are followed&#44; meaning that it should not be a reason for treatment discontinuation&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Method"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Conocer el grado de acuerdo en diversas estrategias de prevenci&#243;n y manejo de la irritaci&#243;n por retinoides t&#243;picos en acn&#233; facial y troncal con la finalidad de mejorarla y evitar&#44; en la medida de lo posible&#44; abandonos de tratamientos&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Tras revisar la literatura&#44; se identificaron 4 &#225;reas de incertidumbre en el manejo de la irritaci&#243;n por retinoides t&#243;picos en acn&#233;&#46; Se desarroll&#243; un cuestionario con 34 recomendaciones que fueron evaluadas por un grupo de 133 dermat&#243;logos &#40;metodolog&#237;a Delphi&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En un 82&#44;3&#37; de las recomendaciones &#40;28 de 34&#41; alcanz&#243; alg&#250;n grado de acuerdo &#40;22 consenso con<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>85&#37; de acuerdo y 6 mayor&#237;a con<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>70&#37; de acuerdo&#41;&#46; Los resultados con mayor grado de acuerdo se centraron en estrategias espec&#237;ficas de educaci&#243;n del paciente &#40;explicar que la irritaci&#243;n es una reacci&#243;n esperable al inicio del tratamiento y que tiende a disminuir con el tiempo&#41;&#44; aplicaci&#243;n gradual y&#47;o espaciada de los retinoides t&#243;picos &#40;por la noche para prevenir y&#47;o reducir la irritaci&#243;n de la piel&#41; y la importancia de usar productos adyuvantes&#44; espec&#237;ficos para piel con acn&#233;&#44; para la hidrataci&#243;n&#44; fotoprotecci&#243;n y limpieza de la piel&#46; Estas recomendaciones reflejan un enfoque integral para gestionar la irritaci&#243;n asociada a retinoides t&#243;picos y fomentar su adherencia a largo plazo&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La irritaci&#243;n de la piel por retinoides t&#243;picos&#44; en acn&#233; facial y troncal&#44; es una reacci&#243;n esperable&#44; leve y controlable si se siguen unas correctas pautas de prevenci&#243;n y manejo&#44; y no deber&#237;a ser motivo de abandono del tratamiento&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todo"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 625
            "Ancho" => 1683
            "Tamanyo" => 107732
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Overall consensus based on the level of agreement&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 2956
            "Ancho" => 2340
            "Tamanyo" => 491220
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Recommendations from the expert group to prevent&#47;reduce skin irritation in the topical treatment of acne with retinoids&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1197
            "Ancho" => 2569
            "Tamanyo" => 186463
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Standard administration protocol for starting topical retinoid treatment for acne&#46; &#8730; indicates the nights when the topical retinoid should be applied&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Criteria for consensus on each recommendation were established if 85&#37; or more of the group members indicated their agreement with the statement in either one of the 2 rounds and the criteria for majority consensus if 70&#37; or more of the participants indicated their agreement with the recommendation in either one of the 2 rounds of voting&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Recommendation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">1<span class="elsevierStyleSup">st</span> round&#37; agreement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2<span class="elsevierStyleSup">nd</span> round&#37; agreement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2<span class="elsevierStyleSup">nd</span> round&#37; disagreement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Final result&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BLOCK A - ON PREFERENCES FOR TOPICAL ACNE TREATMENT</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">What I value most when prescribing a topical treatment is its EFFICACY&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">95&#46;50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CONSENSUS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">What I value most when prescribing a topical treatment is its TOLERABILITY&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90&#46;20&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CONSENSUS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">What I value most when prescribing a topical treatment is its SIMPLICITY in the ROUTINE&#47;DOSAGE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#46;90&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82&#46;70&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MAJORITY&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Skin IRRITATION is a barrier to prescribing a topical treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&#46;10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#46;70&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NO CONSENSUS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The WAITING TIME to obtain results is a barrier to prescribing a topical treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#46;60&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&#46;40&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NO CONSENSUS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PHOTOSENSITIVITY is a barrier to prescribing a topical treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#46;30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#46;10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NO CONSENSUS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BLOCK B - ON SKIN IRRITATION AND TOPICAL ACNE TREATMENT WITH RETINOIDS</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I consider irritation an EXPECTED reaction at the start of treatment and not an undesirable side effect&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94&#46;70&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CONSENSUS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mild and controllable skin irritation occurs FREQUENTLY at the BEGINNING of treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&#46;50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CONSENSUS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Skin irritation tends to DECREASE gradually over time&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">96&#46;20&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CONSENSUS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">It is important to TELL the patient that temporary irritation is normal and expected&#44; and they should not discontinue treatment because of it&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&#46;50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CONSENSUS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Skin irritation can be PREVENTED and&#47;or REDUCED by following proper guidelines&#47;recommendations for treatment