Audit: QRS - Azelaic Acid for Skin Rejuvenation

Audit conducted on 18/09/2026 03:13 using AI4L / Opus 5

Iterations

Summary

Items Count
Total 93
Passed 83
Failed 0
N/A 10
Pass Rate 100.00%
  • Total = Passed + Failed + N/A
  • Pass Rate = Passed / (Passed + Failed) × 100
  • N/A items are excluded from the pass rate calculation

1. General Rules

# Description Result Comments
1.1 Every claim, magnitude, label, recommendation, and statement in the QRS is literally supported by content in the source ER. 🟢 Spot-checked every populated span: at-a-glance vs ER Conclusion (ER 484–486), protocol cells vs ER Therapeutic Protocol (ER 357, 359, 365), time-to-effect vs ER Practical Considerations (ER 416, 418) and ER 361, benefit/risk tiers vs ER sub-headings, gates vs ER 308–333, monitoring table vs ER 446–453, qualitative vs ER 457–462.
1.2 Where the ER uses cautious phrasing (“not formally studied”, “None documented in human trials to date”, “theoretical concern”, “data are limited”), the QRS uses the same phrasing. 🟢 marker_6_target keeps the ER’s “No established target; track change from … own baseline” (ER 453). No cautious ER phrasing is upgraded anywhere.
1.3 The QRS never strengthens an ER claim (e.g., “not formally studied” → “not required”) or softens one (e.g., “do not use during pregnancy” → “use with caution during pregnancy”). 🟢 Contraindication strength preserved (e.g., “Poorly controlled or severe persistent asthma (until reviewed with treating physician)” mirrors ER 330); speculative tiers stay speculative.
1.4 The QRS does not relabel an ER fact under a different decision category. A “Benefit-Modifying Factor” from ER section is not surfaced as a “Caution”; a “Risk-Modifying Factor” is not surfaced as a “Side Effect”; etc. 🟢 All six stop_items come from ER “Populations who should avoid Azelaic Acid” (ER 328–333); all six caution_items come from the ER interaction bullets (ER 308–324). No Benefit-/Risk-Modifying Factor is surfaced as a gate.
1.5 PubMed IDs, study citations, expert names, clinical trial identifiers (NCT*), and brand names appear in the QRS only if they appear in the source ER for the same fact. 🟢 The QRS carries no PMIDs, citations, expert names, NCT IDs or brand names. Named drug classes/agents in the gates (tretinoin, adapalene, tazarotene, clindamycin, erythromycin, hydroquinone, tranexamic acid) all appear in ER 308–316 for the same facts.
1.6 The QRS does not introduce new attributions. 🟢 No attributions present beyond the fixed template header/footer.

