High Body Mass Index is a Risk Factor for Acne Severity in Adolescents: A Preliminary Report.

Acne vulgaris is one of the most common chronic dermatological diseases among adolescents. Recent data indicated that a specific diet may affect the course and appearance of acne. The aim of the study was to analyze the relationship between body mass index (BMI) and acne prevalence and severity. This cross-sectional study was conducted among 143 consecutively recruited adolescents aged between 12 and 18. All participants were physically examined, including measurement of weight and height and type and severity of acne. Acne lesions were evaluated as not present (0), mild (1), moderate (2), and severe (3). The predominant type of acne lesions was used to classify the acne into one of the following subtypes: comedonic acne, papulo-pustular acne, and nodulo-cystic acne. Acne was present in 123 adolescents (86.0%) being more prevalent in teenagers ≥15 years old than in those between 12 and 14 years old (97.1% vs. 76.0%, respectively, P<0.001). The prevalence of acne did not differ significantly between teenagers with different BMI. However, those teenagers who were overweight or obese suffer from the inflammatory type of acne (papulo-pustular or nodulo-cystic) more often compared with underweight, slim, or normal-weight teenagers (P=0.03). The mean BMI value in patients with comedonic acne was significantly lower (mean BMI ± Standard Deviation (SD): 20.0±3.5 kg/m2) when compared with papulo-pustular acne (22.2±3.8 kg/m2, P=0.04) or nodulo-cystic acne (23.9±5.1 kg/m2, P<0.01). The BMI value correlated significantly with the severity of acne (ρ=0.33, P<0.001) and with higher number of skin areas involved with acne (ρ=0.23, P<0.01). Our findings clearly indicate the association between overweight/obesity and acne. Such a relationship has a significant impact on the treatment of patients with acne, as therapy should focus not only on proper selection of medications but also take into account modification of the patient's dietary habits, physical activity, and, if necessary, reduction of body weight.

Correlation between Family History and the Age of Onset of Childhood Acne in Relation to Sex and Type of Acne.

Acne vulgaris is a common chronic skin disorder of the pilosebaceous unit with a wide range of clinical presentations, which depend on the age of onset of acne, sex, family history of acne, and genetic factors, especially the genes affecting keratinization and desquamation. This retrospective study investigated pediatric acne using the patients' past medical history, with patients aged from newborns to 15 years of age. Acne were further stratified by 5 parameters: sex, age, family history, acne type, and localization. Our main aim was to investigate the possible association between selected parameters and the presence or absence of family history of acne. We did not find statistically significant correlation between sex, age of onset, and positive family history of acne. Furthermore, we did not find any association between age of onset and family history according to family members (mother/father/brother or sister). However, we found statistically significant correlation between sex and type of acne. This retrospective analysis of pediatric acne in Croatia did not reveal statistically significant correlation between positive family history and sex, age of onset, and clinical type of acne. In analyzing the correlation between family history and localization of acne, however, we found that the number of patients with acne localized on both the face and trunk and positive family history was statistically significant higher than expected.

Acne vulgaris severity graded by in vivo reflectance confocal microscopy and optical coherence tomography.

INTRODUCTION: Acne is an inflammatory disease of the pilosebaceous unit, which can be investigated in vivo using reflectance confocal microscopy (RCM) and optical coherence tomography (OCT). OBJECTIVES: By means of RCM and OCT to identify morphological characteristics of acne that may be associated with clinical acne severity. METHODS: Patients with mild to moderate facial acne (n = 14, Investigators Global Assessment scale, IGA 1-3), and healthy participants (n = 7, IGA 0) were included in this explorative study. A total of 108 RCM image blocks and 54 OCT scans (each RCM and OCT image measuring 6 × 6 mm) were captured from lesional-, perilesional, and lesion-free skin areas. Acne lesions, infundibular regions of follicles and inflammation degree were compared in acne patients and healthy participants. RESULTS: Combined use of RCM and OCT demonstrated infundibular morphology, acne lesions, and blood flow. RCM images of perilesional- and lesion-free skin in acne patients revealed follicle infundibula with hyperkeratinized borders and abundant keratin plugs, contrasting skin of healthy participants. Higher acne severity related to increased number of follicles with hyperkeratotic borders (P = 0.04) and keratin plugs (P = 0.006), increased infundibulum diameter (P < 0.001), increased density of inflammatory cells (P < 0.001), and blood flow (P = 0.03). Acne lesion morphology was not associated with acne severity. CONCLUSION: Combined use of RCM and OCT elucidated distinctive follicle infundibulum characteristics and inflammation degree that were associated with acne severity. Future trials may apply imaging techniques to support clinical acne grading, and monitor treatment efficacy. Lasers Surg. Med. 51:104-113, 2019. © 2018 Wiley Periodicals, Inc.

