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Isotretinoin is an oral retinoid that is very effective for severe nodular acne, and moderate acne that is stubborn to other treatments.[1][20] One to two months use is typically adequate to see improvement. Acne often resolves completely or is much milder after a 4–6 month course of oral isotretinoin.[1] After a single course, about 80% of people report an improvement, with more than 50% reporting complete remission.[20] About 20% of patients require a second course.[20] Concerns have emerged that isotretinoin use is linked with an increased risk of adverse effects, like depression, suicidality, anemia, although there is no clear evidence to support some of these claims.[1][20] Isotretinoin is superior to antibiotics or placebo in reducing acne lesions.[17] The frequency of adverse events was about twice as high with isotretinoin, although these were mostly dryness-related events.[17] No increased risk of suicide or depression was conclusively found.[17] Isotretinoin use in women of childbearing age is regulated due to its known harmful effects in pregnancy.[20] For such a woman to be considered a candidate for isotretinoin, she must have a confirmed negative pregnancy test and use an effective form of birth control.[20] In 2008, the United States started the iPLEDGE program to prevent isotretinoin use during pregnancy.[85] iPledge requires the woman under consideration for isotretinoin therapy to have two negative pregnancy tests and mandates the use of two types of birth control for at least one month before therapy begins and one month after therapy is complete.[85] The effectiveness of the iPledge program has been questioned due to continued instances of contraception nonadherence.[85][86]

In women, acne can be improved with the use of any combined birth control pill.[89] These medications contain an estrogen and a progestin.[90] They work by decreasing the production of androgen hormones by the ovaries and by decreasing the free and hence biologically active fractions of androgens, resulting in lowered skin production of sebum and consequently reduced acne severity.[10][91] First-generation progestins such as norethindrone and norgestrel have androgenic properties and can worsen acne.[15] Although oral estrogens can decrease IGF-1 levels in some situations and this might be expected to additionally contribute to improvement in acne symptoms,[92][93] combined birth control pills appear to have no effect on IGF-1 levels in fertile women.[90][94] However, cyproterone acetate-containing birth control pills have been reported to decrease total and free IGF-1 levels.[95] Combinations containing third- or fourth-generation progestins including desogestrel, dienogest, drospirenone, or norgestimate, as well as birth control pills containing cyproterone acetate or chlormadinone acetate, are preferred for women with acne due to their stronger antiandrogenic effects.[96][97][98] Studies have shown a 40 to 70% reduction in acne lesions with combined birth control pills.[91] A 2014 review found that antibiotics by mouth appear to be somewhat more effective than birth control pills at decreasing the number of inflammatory acne lesions at three months.[99] However, the two therapies are approximately equal in efficacy at six months for decreasing the number of inflammatory, non-inflammatory, and total acne lesions.[99] The authors of the analysis suggested that birth control pills may be a preferred first-line acne treatment, over oral antibiotics, in certain women due to similar efficacy at six months and a lack of associated antibiotic resistance.[99]
How to Handle It: Consider salicylic acid your secret weapon. "This beta hydroxy acid helps remove excess oil and exfoliate dead cells from the skin's surface to keep pores clear," says Zeichner. Try Clinique's Acne Solution Clearing Gel, a two-time Best of Beauty winner that packs both salicylic acid and sea whip extract — an ingredient with skin-soothing properties — to help counteract the dryness sometimes caused by salicylic acid. The formula does double duty: It works as a spot treatment for mild to moderate acne and as a nightly allover treatment for pimple prevention. And since it dries clear, you can wear it to fight zits whenever, wherever.