2. Focus, Tone & Audience

# Description Result Comments
2.1 The QRS follows the tone of the ER, which is determined by the ER’s own language, phrasing, and framing. 🟢 Measured, declarative register matching the ER; British spellings (“normalisation”, “keratinisation”) carried over from the ER.
2.2 The tone of the QRS is simultaneously expert, accessible, objective, and data-driven, but also empowering and encouraging 🟢 Tiered benefits/risks plus concrete protocol and monitoring values; no hedging or alarmism.
2.3 The QRS reads as a trusted, knowledgeable guide rather than a prescriptive doctor 🟢 Protocol cells are descriptive (“the regimen used in every pivotal trial”), not instructions.
2.4 The QRS avoids language that implies medical or clinical advice 🟢 No imperatives; gates are stated as conditions, not orders.
2.5 The QRS “presents information” instead of “providing guidance”, “recommending”, or “advising” 🟢 No occurrences of “recommended”, “advised”, “should”; all protocol subs use participle/declarative forms.
2.6 The QRS never addresses “the reader” directly — it presents evidence, not guidance 🟢 No second-person pronouns anywhere in the file.
2.7 The QRS is written in plain language, avoiding unnecessary medical jargon 🟢 Clinical terms are the ER’s own tier headings; where space allows the QRS glosses them (“Melasma (brown patches)”, “Rosacea (persistent redness)”).
2.8 Information is presented in a concise and very compact manner 🟢 Gate and tier items are bare facts; protocol subs are single sentences.
2.9 It DOES NOT address the reader directly 🟢 Confirmed — no “you”/”your” in the document.
2.10 The target audience is health- and longevity-oriented adults who are risk-aware, proactive, and actively seeking to optimize health or apply the intervention under review. 🟢 Functional-range biomarker panel, Wood’s-lamp pigment typing and tolerance tracking presuppose a proactive optimiser.
2.11 The target audience is willing to employ lifestyle and behavioral changes as well as follow protocols that may be inconvenient, costly, or require effort. 🟢 Twice-daily application, photographic reassessment cadence and an annual laboratory panel assume high effort tolerance.
2.12 The document is NOT written for the general population, who are unwilling to employ lifestyle and behavioral changes or follow protocols that may be inconvenient, costly, or require effort. 🟢 No simplified “ask your doctor” framing; content assumes engagement with the evidence.
2.13 Framing, takeaways, and risk/benefit weighting throughout the document reflect this audience, including where an intervention’s signal for the average person differs from its signal for this audience. 🟢 At-a-glance states plainly that controlled trials on fine lines, sagging and sun-damaged texture are essentially absent — the distinction that matters to a rejuvenation-focused reader.
2.14 The document’s own voice frames usage in longevity terms, not “anti-aging” (e.g., “anti-aging clinics”, “anti-aging community”, “anti-aging medicine”). Proper names that contain “anti-aging” (e.g., “American Academy of Anti-Aging Medicine”) are quoted verbatim. 🟢 No occurrence of “anti-aging” in the file.
2.15 The document’s own voice uses formal clinical and scientific terminology, not colloquial or consumer-grade language (e.g., “oral medication” not “pill(s)”; “oral” / “administered orally” not “taken by mouth” / “given by mouth”; “injection” not “shot”; “adverse event” not “bad reaction”). This holds on EVERY surface, including the QRS lede — the stricter plain-language bar (see 2.7) does not license lay phrasing for route of administration. Direct quotes from sources are exempt. 🟢 Route is given as topical application (“applied to the face as a cream, gel or foam”, “thin layer”, “layered under sunscreen”); “pea-sized amount” is the ER’s own dermatological dose unit (ER 359).

3. Template Integrity

# Description Result Comments
3.1 The following labels and headings on the QRS are fixed and not modified: Card and section headings: “Protocol”, “Time to effect”, “Benefits”, “Risk & Side Effects”, “Monitoring”, “Qualitative Assessment”; Gate headings: “Contraindications”, “Key Interactions”; Tier labels: “High”, “Medium”, “Low”, “Speculative”; Table column headers in Monitoring: “Marker”, “Target”, “Why” 🟢 All fixed strings verified byte-identical to the template (lines 446, 492, 543, 572, 585, 603, 632, 636–638, 739 and the four tier labels in both tier lists).
3.2 All “” from the [qrs_template] are present in the the QRS. 🟢 Extracted and diffed the full variable set: all 34 fixed template variables present; the repeatable marker_#_* and qualitative_item_# spans expanded to 1–6 and 1–6 respectively.
3.3 Spans that are not addressed in a checklist item are left unchanged 🟢 Full-file diff against [qrs_template] shows only variable substitutions plus the metadata block; CSS, structure, website="evidence_review" / website="audit" / website="full_review" spans, disclaimer and footer are untouched.

