Skip to main content
SpringerLink
Log in

Acne Severity Grading: Determining Essential Clinical Component and Features

  • Living reference work entry
  • First Online:
Cutaneous Biometrics

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  • 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.

    PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • Cook CH, Centner RL, Michaels SE. An acne grading method using photographic standards. Arch Dermatol. 1979;115(5):571–5.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

  • Fried RG, Wechsler A. Psychological problems in the acne patient. Dermatol Ther. 2006;19(4):237–40.

    Article  PubMed  Google Scholar 

  • Gupta UG, Clarke RE. Theory and applications of the Delphi technique: a bibliography (1975–1994). Technol Forecast Soc Chang. 1996;53(2):185–211.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Lehmann HP, Robinson KA, Andrews JS, Holloway V, Goodman SN. Acne therapy: a methodologic review. J Am Acad Dermatol. 2002;47(2):231–40.

    Article  PubMed  Google Scholar 

  • 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.

    CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Patel DP, Bernardis E, Yan AC. The patient-centered acne severity scale study. Pediatr Dermatol. 2017;34(6):656–60.

    Article  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • Rowe G, Wright G. The Delphi technique as a forecasting tool: issues and analysis. Int J Forecast. 1999;15(4):353–75.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Stathakis V, Kilkenny M, Marks R. Descriptive epidemiology of acne vulgaris in the community. Australas J Dermatol. 1997;38(3):115–23.

    Article  CAS  PubMed  Google Scholar 

  • Stern RS. The prevalence of acne on the basis of physical examination. J Am Acad Dermatol. 1992;26(6):931–5.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Tan JK. Current measures for the evaluation of acne severity. Expert Rev Dermatol. 2008;3(5):595–603.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Schulich School of Medicine and Dentistry, Western University, Windsor campus, Windsor, ON, Canada

    Cheng-Wei Liu & Jerry Tan

  2. Windsor Clinical Research Inc., Windsor, ON, Canada

    Jerry Tan

Authors
  1. Cheng-Wei Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jerry Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jerry Tan .

Editor information

Editors and Affiliations

  1. Dept Dermatology, 110 Surge Bldg, UCSF School of Medicine Dept Dermatology, 110 Surge Bldg, San Francisco, CA, USA

    Howard Maibach

  2. Department of Dermatology, University of California, San Francisco Department of Dermatology, San Francisco, CA, USA

    Nily Osman

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Liu, CW., Tan, J. (2019). Acne Severity Grading: Determining Essential Clinical Component and Features. In: Maibach, H., Osman, N. (eds) Cutaneous Biometrics. Springer, Cham. https://doi.org/10.1007/978-3-319-56591-0_22-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-56591-0_22-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-56591-0

  • Online ISBN: 978-3-319-56591-0

  • eBook Packages: Springer Reference Biomedicine and Life SciencesReference Module Biomedical and Life Sciences

Publish with us

Policies and ethics

Search

Navigation