This review has noted CAM therapies advocated for use in acne and examined studies of CAM in acne. But it is possible that a far greater range of CAM therapies than is presented in this review is being used in patients with acne. As Dattner 79 has pointed out, many systems of traditional medicine, unlike Western medicine, "have cosmologies for choosing herbs which are based on the characteristics of the given patient" rather than their diagnosis. Furthermore, it is possible (if not probable) that over-the-counter CAM-containing skin-care products are used "generically" by some consumers--that is, for any skin condition, including acne. Illustrating this point is the large number of phytotherapies in one ethnopharmacognostic survey found to be used for reddened skin, as a facial "skin toner", to treat facial skin inflammation, to "smooth" facial skin, and "to clean the skin". 80 Also, most individuals with acne do not see a doctor regarding their acne 81 and, of those who use CAM for skin conditions, most self-access it rather than visiting a CAM practitioner.6 The "incorporation of herbs into cosmetic and over-the-counter skin preparations has already assumed the force of a whirlwind".79 It is likely that this has resulted in a large and unsystematic range of extant acne therapies, easily accessible to acne sufferers and very unlikely to be subjected to empiric scrutiny.