4. Formatting

# Description Result Comments
4.1 When the source ER section is empty, the QRS uses the ER’s own empty-state phrasing verbatim. Typical phrasings are “None documented in human trials to date” and “Not formally studied” N/A No source ER section drawn on by the QRS is empty.
4.2 Where the ER presents a bulleted item as “Label: content”, the QRS uses the ER’s bold label verbatim as the cell or row label. 🟢 “Standard concentration and frequency”, “Quantity per application” and “Best time of day” are the ER’s bold labels verbatim (ER 357, 359, 365); monitoring row labels are the ER biomarker names verbatim (ER 448–453).
4.3 Labels are not paraphrased, abbreviated, or invented. 🟢 Protocol, tier, monitoring and qualitative labels are all ER-sourced. The three time-to-effect labels name the conditions the ER’s single “Time to effect” bullet covers (ER 416), with the ER’s own plain-language glosses.
4.4 The QRS DOES NOT use emoji indicators (no 🟩, 🟥, 🟨, etc.). Color and emphasis are conveyed through CSS and bold labels. 🟢 Unicode emoji scan over the whole file returns nothing; the ER’s 🟩/🟥/🟨 tier markers and the ⭕️ “Not Central” markers were correctly stripped.
4.5 The QRS is designed to render on one A4 page. Any section that has more content in the ER than fits the per-section budget is condensed by the LLM, not extended onto a second page. 🟢 Every section is condensed to the template budget: 59-word lede, 3+3 protocol cells, one line per benefit/risk tier, 6+6 gate items, 6 monitoring rows and 6 qualitative bullets. No section was extended beyond the template structure.

5. Metadata

# Description Result Comments
5.1 The metadata is placed inside a single HTML comment that is the first element after “<!doctype html>” and before any other comment, head, or body content. 🟢 Lines 2–14, immediately after <!doctype html> on line 1.
5.2 Inside that HTML comment the YAML block is delimited by a line “—” opening and a line “—” closing. Text before the opening “—” is permitted but is not parsed as YAML. 🟢 Opening --- at line 3, closing --- at line 13; the preamble text sits on line 2.
5.3 The metadata is not visible in any rendered view of the QRS and is not surfaced by any other element on the sheet. 🟢 Enclosed in an HTML comment; no metadata value is repeated in the rendered body.
5.4 All frontmatter values are trimmed: no leading or trailing whitespace, no surrounding quotes unless the value contains a colon, bracket, or leading special character that requires YAML quoting. 🟢 Only duration: "00:03" is quoted, and it contains a colon; all other values are bare and trimmed.
5.5 The filename of the source ER is stated as “er_filename: [er_filename]” 🟢 Line 4: er_filename: azelaic_acid_skin_2026-0918-0010_Opus_ER.md.
5.6 Version of the QRS.md file used to create the document is stated as “qrs_prompt_version: [Version of QRS.md]” 🟢 Line 5: qrs_prompt_version: 26.9.11, matching the QRS.md version badge.
5.7 Creation date and time of the document is stated as “qrs_creation_date: [YYYY-MMDD-HHMM]” (e.g., 2026-0501-1430) 🟢 Line 6: qrs_creation_date: 2026-0918-0307.
5.8 The nickname of the AI used to create the document is stated as “qrs_creator_ai_nickname: [qrs_creator_ai_nickname]” 🟢 Line 7: qrs_creator_ai_nickname: Opus.
5.9 The nickname of the AI is just a single word model name without version, etc. (e.g., Opus, Sonnet, Grok, Gemini, ChatGPT) 🟢 “Opus” — single word, no version.
5.10 The full name of the AI used to create the document is stated as “qrs_creator_ai_fullname: [qrs_creator_ai_fullname]” 🟢 Line 8: qrs_creator_ai_fullname: Opus 5.
5.11 The full name of the AI consists of the [qrs_creator_ai_nickname] and the model version number and no additional qualifier (e.g., Opus 4.6, Sonnet 3.2, Grok 4.5, Gemini 3.1, ChatGPT 5.4) 🟢 “Opus 5” — nickname plus version, no qualifier.
5.12 The filename of the document is stated as “qrs_filename: [filename of this document]” 🟢 Line 9 matches the file on disk: azelaic_acid_skin_2026-0918-0010_Opus_QRS.html.
5.13 All frontmatter values are trimmed: no leading or trailing whitespace, no surrounding quotes unless the value contains a colon, bracket, or leading special character that requires YAML quoting. 🟢 Re-verified across all nine keys, including git_user: evipedia-1 and git_issue: 6267.

