A Comprehensive Critique and Review of Published Measures of Acne Severity.
OBJECTIVE
Acne vulgaris is a dynamic, complex condition that is notoriously difficult to evaluate. The authors set out to critically evaluate currently available measures of acne severity, particularly in terms of suitability for use in clinical trials.


METHODS
A systematic review was conducted to identify methods used to measure acne severity, using MEDLINE, CINAHL, Scopus, and Wiley Online. Each method was critically reviewed and given a score out of 13 based on eight quality criteria under two broad groupings of psychometric testing and suitability for research and evaluation.


RESULTS
Twenty-four methods for assessing acne severity were identified. Four scales received a quality score of zero, and 11 scored ≤3. The highest rated scales achieved a total score of 6. Six scales reported strong inter-rater reliability (ICC>0.75), and four reported strong intra-rater reliability (ICC>0.75). The poor overall performance of most scales, largely characterized by the absence of reliability testing or evidence for independent assessment and validation indicates that generally, their application in clinical trials is not supported.


CONCLUSIONS
This review and appraisal of instruments for measuring acne severity supports previously identified concerns regarding the quality of published measures. It highlights the need for a valid and reliable acne severity scale, especially for use in research and evaluation. The ideal scale would demonstrate adequate validation and reliability and be easily implemented for third-party analysis. The development of such a scale is critical to interpreting results of trials and facilitating the pooling of results for systematic reviews and meta-analyses.
School of Nursing & Midwifery, University of South Australia, SAHMRI, Adelaide, South Australia;
Tamara
T
Agnew
Health Economics & Social Policy Group, Centre for Population Health Research, University of South Australia, SAHMRI, Adelaide, South Australia.
Gareth
G
Furber
Health Economics & Social Policy Group, Centre for Population Health Research, University of South Australia, SAHMRI, Adelaide, South Australia.
Matthew
M
Leach
Health Economics & Social Policy Group, Centre for Population Health Research, University of South Australia, SAHMRI, Adelaide, South Australia.
Leonie
L
Segal
Clin Dermatol. 2004 Sep-Oct;22(5):439-44
15556732
J Eur Acad Dermatol Venereol. 2011 Jan;25(1):43-8
20456560
Cochrane Database Syst Rev. 2012 Aug 15;(8):CD002086
22895927
Int J Dermatol. 1997 Jun;36(6):416-8
9248884
Actas Dermosifiliogr. 2010 Nov;101(9):778-84
21034708
Arch Dermatol. 1976 Jul;112(7):971-3
132901
Paediatr Drugs. 2003;5(5):301-13
12716217
J Biomed Opt. 2008 Nov-Dec;13(6):064007
19123654
Health Qual Life Outcomes. 2012 Jun 06;10:60
22672256
Br J Dermatol. 1999 Apr;140(4):672-6
10233319
Dermatology. 2008;217(2):164-8
18525203
Int J Dermatol. 2011 Dec;50(12):1486-90
22097994
J Am Acad Dermatol. 1991 Mar;24(3):495-500
1829466
Br J Dermatol. 1971 Aug;85(2):119-26
4255129
J Am Acad Dermatol. 2013 Nov;69(5):754-61
23972509
J Am Acad Dermatol. 2007 Nov;57(5):791-9
17655969
Lancet. 2012 Jan 28;379(9813):361-72
21880356
J Am Acad Dermatol. 2012 Aug;67(2):187-93
22036609
J Dermatol. 2008 May;35(5):255-60
18477223
Clin Dermatol. 2004 Sep-Oct;22(5):394-7
15556725
Acta Derm Venereol Suppl (Stockh). 1980;Suppl 89:47-52
6451126
J Am Acad Dermatol. 2006 Mar;54(3):420-6
16488292
Arch Dermatol. 1979 May;115(5):571-5
156006
J Cutan Med Surg. 2007 Nov-Dec;11(6):211-6
18042334
Int J Nurs Stud. 2010 Nov;47(11):1451-8
20598692
J Drugs Dermatol. 2013 Jul 1;12(7):746-56
23884485
Arch Dermatol. 1977 Jan;113(1):31-6
137693
J Eur Acad Dermatol Venereol. 2010 Feb;24(2):196-8
19486229
Eur J Dermatol. 2013 Apr 1;23(2):233-40
23608147
Clin Ther. 2005 Feb;27(2):216-24
15811485
Br J Dermatol. 1998 Nov;139(5):840-5
9892951
J Dermatolog Treat. 2014 Apr;25(2):100-5
23758271
J Am Acad Dermatol. 2007 Apr;56(4):651-63
17276540
Scand J Caring Sci. 2008 Sep;22(3):430-6
18840226
J Health Psychol. 2008 Jan;13(1):47-54
18086717
J Am Acad Dermatol. 1996 Oct;35(4):559-65
8859284
Br J Dermatol. 1998 Nov;139(5):846-50
9892952
JAMA. 1966 May 2;196(5):397-400
4222373
Dermatologica. 1976;153(3):172-6
138608
Arch Dermatol. 1982 Jan;118(1):23-5
6460474
Am J Clin Dermatol. 2008;9(5):279-84
18717602
Telemed J E Health. 2009 Jun;15(5):426-30
19548822
Br J Dermatol. 2009 Jan;160(1):132-6
19067711
Dermatology. 2007;214(1):46-51
17191047
J Am Acad Dermatol. 1985 Mar;12(3):461-7
3157706
JAMA Dermatol. 2014 Jan;150(1):14-6
24305726
JAMA Dermatol. 2015 Apr;151(4):375-81
25549367
J Am Acad Dermatol. 2002 Aug;47(2):231-40
12140469
Br J Dermatol. 1984 Jul;111(1):83-92
6234917
J Dtsch Dermatol Ges. 2006 Dec;4(12):1027-36
17176410
J Paediatr Child Health. 2006 Dec;42(12):793-6
17096715
Indian J Dermatol Venereol Leprol. 2009 May-Jun;75(3):323-6
19439902
Int J Dermatol. 2013 Aug;52(8):946-8
23786338
Clin Dermatol. 2004 Sep-Oct;22(5):380-4
15556722