Dissecting folliculitis (dissecting cellulitis) of the scalp: a 66-patient case series and proposal of classification.

BACKGROUND AND OBJECTIVES: Dissecting folliculitis (DF) or dissecting cellulitis of the scalp is regarded as a rare disease with disfiguring scarring alopecia. This study aimed to analyze the features of DF and to propose a classification to define its severity. PATIENTS AND METHODS: A hospital-based retrospective study was conducted. Patients with a histopathological diagnosis or clinical features leading to diagnosis of DF were included and classified into three stages. RESULTS: Among the 66 patients recruited (63 men / 3 women, mean age 24.9 years), multiple interconnected alopecic nodules involving the vertex scalp were the main feature. Histopathology showed an extensive inflamed granulation abscess forming a dissection plane in the lower dermis/subcutis in the acute stage. Lymphocytic infiltration was predominant in seven of 21 histology specimens. Overweight and obesity were noted in 29 of 45 patients examined. No association with smoking was found. There was comorbidity with acne conglobata in 15 of 66 patients, two of whom had acne inversa. Longer disease duration and greater number of nodules were associated with higher severity of DF (p < 0.05). A complete remission rate of 25 % was achieved by any treatment, and a rate of 37.5 % was achieved with oral isotretinoin alone. CONCLUSIONS: DF is not uncommon in Taiwan. An association with obesity needs to be clarified.

Evidence-based recommendations for the management of acne fulminans and its variants.

BACKGROUND: Acne fulminans (AF) is a severe variant of inflammatory acne. It typically manifests as an explosive worsening and ulceration of skin lesions, and can be associated with systemic symptoms. However, there is a paucity of evidence-based information and no clear guidelines concerning the classification and treatment of AF. OBJECTIVE: To better define the spectrum of AF and its variants, devise optimal therapeutic approaches, and identify areas of future research. METHODS: A panel of physicians with expertise in severe acne vulgaris was convened after a comprehensive literature review of severe acne variants. Priority topics were reviewed and presented by each panelist at a 5-hour conference. Following review of the audiotape and scribed notes from the conference, surveys were utilized to address points of controversy and to clarify consensus recommendations. RESULTS: Appropriate clinical case presentations and consensus survey questions were utilized to create final recommendations based on both the literature and the expert consensus. LIMITATIONS: Limited evidenced-based data and prospective studies in the literature concerning the treatment of AF is available. CONCLUSION: These guidelines better characterize AF and provide health care practitioners approaches to the classification, treatment, and prevention of AF and its variants.

Consenso español para establecer una clasificación y un algoritmo de tratamiento del acné / Consensus-based acne classification system and treatment algorithm for Spain

El acné es una enfermedad inflamatoria crónica que conlleva una serie de efectos psicosociales que pueden afectar en gran medida la calidad de vida del paciente. Existen distintas escalas de clasificación de gravedad del acné y otros tantos algoritmos de tratamiento, sin que haya consenso sobre la escala y guía de manejo que seguir. Por ello, un grupo de expertos españoles se reúnen para consensuar por votación la forma más apropiada de clasificar el acné y el tratamiento según la gravedad del mismo. El acné se clasifica como acné comedoniano, acné papulopustuloso leve o moderado, acné papulopustuloso grave o nodular moderado y acné grave noduloquístico o con tendencia a desarrollar cicatrices. Se consensuaron una primera y una segunda opción de tratamiento para cada grado de gravedad y un tratamiento de mantenimiento. Se efectuaron recomendaciones específicas con relación al uso combinado de antibióticos (a partir de grado papulopustuloso leve o moderado), siempre en combinación con retinoides y/o peróxido de benzoilo (POB), y el uso de isotretinoína a partir del grado papulopustuloso grave o nodular moderado