6. Page Title & Header

# Description Result Comments
6.1 [page_title] is set to the [canonical_topic] of the ER frontmatter followed by “ - Quick Reference Sheet” (e.g., “Intervention - Quick Reference Sheet”). The [canonical_topic] is HTML-entity-encoded as needed (e.g., &amp; for &) 🟢 Line 22: “Azelaic Acid for Skin Rejuvenation - Quick Reference Sheet”; ER canonical_topic is “Azelaic Acid for Skin Rejuvenation” (ER 8). No entity encoding required.
6.2 [header_topic] is set to the [canonical_topic] of the ER frontmatter, with HTML entities encoded as needed (e.g., &amp; for &) 🟢 Line 417: “Azelaic Acid for Skin Rejuvenation”.
6.3 [header_subline_date] is set to [qrs_creation_date reformatted as MM/DD/YYYY] 🟢 Line 421: “09/18/2026”, matching qrs_creation_date: 2026-0918-0307.
6.4 [header_subline_model] is set to [qrs_creator_ai_fullname] 🟢 Line 425: “Opus 5”.
6.5 No additional header content appears: no badge, version stamp, AKA / alternate names line, source-AI attribution, audit date, or QRS variant marker. 🟢 Header block (lines 415–428) is structurally identical to the template; the ER’s alternate_names line was not carried over.

7. At-A-Glance Section

# Description Result Comments
7.1 [at_a_glance] is dense, execution-oriented summary of the ER Conclusion section 🟢 Condenses ER 484 and 486: what it is, what it is best supported for, where evidence is absent, and the dominant tolerability cost.
7.2 [at_a_glance] is no longer than 60 words 🟢 59 words.
7.3 Every fact in [at_a_glance] is supported by a distinct passage in the ER. 🟢 Sentence 1 ↔ ER 484 opening; sentence 2 ↔ ER 484 “best-supported effects”; sentence 3 ↔ ER 484 “controlled trials are essentially absent”; sentence 4 ↔ ER 486.
7.4 It DOES NOT use acronyms or technical classifications that require specialist knowledge, uses plain-language terms instead 🟢 Uses “brown facial patches”, “persistent facial redness with inflamed bumps”, “fine lines, sagging and sun-damaged texture” rather than melasma/rosacea/photoaging. No acronyms.
7.5 It DOES NOT cite specific trials (names, years, sample sizes, p-values) 🟢 No trial names, years, sample sizes or p-values.
7.6 It DOES NOT cite effect sizes, relative risks, or statistical results 🟢 No percentages, risk ratios or confidence intervals.

8. Contraindications

# Description Result Comments
8.1 The section is derived from the ER Key Interactions & Contraindications section 🟢 All six items map to ER 328–333 (“Populations who should avoid Azelaic Acid”).
8.2 [stop_items] represent the Contraindications from the ER 🟢 All six ER avoid-populations are present, none added.
8.3 Individual [stop_items] are formatted as <li></li> 🟢 Lines 575–580, six <li> elements inside the span.
8.4 Items are as concise as possible. No trailing explanations, no elaborations, no mechanistic rationale, no attributions, no citations, no study details. No content after an em-dash, en-dash, or hyphen-dash (e.g., “— dose reduction required”, “— reduced efficacy”) — these trailing clauses are stripped. Just the key fact. 🟢 ER rationales stripped: “given labelled reports of exacerbation” (ER 330), “in whom safety and effectiveness have not been established” (ER 332) and “where topical penetration cannot reach the pigment” (ER 333) are all absent. No dash-trailing clauses.
8.5 Parenthetical qualifiers from the ER bullet — time windows, severity classes, threshold values, clinical staging — ARE preserved as part of the item, kept as concise as possible (shortened or trimmed where needed to fit the one-page budget, but never dropped entirely). 🟢 Severity class “Poorly controlled or severe persistent” kept; “(propylene glycol in 15% gel)”, “(until reviewed with treating physician)”, “(confirmed on Wood’s lamp)” and the under-12 age threshold all preserved.
8.6 When the ER uses ranking notation inside parens (e.g., “>” for severity ordering) that depends on an explanatory phrase to interpret, normalize the items to a plain comma-separated list rather than carrying through the bare symbol. N/A The ER uses no ranking notation inside parentheses in this section.
8.7 The section is left empty ONLY IF the ER’s Key Interactions & Contraindications section identifies no population, condition, or scenario for which the intervention should be avoided, deferred, or used only under specialist supervision. 🟢 The ER does identify such populations (ER 326–333) and the section is correspondingly populated.
8.8 If the section is left empty, an HTML comment inside the [stop_items] span records the ER basis for the absence, naming or quoting the ER text relied on. E.g. N/A The section is not empty.

