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Acne Severity Grading: Determining Essential Clinical Component and Features

  • Cheng-Wei Liu
  • Jerry TanEmail author
Living reference work entry

Abstract

Acne vulgaris is one of the most common skin diseases, affecting 9.4% of the global population, and is the second most burdensome skin disease. To facilitate clinical management and research, an accurate and practical method of assessing acne severity is required. Over the years, a myriad of acne global grading scales (AGGSs) have been developed. However, the lack of agreement regarding elements required for an AGGS has prevented the institution of a gold standard. Using the Delphi method of consensus building, the clinical components and features that should be incorporated into an AGGS were identified. Clinical components include assessment of primary lesions, quantity, extrafacial sites, and extent of involvement. Features comprise of clinimetric properties, efficiency, acceptability, and categorization. None of the current AGGSs fulfill the criteria entirely, necessitating improvement or innovation toward a harmonized standard. Recently developed clinical AGGSs, core outcome measures in acne clinical trials, and patient quality-of-life metrics are also reviewed.

Keywords

Acne Acne severity Acne grading Outcome measures Quality of life Delphi Consensus 

References

  1. Alexis A, Daniels SR, Johnson N, Pompilus F, Burgess SM, Harper JC. Development of a new patient-reported outcome measure for facial acne: the Acne Symptom and Impact Scale (ASIS). J Drugs Dermatol. 2014;13(3):333–40.PubMedGoogle Scholar
  2. Auffret N, Claudel J-P, Leccia M-T, Poli F, Farhi D, Dréno B. AFAST – Adult Female Acne Scoring Tool: an easy-to-use tool for scoring acne in adult females. J Eur Acad Dermatol Venereol. 2016;30(5):824–8.PubMedGoogle Scholar
  3. Augustin M, Herberger K, Hintzen S, Heigel H, Franzke N, Schäfer I. Prevalence of skin lesions and need for treatment in a cohort of 90880 workers. Br J Dermatol. 2011;165(4):865–73.PubMedGoogle Scholar
  4. Barratt H, Hamilton F, Car J, Lyons C, Layton A, Majeed A. Outcome measures in acne vulgaris: systematic review. Br J Dermatol. 2009;160(1):132–6.PubMedGoogle Scholar
  5. Cook CH, Centner RL, Michaels SE. An acne grading method using photographic standards. Arch Dermatol. 1979;115(5):571–5.PubMedGoogle Scholar
  6. Dalgard F, Gieler U, Holm JØ, Bjertness E, Hauser S. Self-esteem and body satisfaction among late adolescents with acne: results from a population survey. J Am Acad Dermatol. 2008;59(5):746–51.PubMedGoogle Scholar
  7. Del Rosso JQ. Study results of benzoyl peroxide 5%/clindamycin 1% topical gel, adapalene 0.1% gel, and use in combination for acne vulgaris. J Drugs Dermatol. 2007;6(6):616–22.PubMedGoogle Scholar
  8. Dréno B, Poli F, Pawin H, Beylot C, Faure M, Chivot M, et al. Development and evaluation of a Global Acne Severity Scale (GEA Scale) suitable for France and Europe. J Eur Acad Dermatol Venereol. 2011;25(1):43–8.PubMedGoogle Scholar
  9. Food and Drug Administration. Guidance for Industry; Acne Vulgaris: Developing Drugs for Treatment (Draft Guidance). Rockville;2005 [cited 2018 March 22]; p. 1–14. Available from: http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM071292.pdf.
  10. Fried RG, Wechsler A. Psychological problems in the acne patient. Dermatol Ther. 2006;19(4):237–40.PubMedGoogle Scholar
  11. Gupta UG, Clarke RE. Theory and applications of the Delphi technique: a bibliography (1975–1994). Technol Forecast Soc Chang. 1996;53(2):185–211.Google Scholar
  12. Hassan J, Grogan S, Clark-Carter D, Richards H, Yates VM. The individual health burden of acne: appearance-related distress in male and female adolescents and adults with back, chest and facial acne. J Health Psychol. 2009;14(8):1105–18.PubMedGoogle Scholar
  13. Hudgens S, Harper JC, Daniels SR, Banderas B, Varon S, Alexis AF. Validation of a new patient-reported outcome measure for facial acne: the Acne Symptom and Impact Scale (ASIS). J Drugs Dermatol. 2015;14(6):552–9.PubMedGoogle Scholar