application&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">97&#46;00&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CONSENSUS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patients who PROPERLY FOLLOW the application recommendations&#47;guidelines tend to have fewer skin irritation problems than those who DO NOT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94&#46;70&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CONSENSUS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BLOCK C - ON RECOMMENDATIONS&#47;GUIDELINES TO PREVENT&#47;REDUCE SKIN IRRITATION IN TOPICAL ACNE TREATMENT WITH RETINOIDS</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Correctly applying the topical retinoid at night helps PREVENT and&#47;or REDUCE skin irritation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#46;00&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CONSENSUS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">WASHING THE FACE with specific products in the morning to remove retinoid residues helps PREVENT and&#47;or REDUCE skin irritation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79&#46;70&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&#46;97&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CONSENSUS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DRYING THE FACE &#8220;BY PATTING&#8221; &#40;without rubbing&#41; helps PREVENT and&#47;or REDUCE skin irritation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77&#46;40&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&#46;47&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CONSENSUS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SPACING OUT topical retinoid applications helps PREVENT and&#47;or REDUCE skin irritation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99&#46;20&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CONSENSUS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Combining treatment with specific non-comedogenic moisturizers with SPF helps PREVENT and&#47;or REDUCE skin irritation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94&#46;00&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CONSENSUS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The wash-off technique &#40;applying treatment&#44; waiting 30-60 minutes&#44; and washing the face with a specific product&#41; helps PREVENT and&#47;or REDUCE skin irritation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#46;90&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#46;94&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MAJORITY&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I find the following standard administration protocol for starting topical retinoid treatment for acne to be correct - SEE <a class="elsevierStyleCrossRef" href="#fig0015">FIGURE 3</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&#46;00&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CONSENSUS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BLOCK D - ON EXTREME WEATHER CONDITIONS AND SKIN IRRITATION AND TOPICAL ACNE TREATMENT WITH RETINOIDS</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">It is preferable to START topical retinoid treatment for acne when the WEATHER IS NOT EXTREME&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#46;20&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#46;67&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NO CONSENSUS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The time of year DOES NOT MATTER when starting topical retinoid treatment for acne&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#46;80&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#46;85&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NO CONSENSUS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I prefer to INTERRUPT topical retinoid treatment during periods of EXTREME WEATHER in ANY patient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&#46;72&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CONSENSUS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In PATIENTS WHO HAVE BEEN ON THERAPY FOR A SHORT PERIOD OF TIME&#44; I prefer to DISCONTINUE topical retinoid treatment during periods of EXTREME WEATHER&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;80&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;80&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#46;95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MAJORITY&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">In PATIENTS WHOSE ACNE IS ALREADY UNDER CONTROL&#44; I suggest spacing out treatment when it coincides with periods of EXTREME WEATHER&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">57&#46;90&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&#46;20&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MAJORITY&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">If the PATIENT TOLERATES topical retinoids WELL and HAS NO IRRITATION&#44; it is NOT necessary to DISCONTINUE treatment at any time of year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&#46;50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CONSENSUS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">During extreme weather conditions&#44; I prefer my patients to SPACE OUT the applications of topical retinoids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#46;60&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#46;40&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NO CONSENSUS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">By following good application guidelines and recommendations&#44; I consider that it is NOT NECESSARY to DISCONTINUE topical retinoid treatment during periods of extreme weather &#40;intense cold or high sun exposure&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&#46;70&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CONSENSUS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">With good sun protection &#40;SPF 30-50&#41;&#44; topical retinoids can be prescribed at ANY time of year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&#46;20&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CONSENSUS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Good sun protection &#40;SPF 30-50&#41; helps PREVENT and&#47;or REDUCE SUN EXPOSURE IRRITATION in skin treated with topical retinoids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&#46;50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CONSENSUS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Good MOISTURIZATION WITH SPF with specific non-comedogenic products helps PREVENT and&#47;or REDUCE irritation during periods of intense cold&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">97&#46;00&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CONSENSUS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">PROTECTING THE SKIN WITH APPROPRIATE CLOTHING &#40;long sleeves&#44; hats&#44; etc&#46;&#41; during periods of EXTREME WEATHER helps PREVENT and&#47;or REDUCE irritation in skin treated with topical retinoids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#46;50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CONSENSUS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I avoid topical retinoid treatment in patients with FAIR SKIN TYPES during periods of high sun exposure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;60&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;80&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#46;20&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MAJORITY&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Irritation due to photosensitization from topical retinoids is a VERY COMMON issue in my clinical practice&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;02&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&#46;50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MAJORITY&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">It is important to REAPPLY sun protection if spending a long time outside&#44; sweating excessively&#44; or if the patient showers&#47;bathes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94&#46;70&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CONSENSUS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3637933.