9. Key Interactions

# Description Result Comments
9.1 The section is derived from the ER Key Interactions & Contraindications section 🟢 All six items map to ER 308–324.
9.2 [caution_items] represent the Key Interactions from the ER, excluding any that are already listed as Contraindications 🟢 The five caution/monitor bullets plus “Procedural interventions” are carried; the three “no clinically relevant interaction” bullets (ER 318, 320, 322) are correctly omitted, and no contraindication is duplicated.
9.3 Individual [caution_items] are formatted as <li></li> 🟢 Lines 588–593, six <li> elements inside the span.
9.4 Items are as concise as possible. No trailing explanations, no elaborations, no mechanistic rationale, no attributions, no citations, no study details. No content after an em-dash, en-dash, or hyphen-dash (e.g., “— dose reduction required”, “— reduced efficacy”) — these trailing clauses are stripped. Just the key fact. 🟢 Every ER mechanism and “Mitigation:” clause is stripped, as is the Lai et al. 2024 citation attached to the procedural bullet (ER 324). No dash-trailing clauses.
9.5 Parenthetical qualifiers from the ER bullet — example drug lists, time windows, severity classes, threshold values, clinical staging — ARE preserved as part of the item, kept as concise as possible (shortened or trimmed where needed to fit the one-page budget, but never dropped entirely). 🟢 “(tretinoin, adapalene, tazarotene)”, “(clindamycin, erythromycin)”, “(glycolic, lactic, salicylic, mandelic)” preserved verbatim; “(lasers, chemical peels, microneedling)” is the permitted trimmed form of ER 324.
9.6 When the ER uses ranking notation inside parens (e.g., “>” for severity ordering) that depends on an explanatory phrase to interpret, normalize the items to a plain comma-separated list rather than carrying through the bare symbol. N/A The ER uses no ranking notation inside parentheses in this section.
9.7 The section is left empty ONLY IF the ER’s Key Interactions & Contraindications section identifies no interaction, additive effect, or exposure that changes how the intervention is used. 🟢 The ER identifies several additive-irritation interactions and the section is correspondingly populated.
9.8 If the section is left empty, an HTML comment inside the [caution_items] span records the ER basis for the absence, naming or quoting the ER text relied on. E.g. N/A The section is not empty.

10. Protocol

# Description Result Comments
10.1 The section is derived from the ER Protocol section 🟢 All three cells map to ER Therapeutic Protocol bullets at ER 357, 359 and 365.
10.2 The three sets of [action] items cover the three most important actionable implementation aspects from the ER Protocol section 🟢 Concentration/frequency, quantity per application and timing of day are the three execution-critical bullets; the remaining ER bullets are contextual (genetics, sex, age, half-life) or approach descriptions.
10.3 If less that three distinct actionable implementation aspects are mentioned in the ER the unused sets are left empty and made invisible, not filled with placeholder text or empty-state phrasing. N/A The ER supplies more than three actionable aspects; all three sets are used.
10.4 All used [action_#label], [action#value], [action#_sub] items are filled with meaningful content derived from the ER Protocol section. 🟢 All nine spans populated from ER 357, 359, 365; no placeholder text remains.

11. Time to Effect

# Description Result Comments
11.1 The three sets of [time] items cover the three most important time-to-effect aspects from the ER 🟢 Melasma, rosacea and acne — the three windows the ER’s “Time to effect” bullet gives (ER 416).
11.2 The sets are picked and ordered by the magnitude of the related benefit 🟢 All three are High-tier benefits; the QRS order (melasma → rosacea → acne) matches the ER’s own High-tier ordering (ER 162, 168, 174).
11.3 If less that three distinct time-to-effect aspects are mentioned in the ER the unused sets are left empty and made invisible, not filled with placeholder text or empty-state phrasing. N/A The ER supplies three distinct time-to-effect windows; all three sets are used.
11.4 All used [time_#label], [time#value], [time#_sub] items are filled with meaningful content derived from the ER. 🟢 All nine spans populated; values “Week 8 to 6 months”, “12 weeks” and “4 weeks” trace to ER 416, and the subs to ER 416, 361 and 418.
11.5 If the ER does not provide any information on time to effect, the section is removed completely from the Protocol Panel N/A The ER does provide time-to-effect information, so the section is correctly retained.