What's Going On: Do you tend to get these at the same time every month — say, just before you get your period? Because these are the work of fluctuating hormones, says Joshua Zeichner, a dermatologist and the director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City. Hormones can put oil production into overdrive, and having an excess of it means that it’s more likely to settle in your pores and cause zits.
Cystic Acne: The most severe type of acne, cystic acne requires dermatological care and prescription acne medication to treat. Even the best acne products available over the counter are no match for this painful condition in which the area of the outbreak becomes inflamed, but not infected. Cystic acne can result in permanent scarring. However, it's important to know that all acne lesions can scar. Scarring is related to size, amount of inflammation, genetics and delay in therapy.
Lavender oil is another favorite of mine, not only because it can help prevent and keeps acne at bay, but it smells amazing, and provides relaxation qualities — something much needed in today’s world. Lavender helps regenerate skin cells, minimize sun spots and even reduce scarring caused by acne. Additionally, it can help reduce swelling and inflammation that may be caused by acne due to the polysaccharides it contains. (20) 
Flutamide, a pure antagonist of the androgen receptor, is effective in the treatment of acne in women.[101][108] It has generally been found to reduce symptoms of acne by 80 or 90% even at low doses, with several studies showing complete acne clearance.[101][109][110] In one study, flutamide decreased acne scores by 80% within 3 months, whereas spironolactone decreased symptoms by only 40% in the same time period.[110][111][112] In a large long-term study, 97% of women reported satisfaction with the control of their acne with flutamide.[113] Although effective, flutamide has a risk of serious liver toxicity, and cases of death in women taking even low doses of the medication to treat androgen-dependent skin and hair conditions have occurred.[114] As such, the use of flutamide for acne has become increasingly limited,[113][115][116] and it has been argued that continued use of flutamide for such purposes is unethical.[114] Bicalutamide, a pure androgen receptor antagonist with the same mechanism as flutamide and with comparable or superior antiandrogenic efficacy but without its risk of liver toxicity, is a potential alternative to flutamide in the treatment of androgen-dependent skin and hair conditions in women.[106][117][118][119]
The educational health content on What To Expect is reviewed by our team of experts to be up-to-date and in line with the latest evidence-based medical information and accepted health guidelines, including the medically reviewed What to Expect books by Heidi Murkoff. This site complies with the HONcode standard for trustworthy health information. This educational content is not medical or diagnostic advice. Use of this site is subject to our terms of use and privacy policy. © 2019 Everyday Health, Inc

Salicylic acid is a topically applied beta-hydroxy acid that stops bacteria from reproducing and has keratolytic properties.[132][133] It opens obstructed skin pores and promotes shedding of epithelial skin cells.[132] Salicylic acid is known to be less effective than retinoid therapy.[20] Dry skin is the most commonly seen side effect with topical application, though darkening of the skin has been observed in individuals with darker skin types.[1]
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Acne appears to be strongly inherited with 81% of the variation in the population explained by genetics.[15] Studies performed in affected twins and first-degree relatives further demonstrate the strongly inherited nature of acne.[2][15] Acne susceptibility is likely due to the influence of multiple genes, as the disease does not follow a classic (Mendelian) inheritance pattern. Several gene candidates have been proposed including certain variations in tumor necrosis factor-alpha (TNF-alpha), IL-1 alpha, and CYP1A1 genes, among others.[19] The 308 G/A single nucleotide polymorphism variation in the gene for TNF is associated with an increased risk for acne.[40] Acne can be a feature of rare genetic disorders such as Apert's syndrome.[15] Severe acne may be associated with XYY syndrome.[41]
Inflammatory Acne: Inflammatory acne is red bumps and pustules, not whiteheads, blackheads and comedones. It doesn't necessarily start as them, either. It arises on its own. Whiteheads, blackheads or comedones that become inflamed can be painful and unsightly. Persistent inflammatory acne may require treatment by a physician or dermatologist, in addition to over-the-counter acne remedies.
If one of you is a night owl and the other an early riser, bedtime can become a source of conflict. It’s hard for a light sleeper to be jostled by their partner coming to bed four hours after them. Talk to your partner about negotiating some compromises. If you’re finding it difficult to agree on a bedtime, negotiate with your partner. Don’t come to bed before or after a certain time, giving the early bird a chance to fully fall asleep before the other comes in. Consider giving the night owl an eye mask to allow them to stay in bed while their partner gets up to start the day.
The severity of acne vulgaris (Gr. ἀκµή, "point" + L. vulgaris, "common")[24] can be classified as mild, moderate, or severe as this helps to determine an appropriate treatment regimen.[20] There is no universally accepted scale for grading acne severity.[15] Mild acne is classically defined by the presence of clogged skin follicles (known as comedones) limited to the face with occasional inflammatory lesions.[20] Moderate severity acne is said to occur when a higher number of inflammatory papules and pustules occur on the face compared to mild cases of acne and are found on the trunk of the body.[20] Severe acne is said to occur when nodules (the painful 'bumps' lying under the skin) are the characteristic facial lesions and involvement of the trunk is extensive.[20][25]

All the dermatologists we talked to agreed that there is no one-size-fits-all solution to acne. Every patient responds to treatments differently, and sometimes it can get worse before it gets better. But with the help of your dermatologist, you can find an acne treatment regimen that works for you. And, yes, we do stress how helpful it is to work with a derm to get it right.