Acne is a chronic inflammatory disease whose psychosocial effects can greatly impair quality of life. Various scales are used to classify the severity of acne, and several treatment algorithms are currently applied: no consensus on a common scale or treatment guidelines has been reached. A group of Spanish experts therefore met to identify a scale the majority could accept as the most appropriate for classifying severity and treating accordingly. The group chose the following classifications: comedonal acne, mild or moderate papulopustular acne, severe papulopustular acne, moderate nodular acne, and nodular-cystic acne (or acne tending to leave scars). Consensus was reached on first- and second-choice treatments for each type and on maintenance treatment. The experts also issued specific recommendations on antibiotic use (starting with mild or moderate papulopustular acne), always in combination with retinoids and/or benzoyl peroxide. The use of isotretinoin (starting at severe papulopustular or moderate nodular acne) was also covered

Consensus-Based Acne Classification System and Treatment Algorithm for Spain. / Consenso español para establecer una clasificación y un algoritmo de tratamiento del acné.

Acne is a chronic inflammatory disease whose psychosocial effects can greatly impair quality of life. Various scales are used to classify the severity of acne, and several treatment algorithms are currently applied: no consensus on a common scale or treatment guidelines has been reached. A group of Spanish experts therefore met to identify a scale the majority could accept as the most appropriate for classifying severity and treating accordingly. The group chose the following classifications: comedonal acne, mild or moderate papulopustular acne, severe papulopustular acne, moderate nodular acne, and nodular-cystic acne (or acne tending to leave scars). Consensus was reached on first- and second-choice treatments for each type and on maintenance treatment. The experts also issued specific recommendations on antibiotic use (starting with mild or moderate papulopustular acne), always in combination with retinoids and/or benzoyl peroxide. The use of isotretinoin (starting at severe papulopustular or moderate nodular acne) was also covered.

New Atrophic Acne Scar Classification: Reliability of Assessments Based on Size, Shape, and Number.

BACKGROUND: Post-acne atrophic scarring is a major concern for which standardized outcome measures are needed. Traditionally, this type of scar has been classified based on shape; but survey of practicing dermatologists has shown that atrophic scar morphology has not been well enough defined to allow good agreement in clinical classification. Reliance on clinical assessment is still needed at the current time, since objective tools are not yet available in routine practice.
OBJECTIVES: Evaluate classification for atrophic acne scars by shape, size, and facial location and establish reliability in assessments.
METHODS: We conducted a non-interventional study with dermatologists performing live clinical assessments of atrophic acne scars. To objectively compare identification of lesions, individual lesions were marked on a high-resolution photo of the patient that was displayed on a computer during the clinical evaluation. The Jacob clinical classification system was used to define three primary shapes of scars 1) icepick, 2) boxcar, and 3) rolling. To determine agreement for classification by size, independent technicians assessed the investigators' markings on digital images. Identical localization of scars was denoted if the maximal distance between their centers was ≤ 60 pixels (approximately 3 mm). Raters assessed scars on the same patients twice (morning/afternoon). Aggregate models of rater assessments were created and analyzed for agreement.
RESULTS: Raters counted a mean scar count per subject ranging from 15.75 to 40.25 scars. Approximately 50% of scars were identified by all raters and ~75% of scars were identified by at least 2 of 3 raters (weak agreement, Kappa pairwise agreement 0.30). Agreement between consecutive counts was moderate, with Kappa index ranging from 0.26 to 0.47 (after exclusion of one outlier investigator who had significantly higher counts than all others). Shape classifications of icepick, boxcar, and rolling differed significantly between raters and even for same raters at consecutive sessions (P<.001 and P=0.4, respectively). Analysis showed only 65% of scars were identical in both sessions. We also found that there is a threshold of detection in terms of size, with poor agreement among investigators for very small scars (<2 mm). The repeatability of identification of scars ≥ 2.0 mm was acceptable, and we found that increasing scar size was positively correlated with agreement. Reliability was improved when only scars >2 mm were included. For smaller scars (<2 mm), inter-rater reliability was poor.
CONCLUSIONS: While intuitively it makes sense that describing scar morphology could guide treatment, we have shown that shape-based evaluations are subjective and do not readily yield strong agreement. Until there is a more objective way to evaluate morphology that is readily available to practicing clinicians, we propose that size should be considered a primary characteristic for scar classification systems. We further suggest classification of <2 mm, 2-4 mm, and >4 mm based on how the size would likely affect diagnostic and therapeutic choices. Finally, we recommend that scars <2 mm not be included in a clinical classification but should be evaluated by an objective method that may be refined in the future.