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Recommendations with &#62; 85&#37; majority consensus in the 1<span class="elsevierStyleSup">st</span> round were not submitted for voting in the 2<span class="elsevierStyleSup">nd</span> round&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Delphi results&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:19 [
            0 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "CADIME&#46; Acn&#233;&#58; tratamiento&#46; Bolet&#237;n Ter Andaluz&#46; 2010&#59; 26&#46;&#40;1&#41;&#46;"
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Consenso espa&#241;ol para establecer una clasificaci&#243;n y un algoritmo de tratamiento del acn&#233;"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "el grupo de dermat&#243;logos expertos en acn&#233;"
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;L&#46; L&#243;pez-Estebaranz"
                            1 => "P&#46; Herranz-pinto"
                            2 => "B&#46; Dr&#233;no"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ad.2016.10.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr&#46;"
                        "fecha" => "2017"
                        "volumen" => "108"
                        "paginaInicial" => "120"
                        "paginaFinal" => "131"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27816123"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines of care for the management of acne vulgaris"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;L&#46; Zaenglein"
                            1 => "A&#46;L&#46; Pathy"
                            2 => "B&#46;J&#46; Schlosser"
                            3 => "A&#46; Alikhan"
                            4 => "H&#46;E&#46; Baldwin"
                            5 => "D&#46;S&#46; Berson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2015.12.037"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol &#91;Internet&#93;&#46;"
                        "fecha" => "2016"
                        "volumen" => "74"
                        "paginaInicial" => "945"
                        "paginaFinal" => "973"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26897386"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of acne&#58; A report from a global alliance to improve outcomes in acne"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46; Gollnick"
                            1 => "W&#46; Cunliffe"
                            2 => "D&#46; Berson"
                            3 => "B&#46; Dreno"
                            4 => "A&#46; Finlay"
                            5 => "J&#46;J&#46; Leyden"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1067/mjd.2003.618"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Am Acad Dermatol&#46;"
                        "fecha" => "2003"
                        "volumen" => "49"
                        "numero" => "1 Suppl"
                        "paginaInicial" => "S1"
                        "paginaFinal" => "S37"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12833004"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "New insights into the management of acne&#58; An update from the Global Alliance to Improve Outcomes in Acne Group"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Thiboutot"
                            1 => "H&#46; Gollnick"
                            2 => "V&#46; Bettoli"
                            3 => "B&#46; Dr&#233;no"
                            4 => "S&#46; Kang"
                            5 => "J&#46;J&#46; Leyden"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol&#46;"
                        "fecha" => "2009"
                        "volumen" => "60&#46;"
                        "numero" => "5 Suppl"
                        "paginaInicial" => "S1"
                        "paginaFinal" => "S50"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "European evidence-based &#40;S3&#41; guideline for the treatment of acne &#8211; update 2016 &#8211; short version"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Nast"
                            1 => "B&#46; Dr&#233;no"
                            2 => "V&#46; Bettoli"
                            3 => "Z&#46; Bukvic Mokos"
                            4 => "K&#46; Degitz"
                            5 => "C&#46; Dressler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Eur Acad Dermatology Venereol&#46;"
                        "fecha" => "2016"
                        "volumen" => "30"
                        "paginaInicial" => "1261"
                        "paginaFinal" => "1268"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Topical retinoids in acne vulgaris&#58; Update on efficacy and safety"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Thielitz"
                            1 => "H&#46; Gollnick"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2165/0128071-200809060-00003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Clin Dermatol&#46;"
                        "fecha" => "2008"
                        "volumen" => "9"
                        "paginaInicial" => "369"
                        "paginaFinal" => "381"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18973403"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Vademecum &#91;Internet&#93;&#46; &#91;acceso 3 Mar 2023&#93;&#46; Available from&#58; <a target="_blank" href="https://www.vademecum.es/atc-d10ad">https&#58;&#47;&#47;www&#46;vademecum&#46;es&#47;atc-d10ad</a>"
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "EAACI guideline&#58; Preventing the development of food allergy in infants and young children &#40;2020 update&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Halken"
                            1 => "A&#46; Muraro"
                            2 => "D&#46; de Silva"
                            3 => "E&#46; Khaleva"
                            4 => "E&#46; Angier"
                            5 => "S&#46; Arasi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/pai.13496"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Allergy Immunol &#91;Internet&#93;&#46;"
                        "fecha" => "2021"
                        "volumen" => "32"
                        "paginaInicial" => "843"