  14. Karimkhani C, Dellavalle RP, Coffeng LE, Flohr C, Hay RJ, Langan SM, et al. Global skin disease morbidity and mortality: an update from the global burden of disease study 2013. JAMA Dermatol. 2017;153(5):406–12.PubMedPubMedCentralGoogle Scholar
  15. Kellett SC, Gawkrodger DJ. The psychological and emotional impact of acne and the effect of treatment with isotretinoin. Br J Dermatol. 1999;140(2):273–82.PubMedGoogle Scholar
  16. Layton AM, Eady EA, Thiboutot DM, Tan J. Acne Core Outcomes Research Network (ACORN) outcomes identification group. Identifying what to measure in acne clinical trials: first steps towards development of a core outcome set. J Invest Dermatol. 2017;137(8):1784–6.PubMedPubMedCentralGoogle Scholar
  17. Lehmann HP, Robinson KA, Andrews JS, Holloway V, Goodman SN. Acne therapy: a methodologic review. J Am Acad Dermatol. 2002;47(2):231–40.PubMedGoogle Scholar
  18. Lello J, Pearl A, Arroll B, Yallop J, Birchall NM. Prevalence of acne vulgaris in Auckland senior high school students. N Z Med J. 1995;108(1004):287–9.PubMedGoogle Scholar
  19. Mallon E, Newton JN, Klassen A, Stewart-Brown SL, Ryan TJ, Finlay AY. The quality of life in acne: a comparison with general medical conditions using generic questionnaires. Br J Dermatol. 1999;140(4):672–6.PubMedGoogle Scholar
  20. McLellan C, Frey MP, Thibotout D, Layton A, Chren M-M, Tan J. Development of a Comprehensive Quality-of-Life Measure for Facial and Torso Acne. J Cutan Med Surg. 2018;22(3):304–11.  https://doi.org/10.1177/1203475418756379.PubMedGoogle Scholar
  21. Miró J, Castarlenas E, Huguet A. Evidence for the use of a numerical rating scale to assess the intensity of pediatric pain. Eur J Pain. 2009;13(10):1089–95.PubMedGoogle Scholar
  22. Patel DP, Bernardis E, Yan AC. The patient-centered acne severity scale study. Pediatr Dermatol. 2017;34(6):656–60.PubMedGoogle Scholar
  23. Pochi PE, Shalita AR, Strauss JS, Webster SB, Cunliffe WJ, Katz HI, et al. Report of the consensus conference on Acne classification. Washington, D.C., March 24 and 25, 1990. J Am Acad Dermatol. 1991;24(3):495–500.PubMedGoogle Scholar
  24. Rowe G, Wright G. The Delphi technique as a forecasting tool: issues and analysis. Int J Forecast. 1999;15(4):353–75.Google Scholar
  25. Shen Y, Wang T, Zhou C, Wang X, Ding X, Tian S, et al. Prevalence of acne vulgaris in Chinese adolescents and adults: a community-based study of 17,345 subjects in six cities. Acta Derm Venereol. 2012;92(1):40–4.PubMedGoogle Scholar
  26. Stathakis V, Kilkenny M, Marks R. Descriptive epidemiology of acne vulgaris in the community. Australas J Dermatol. 1997;38(3):115–23.PubMedGoogle Scholar
  27. Stern RS. The prevalence of acne on the basis of physical examination. J Am Acad Dermatol. 1992;26(6):931–5.PubMedGoogle Scholar
  28. Tan J, Wolfe B, Weiss J, Stein-Gold L, Bikowski J, Del Rosso J, et al. Acne severity grading: determining essential clinical components and features using a Delphi consensus. J Am Acad Dermatol. 2012;67(2):187–93.PubMedGoogle Scholar
  29. Tan JK. Current measures for the evaluation of acne severity. Expert Rev Dermatol. 2008;3(5):595–603.Google Scholar
  30. Tan JKL, Jones E, Allen E, Pripotnev S, Raza A, Wolfe B. Evaluation of essential clinical components and features of current acne global grading scales. J Am Acad Dermatol. 2013;69(5):754–61.PubMedGoogle Scholar
  31. Tan JKL, Tang J, Fung K, Gupta AK, Thomas DR, Sapra S, et al. Development and validation of a comprehensive acne severity scale. J Cutan Med Surg. 2007;11(6):211–6.PubMedGoogle Scholar
  32. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2163–96.Google Scholar
  33. Witkowski JA, Parish LC. The assessment of acne: an evaluation of grading and lesion counting in the measurement of acne. Clin Dermatol. 2004;22(5):394–7.PubMedGoogle Scholar
  34. World Health Organization. The World Health Organization quality of life assessment (WHOQOL): position paper from the World Health Organization. Soc Sci Med. 1995;41(10):1403–9.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Schulich School of Medicine and Dentistry, Western University, Windsor campusWindsorCanada
  2. 2.Windsor Clinical Research Inc.WindsorCanada

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