J Drugs Dermatol. 2016;15(6):693-702.

Validating the diagnostic code for acne in a tertiary care dermatology centre.

BACKGROUND: Administrative databases provide valuable patient data and are used to conduct population-based studies. However, no studies have been conducted to validate the codes for dermatological conditions. OBJECTIVE: To evaluate the validity of ICD 9 code 706 for acne. METHODS: This was a retrospective chart review of patients seen in dermatology clinics at Sunnybrook Health Sciences Centre between March 1 and May 31, 2013. The billing code for a clinic visit was compared to the diagnosis documented in the medical chart. RESULTS: There were 4,248 participants; 201 with an ICD-9 code of acne. This code had a PPV and sensitivity with 95% confidence intervals (CI) of 84.58% (78.67-89.13%) and 86.29% (80.51-90.62%), respectively. The specificity was 99.20% (98.86-99.45%). CONCLUSIONS: We showed that ICD-9 code 706 can be used to accurately identify patients with acne in a dermatology setting. This information can be applied to future epidemiologic studies.

Características clínicas y epidemiológicas de pacientes que consultan por acné / Clinical and epidemiological characteristics of patients with acne

El acné es una enfermedad multifactorial que afecta a más de 40 millones de personas a nivel mundial. A pesar de ser uno de los motivos más frecuentes de consulta dermatológica, se carece a nivel nacional de estudios epidemiológicos sobre esta afección. El objetivo del estudio fue describir las características clínico-epidemiológicas de los pacientes que consultaron por acné en la Cátedra de Dermatología del Hospital de Clínicas de marzo a julio de 2013. En este estudio observacional, descriptivo de corte transversal se incluyeron en forma consecutiva 130 pacientes con acné, edad media: 20,3 ± 5,5 años, 62,3% de sexo femenino, y >90% era procedente de Asunción o Departamento Central. El 65,3% reportó antecedentes familiares de acné y la edad de inicio fue más temprana en hombres. La ingesta de grasas fue el factor desencadenante más citado por los hombres, mientras que en las mujeres fue el periodo menstrual. El 63,15% de las mujeres que ingería anticonceptivos refirieron mejoría del acné. Un alto porcentaje (60%) de mujeres presentó acné leve a moderado mientras que el acné severo a muy severo fue más frecuente (65%) en los hombres. Los pacientes con acné leve tuvieron en promedio edades mayores (23 ± 7,4 años) que aquellos con acné severo (18 ± 3,7 años). No se encontró asociación entre la presencia de antecedentes familiares, tabaquismo, irregularidades menstruales, fototipo cutáneo, índice de masa corporal y severidad del acné. Estos resultados pueden servir de base para futuras investigaciones y el establecimiento de protocolos diagnósticos y terapéuticos en el país.

Acne is a multifactorial disease affecting over 40 million people worldwide. Despite thefact that is one of the most frequent reasons for dermatologic consultation, the countryhas no epidemiological studies about this affection. The objective of this study was todescribe the clinical and epidemiological characteristics of patients that consulted for acnein the Department of Dermatology of the Clinical Hospital from March to July 2013. This isa cross-sectional descriptive observational study that included consecutively 130 patientswith acne, mean age: 20.3±5.5 years, 62.3% was women and >90% came fromAsunción and Central Department. Family history of acne was reported by 65.3%. Theacne onset was earlier in men than in women. Fat intake was the triggering factormentioned more frequently by men while beginning of menstruation was in women.Improvement of acne was mentioned by 63.15% of women who used oral contraceptives.A high percentage (60%) of women presented mild to moderate acne while severe tovery severe acne was more common in men (65%). The mean age (23±7.4 years) inpatients with mild acne was higher than in those patients with severe acne (18±3.7 years). No association between the presence of family history, smoking, menstrualirregularities, cutaneous phototype, body mass index was observed. These results mayserve as a baseline for future research and the establishment of diagnostic andtherapeutic protocols in the country.