12. Benefits

# Description Result Comments
12.1 The section is derived from the ER Expected Benefits section 🟢 All eight entries are the ER’s Expected Benefits sub-headings (ER 162–210), in ER tier and order.
12.2 Key variables are [benefits_high], [benefits_medium], [benefits_low], [benefits_speculative] 🟢 All four spans present and populated (lines 545–565).
12.3 Items are as concise as possible. No explanations, no elaborations, no effect sizes, no qualifiers, no attributions, no citations, no study details, no mechanistic explanations, etc. Just the key fact. 🟢 Bare heading text only; every ER Magnitude: paragraph, percentage, risk ratio and citation is excluded.
12.4 Parenthetical content — including effect sizes, sample notes, mechanistic hints, and example studies — is stripped, NOT preserved. 🟢 No parentheses in any benefit entry; the ER’s ⭕️ “Not Central to Skin Rejuvenation” markers are also dropped.
12.5 If no items of a specific sub-section (high, medium, low, speculative) are present the respective is set to “display=none”, not filled with “None documented in human trials to date” or similar empty-state phrasing. N/A All four ER benefit tiers contain items, so no span needed hiding.

13. Risks

# Description Result Comments
13.1 The section is derived from the ER Potential Risks & Side Effects section 🟢 All eight entries are the ER’s Potential Risks & Side Effects sub-headings (ER 234–284), in ER tier and order.
13.2 Key variables are [risks_high], [risks_medium], [risks_low], [risks_speculative] 🟢 All four spans present and populated (lines 605–626).
13.3 Items are as concise as possible. No explanations, no elaborations, no effect sizes, no qualifiers, no attributions, no citations, no study details, no mechanistic explanations, etc. Just the key fact. 🟢 Bare heading text only; the ER frequency figures (29%, 11%, 8%, 4%, ~1%, 0.01–0.1%) and prescribing-information citations are excluded.
13.4 Parenthetical content — including frequencies, severity grades, sample notes, mechanistic hints, and example studies — is stripped, NOT preserved. 🟢 No parentheses in any risk entry; the ER’s inline glosses (e.g., “(itching)”, “(hives)”) are not carried over.
13.5 If no items of a specific sub-section (high, medium, low, speculative) are present the respective is set to “display=none”, not filled with “None documented in human trials to date” or similar empty-state phrasing. N/A All four ER risk tiers contain items, so no span needed hiding.

14. Monitoring

# Description Result Comments
14.1 The section is derived from the ER Monitoring section 🟢 Table rows and cadence both come from ER Monitoring Protocol & Defining Success (ER 444–453).
14.2 All measurable/quantifiable biomarkers from the Monitoring section are listed 🟢 All six ER biomarkers present with matching optimal ranges and rationales: TSH 0.5–2.0 mIU/L, 25-OH-D 40–60 ng/mL, fasting insulin 2–5 µIU/mL, HbA1c 4.8–5.2%, hs-CRP below 0.5 mg/L, facial serine protease activity.
14.3 [monitoring_cadence] is populated with the monitoring cadence/frequency derived from the ER Monitoring section. It is not left with placeholder text or empty. 🟢 Lines 729–733 reproduce the ER cadence sentence (ER 444): 2-week tolerance review, 4- and 12-week photographic reassessment, then every 3–6 months, with an annual laboratory panel.

15. Qualitative Assessment

# Description Result Comments
15.1 The section is derived from the ER Monitoring section 🟢 All six items come from the ER’s “Qualitative markers tracked alongside the panel” list (ER 457–462).
15.2 All subjective/qualitative biomarkers from the Monitoring section are listed 🟢 All six ER qualitative markers present and in ER order, none omitted or added.

Issues 18/09/2026 03:13

Pass rate 100.00%. No issues found.