                        "paginaFinal" => "858"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33710678"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Retinoids in the treatment of skin aging&#58; an overview of clinical efficacy and safety"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46; Mukherjee"
                            1 => "A&#46; Date"
                            2 => "V&#46; Patravale"
                            3 => "H&#46;C&#46; Korting"
                            4 => "A&#46; Roeder"
                            5 => "G&#46; Weindl"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2147/ciia.2006.1.4.327"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Interv Aging&#46;"
                        "fecha" => "2006"
                        "volumen" => "1"
                        "paginaInicial" => "327"
                        "paginaFinal" => "348"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18046911"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The mechanism of retinol-induced irritation and its application to anti-irritant development"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46;H&#46; Kim"
                            1 => "Y&#46;S&#46; Lee"
                            2 => "K&#46;S&#46; Kang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.toxlet.2003.09.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Toxicol Lett&#46;"
                        "fecha" => "2003"
                        "volumen" => "146"
                        "paginaInicial" => "65"
                        "paginaFinal" => "73"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14615068"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Why topical retinoids are mainstay of therapy for acne"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Leyden"
                            1 => "L&#46;S&#46; Jonathan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s13555-017-0185-2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dermatol Ther &#40;Heidelb&#41;&#46;"
                        "fecha" => "2017"
                        "volumen" => "7"
                        "paginaInicial" => "293"
                        "paginaFinal" => "304"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28585191"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "50 years of topical retinoids for acne&#58; Evolution of treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46; Baldwin"
                            1 => "G&#46; Webster"
                            2 => "L&#46; Stein"
                            3 => "G&#46; Valerie"
                            4 => "F&#46;E&#46; Cook"
                            5 => "B&#46; Eric"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s40257-021-00594-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Clin Dermatol &#91;Internet&#93;&#46;"
                        "fecha" => "2021"
                        "volumen" => "22"
                        "paginaInicial" => "315"
                        "paginaFinal" => "327"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33871811"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Delphi technique in health sciences education research"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;R&#46; De Villiers"
                            1 => "P&#46;J&#46;T&#46; de Villiers"
                            2 => "A&#46;P&#46; Kent"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Teach&#46;"
                        "fecha" => "2005"
                        "volumen" => "27"
                        "paginaInicial" => "639"
                        "paginaFinal" => "643"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Consensus and dissention&#58; A measure of ordinal dispersion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "W&#46;J&#46; Tastle"
                            1 => "M&#46;J&#46; Wierman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Approx Reason&#46;"
                        "fecha" => "2007"
                        "volumen" => "45"
                        "paginaInicial" => "531"
                        "paginaFinal" => "545"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Isotretinoin laboratory monitoring in acne treatment&#58; A Delphi Consensus Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Xia"
                            1 => "J&#46; Han"
                            2 => "A&#46; Faletsky"
                            3 => "H&#46; Baldwin"
                            4 => "K&#46; Beleznay"
                            5 => "V&#46; Bettoli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "JAMA Dermatol&#46;"
                        "fecha" => "2022"
                        "volumen" => "158"
                        "paginaInicial" => "942"
                        "paginaFinal" => "948"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Identifying the impacts of acne&#58; A Delphi survey of patients and clinicians"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Tan"
                            1 => "M&#46;P&#46; Frey"
                            2 => "D&#46; Thiboutot"
                            3 => "A&#46; Layton"
                            4 => "A&#46; Eady"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/1203475420907088"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cutan Med Surg&#46;"
                        "fecha" => "2020"
                        "volumen" => "24"
                        "paginaInicial" => "259"
                        "paginaFinal" => "266"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32096429"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The use of isotretinoin for acne&#8211;an update on optimal dosing&#44; surveillance&#44; and adverse effects"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "E&#46; Bagatin"
                            1 => "C&#46;S&#46; Costa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/17512433.2020.1796637"
                      "Revista" => array:6 [
                        "tituloSerie" => "Expert Rev Clin Pharmacol &#91;Internet&#93;&#46;"
                        "fecha" => "2020"
                        "volumen" => "13"
                        "paginaInicial" => "885"
                        "paginaFinal" => "897"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32744074"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fotoexposici&#243;n y enfermedad"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46;E&#46; G&#243;mez Ayala"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Farm Prof&#46;"
                        "fecha" => "2008"
                        "volumen" => "22"
                        "paginaInicial" => "37"
                        "paginaFinal" => "41"
                        "itemHostRev" => array:3 [
                          "pii" => "S0022347622002074"
                          "estado" => "S300"
                          "issn" => "00223476"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/00017310/0000011500000008/v1_202409020432/S0001731024005830/v1_202409020432/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "97724"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Documentos de consenso"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/00017310/0000011500000008/v1_202409020432/S0001731024005830/v1_202409020432/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731024005830?idApp=UINPBA000044"
]