Acne Severity Grading: Determining Essential Clinical Component and Features

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.