Contrary to the marketing promises of “blemish banishers” and “zit zappers,” immediate results are not the trademark of acne treatments — a frustrating truth to anyone suffering through a breakout. And while pimples are personal (your stress-induced spots will look and act differently than your best friend’s breakout), the best acne treatments will include a regimen of products to hit all of acne’s root causes. We tested 43 kits to find the most well-rounded breakout-fighting solutions on the market.


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Any acne treatment is a weeks-long experiment that you’re conducting with your skin. Acne is slow to heal, and in some cases, it can get worse before it gets better (nearly every benzoyl peroxide product we looked at emphasized the likeliness of irritating acne further, and starting off with a lighter application). April W. Armstrong, a doctor at the University of California Davis Health System, recommends waiting at least one month before you deem a product ineffective.

Pustules are another form of moderate acne very similar to papules. The difference is that pustules are filled with liquid pus, giving them a white or yellowish appearance akin to blisters. They’re accompanied by surrounding inflammation and are usually tender and hard (but not as hard as papules). Pustules appear when white blood cells attempt to fight off infection within a given area.
Topical treatments on their own may not be enough to give you clear skin, especially in those with complicated, inflammatory cystic acne. There are several acne medication options approved for use by the FDA, but which one is best for you is a question for your dermatologist and/or general practitioner. Baldwin says if you have insurance and you have acne, a prescription may be the best step because "it makes no sense to try to handle the condition yourself or to use over the counter products that are always less effective than prescriptions meds." Here are a few of the acne medications you'll want to ask about:

Clascoterone is a topical antiandrogen which has demonstrated effectiveness in the treatment of acne in both males and females and is currently in the late stages of clinical development.[120][121][122][123] It has shown no systemic absorption or associated antiandrogenic side effects.[122][123][124] In a direct head-to-head comparison, clascoterone showed greater effectiveness than topical isotretinoin.[122][123][124] 5α-Reductase inhibitors such as finasteride and dutasteride may be useful for the treatment of acne in both males and females, but have not been thoroughly evaluated for this purpose.[1][125][126][127] In addition, the high risk of birth defects with 5α-reductase inhibitors limits their use in women.[1][126] However, 5α-reductase inhibitors can be combined with birth control pills to prevent pregnancy, and are frequently used to treat excessive hair in women.[125] There is no evidence as of 2010 to support the use of cimetidine or ketoconazole in the treatment of acne.[128]
Temporary skin fillers have been used for years for acne scar treatment, but a permanent dermal filler was approved for use by the FDA only recently. Designed to remove moderate to severe acne scarring, Bellafill is made up of 80 percent collagen to replace lost volume and 20 percent polymethylmethacrylate, which helps your body heal by boosting protein production.
You've probably seen the Proactiv clear skin system advertised on television at some point over the last several years, but does it work? Proactiv is one of the better acne remedies out there for mild cases of inflammatory and noninflammatory acne, hormonal acne and adult acne. The starter kit comes with a gentle benzoyl peroxide exfoliating cleanser, a glycolic acid pore cleanser, and a benzoyl peroxide repairing treatment.
How to Handle It: Speaking of touching, don't! Picking it, squeezing it, or poking at it will only worsen the situation. These may disappear on their own after a few days. Otherwise, Zeichner suggests visiting your dermatologist for a shot of cortisone, which will reduce inflammation and shrink it in just 24 to 48 hours. But if a last-minute appointment isn't in the cards, play mad scientist. First, ice the area, and then apply salicylic acid gel, benzoyl peroxide gel, and 1 percent hydrocortisone cream. The combo will calm skin, kill bacteria, and draw out excess oil from the pimple — all things necessary to take this down, says Zeichner.
The three-piece set doesn’t come with a sun protection treatment, but Paula’s Choice has one in the line, the Clear Ultra-Light Daily Fluid SPF 30+. “Sun protection is really important, especially with acneic skin,” says Townsend. “In many cases, stronger acne products can make the skin photosensitive to the sun.” This isn’t your normal gloppy white sunscreen. Its fluid formula slips over tender skin, doesn’t need a ton of rubbing in, and also leaves a mattifying finish.
Sugar: For starters, sugar can use up your valuable acne-fighting minerals, particularly zinc because it’s used to process the sugar you consume. Sugar also causes a spike in blood sugar level, leading to high insulin levels, which creates increased sebum production and blocked pores. Additionally, studies show that sugar also has an inflammatory effect which can worsen existing acne. Steer clear of sweets like cookies and cakes, but don’t worry – chocolate is considered safe for skin.
Acne vulgaris and its resultant scars have been associated with significant social and academic difficulties that can last into adulthood, including difficulties obtaining employment.[31][178] Until the 1930s, it was largely seen as a trivial problem among middle-class girls – a trivial problem, because, unlike smallpox and tuberculosis, no one died from it, and a feminine problem, because boys were much less likely to seek medical assistance for it.[166] During the Great Depression, dermatologists discovered that young men with acne had difficulty obtaining jobs, and during World War II, some soldiers in tropical climates developed such severe and widespread tropical acne on their bodies that they were declared medically unfit for duty.[166]
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Popping pimples seems to be the quickest way to make the red spots on our skin disappear. But it can permanently damage your skin! When you squeeze a pimple, you’re actually forcing the oil substance and dead skin cells deeper into the follicle. The extra pressure exerted will make the follicle wall rupture, and spill the infected materials into the innermost part of our skin. This skin damage will lead to the loss of tissue, and finally cause acne scars.[2]
The other downside to Proactiv+ is that the bottles are small — like, half the size of Paula’s Choice small. Combine that with its recommended two or three-times daily application, and you’re going to be going through a lot of kits, which ultimately means spending more money on your treatment. If Proactiv is the only thing that works for you, it may very well be worth the investment, but we recommend starting with Paula’s Choice to see if you can get the same results at a cheaper price.
The verdict on smoking and its relationship to acne is still undecided. The evidence goes back and forth; while many studies seem to prove this theory, other studies contradict such research. For example, research published in 2001 by the British Journal of Dermatology concluded that out of 896 participants, smokers tended to have more acne in general; the more they smoked, the worse their acne felt and appeared. Confusingly, a study published just five years later in the Journal of Investigative Dermatology offered opposing research; nurses interviewed over 27,000 men within a span of 20 years and found that active smokers showed significantly lower severe than non-smokers. Although smoking’s relationship with acne vulgaris is undetermined, smoking has proven effects on acne inversa. It also disrupts hormonal balance, lowers vitamin E levels (an essential antioxidant in skin), induces higher instances of psoriasis, decreases oxygen flow to skin cells, and slows the healing process of open sores. Acne aside, smoking promotes wrinkles and premature aging. Did we mention it’s also deadly? Kick this habit to the curb; your skin will thank you.
Not only can the sun prolong PIE appearance, it can lead to premature aging including sun spots, fine lines, and wrinkles. UV damage is DNA damage. Sunscreen is an anti-aging must for all ages young and old--preventing future skin cancer. It is the fountain of youth in a bottle. Prevention is better than treatment. There is no such thing as safe tanning, as tanning is the result of sun damage.

^ Jump up to: a b GBD 2015 Disease and Injury Incidence and Prevalence, Collaborators. (8 October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
Blackheads appear as small black dots on the skin. They usually occur on the face – especially the nose and T-Zone – but can also be seen on the back, neck, chest, shoulders and arms. Blackheads are one of two types of comedones, or acne lesions caused by clogged pores. Blackhead comedones are open versus closed, leaving the plug at the top of the clogged pore exposed to air on the skin’s surface. It’s this exposure to oxygen that accounts for their color, which can not only be black but also gray, yellow or brown. When melanin – a pigment produced by oil glands and found within sebum – makes contact with air, it oxidizes and turns dark. Blackheads are a mild, usually painless form of acne, as there’s less inflammation associated with this type of lesion.
Back acne (sometimes called "bacne") is a potentially embarrassing and sometimes painful condition where clogged hair follicles on the back cause pimples and blackheads. Back acne can be caused by the same factors as other types of acne: diet, hormones, certain medications, genetics or any combination thereof. But when you're considering how to get rid of back acne, also remember that most people have their back covered the majority of the day. The clothing we wear matters, and the way in which we wash the skin on our back is key for clear skin, the whole body over. Learn more about common back acne causes, the best acne products for your body, and how to prevent acne on the back from returning in this section.
Microneedling is a procedure in which an instrument with multiple rows of tiny needles is rolled over the skin to elicit a wound healing response and stimulate collagen production to reduce the appearance of atrophic acne scars in people with darker skin color.[140] Notable adverse effects of microneedling include postinflammatory hyperpigmentation and tram track scarring (described as discrete slightly raised scars in a linear distribution similar to a tram track). The latter is thought to be primarily attributable to improper technique by the practitioner, including the use of excessive pressure or inappropriately large needles.[140][147]
If you're willing to invest in some serious skincare to soothe your acne-prone skin woes, Lancer's blemish-control polish is a great addition to your skincare routine. This treatment can be used as an exfoliant in conjunction with the best spot treatment for your acne type to further treat severe acne and improve the overall appearance of blemishes.
Every expert we spoke with said the most critical part of combating acne is combating it every day. “The only way to make any medication work is to use it on a daily basis,” says Dr. Green. Aesthetician and Rodan + Fields Consultant, Jessica Fitz Patrick emphasizes that it really comes down to what you can maintain for the long term: “Kits are great because they take out all the guesswork -- you just follow the instructions. But if four steps is going to be too many for you to keep up week after week, you’ll be better off finding one that has fewer treatments.”
The path to clear skin is often one of trial and error; you might need to try several acne remedies before you find the right treatment for the types of acne affecting your skin. Before trying acne medication, you may prefer to give different natural acne treatment options a chance. While there's no research supporting the effective use of natural acne treatments, here are two popular options that you may want to try.

That’s good news because the British Medical Journal reports that acne affects more than 80 percent of teenagers and continues in adult life in 3 percent of men and 12 percent of women. In fact, it seems to be increasing, which could be due to autoimmune disease, leaky gut syndrome or allergies, for example. Hormonal factors may play a role in breakouts as well. (1)
Antibiotics are frequently applied to the skin or taken orally to treat acne and are thought to work due to their antimicrobial activity against C. acnes and their ability to reduce inflammation.[20][81][87] With the widespread use of antibiotics for acne and an increased frequency of antibiotic-resistant C. acnes worldwide, antibiotics are becoming less effective,[81] especially macrolide antibiotics such as topical erythromycin.[16][87] Therefore, they are not recommended for use alone but are preferred as part of combination therapy.[15] Commonly used antibiotics, either applied to the skin or taken orally, include clindamycin, erythromycin, metronidazole, sulfacetamide, and tetracyclines such as doxycycline and minocycline.[47] Doxycycline 40 milligrams daily (low-dose) appears to have similar efficacy to doxycycline 100 milligrams daily and has fewer gastrointestinal side effects.[15] When antibiotics are applied to the skin, they are typically used for mild to moderately severe acne.[20] Antibiotics taken orally are generally considered to be more effective than topical antibiotics, and produce faster resolution of inflammatory acne lesions than topical applications.[1] Topical and oral antibiotics are not recommended for use together.[87]

Flutamide, a pure antagonist of the androgen receptor, is effective in the treatment of acne in women.[101][108] It has generally been found to reduce symptoms of acne by 80 or 90% even at low doses, with several studies showing complete acne clearance.[101][109][110] In one study, flutamide decreased acne scores by 80% within 3 months, whereas spironolactone decreased symptoms by only 40% in the same time period.[110][111][112] In a large long-term study, 97% of women reported satisfaction with the control of their acne with flutamide.[113] Although effective, flutamide has a risk of serious liver toxicity, and cases of death in women taking even low doses of the medication to treat androgen-dependent skin and hair conditions have occurred.[114] As such, the use of flutamide for acne has become increasingly limited,[113][115][116] and it has been argued that continued use of flutamide for such purposes is unethical.[114] Bicalutamide, a pure androgen receptor antagonist with the same mechanism as flutamide and with comparable or superior antiandrogenic efficacy but without its risk of liver toxicity, is a potential alternative to flutamide in the treatment of androgen-dependent skin and hair conditions in women.[106][117][118][119]
Do a Google search for "how to get rid of acne fast" and you'll see plenty of websites telling you to eat better for clear skin. But are there really foods that cause acne, or is that an old wives' tale? Dermatologist Hilary Baldwin, MD, of the Acne Treatment and Research Centre in Morristown, New Jersey, says the answer isn't really simple at all. "The simple answer is, we don't know. So far studies have suggested that high-glycemic index diets (those with lots of white foods like potatoes, pasta, bread, rice and sweets), as well as diets high in skim-milk dairy products and whey protein supplements might be associated with worsening of existing acne but are less likely to cause acne," Baldwin says.

^ Jump up to: a b c Zaenglein, AL; Graber, EM; Thiboutot, DM (2012). "Chapter 80 Acne Vulgaris and Acneiform Eruptions". In Goldsmith, Lowell A.; Katz, Stephen I.; Gilchrest, Barbara A.; Paller, Amy S.; Lefell, David J.; Wolff, Klaus (eds.). Fitzpatrick's Dermatology in General Medicine (8th ed.). New York: McGraw-Hill. pp. 897–917. ISBN 978-0-07-171755-7.


To many parents’ dismay, their beautiful newborn’s face breaks out with red bumps at around 3 to 4 weeks of age. This is called baby acne. It tends to occur at about the same age as the baby’s peak gas production and fussiness. How attractive! (This all coincides with parents’ maximum sleep deprivation.) Parents are often quite concerned both about how these bumps look and about their significance.
For UVA protection, a sunscreen with a high UVA protection of PA+++ or higher of PA++++ as recommended, especially to treat PIE. PPD is the UVA equivalent of SPF; use a sunscreen with a minimum of PPD20. The PA+ system has a + that corresponds to a tier of PPD protection. Of note, different countries use different PA systems. Japan and Taiwan changed their PA system to a 4+ tier system while Korea uses a 3+ tier system.
In the simplest sense, acne is caused when pores containing hair follicles and sebaceous (oil) glands become clogged. The sebaceous gland is responsible for producing sebum, an oily substance necessary for skin to stay hydrated and soft. However, too much sebum can plug the opening at the top of the pore, trapping a buildup of oil, dead skin cells, and bacteria leading to acne lesions.
Dermal or subcutaneous fillers are substances injected into the skin to improve the appearance of acne scars. Fillers are used to increase natural collagen production in the skin and to increase skin volume and decrease the depth of acne scars.[146] Examples of fillers used for this purpose include hyaluronic acid; poly(methyl methacrylate) microspheres with collagen; human and bovine collagen derivatives, and fat harvested from the person's own body (autologous fat transfer).[146]
C. acnes also provokes skin inflammation by altering the fatty composition of oily sebum.[45] Oxidation of the lipid squalene by C. acnes is of particular importance. Squalene oxidation activates NF-κB (a protein complex) and consequently increases IL-1α levels.[45] Additionally, squalene oxidation leads to increased activity of the 5-lipoxygenase enzyme responsible for conversion of arachidonic acid to leukotriene B4 (LTB4).[45] LTB4 promotes skin inflammation by acting on the peroxisome proliferator-activated receptor alpha (PPARα) protein.[45] PPARα increases activity of activator protein 1 (AP-1) and NF-κB, thereby leading to the recruitment of inflammatory T cells.[45] The inflammatory properties of C. acnes can be further explained by the bacterium's ability to convert sebum triglycerides to pro-inflammatory free fatty acids via secretion of the enzyme lipase.[45] These free fatty acids spur production of cathelicidin, HBD1, and HBD2, thus leading to further inflammation.[45]
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