Acne e dieta: uma revisão / Acne and diet: a review

Objective: To evaluate the relationship between diet and acne in adolescents and adults through a review of observational studies and drandomized trials conducted between 2003 and 2013. Data source: The search was performed in the Medline, Lilacs, Scielo, Cochrane and Coordination of Improvement of Higher Education (CAPES) databases. Data synthesis: 13 studies were included in this review and had their quality evaluated by two independent reviewers. Evidence suggests involvement of diet in the pathology of acne in adolescents and adults, especially in relation to dairy products and high glycemic load foods. Conclusions: Most of the studies included in the review suggest that there is a relationship between diet and acne. The relationship between acne and fish intake and specific diets, such as the Mediterranean, need to be further investigated

Objetivo: Avaliar a relação entre acne e dieta em adolescentes e adultos por meio de revisão de estudos observacionais e ensaios randomizados realizados entre 2003 e 2013. Fonte de dados: A busca foi realizada nas bases de dados Medline, Lilacs, Scielo, Cochrane e banco de teses da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes). Síntese dos dados: Foram incluídos nesta revisão 13 estudos que tiveram suas qualidades avaliadas por dois revisores, independentemente. As evidências sugerem relação da dieta na patologia da acne, em adolescentes e adultos, principalmente em relação aos laticínios e alimentos com alta carga glicêmica. Conclusões: A maioria dos estudos incluídos na revisão sugere relação da dieta com a acne. As relações da acne com o consumo de peixe e com dietas específicas, como a mediterrânea, ainda precisam ser mais investigadas.

[ACNE VULGARIS--AETIOLOGY, CLASSIFICATION, TREATMENT]. / TRADZIK POSPOLITY--ETIOLOGIA, KLASYFIKACJA, LECZENIE.

A spotless skin is a rarity. Both women and men have different problems related to the complexion. One of the most common problems is acne, which affects an increasing number of people of all ages. Seborrhea skin areas rich in sebaceous glands, the formation of comedones, inflammation, and scars are characteristic for this disease. The aim of the study was to discuss the causes of acne vulgaris, methods of treatment, and proper care of the skin affected by this problem.

Auto-classification of acne lesions using multimodal imaging.

Differentiating inflammatory and non-inflammatory acne lesions and obtaining lesion counts is pivotal part of acne evaluation. Manual lesion counting has reliably demonstrated the clinical efficacy of anti-acne products for decades. However, maintaining assessment consistency within and across acne trials is an important consideration since lesion counting can be subjective to the individual evaluators, and the technique has not been rigorously standardized. VISIA-CR is a multi-spectral and multi-modal facial imaging system. It captures fluorescence images of Horn and Porphyrin, absorption images of Hemoglobin and Melanin, and skin texture and topography characterizing broad-spectrum polarized and non-polarized images. These images are analyzed for auto-classification of inflammatory and non-inflammatory acne lesion, measurement of erythema, and post-acne pigmentation changes. In this work the accuracy of this acne lesion auto-classification technique is demonstrated by comparing the auto-detected lesions counts with those counted by expert physicians. The accuracy is further substantiated by comparing and confirming the facial location and type of every auto-identified acne lesion with those identified by the physicians. Our results indicate a strong correlation between manual and auto-classified lesion counts (correlation coefficient >0.9) for both inflammatory and non inflammatory lesions This technology has the potential to eliminate the tedium of manual lesion counting, and provide an accurate, reproducible, and clinically relevant evaluation of acne lesions. As an aid to physicians it will allow development of a standardized technique for evaluating acne in clinical research, as well as accurately choosing treatment options for their patients according to the severity of a specific lesion type in clinical practice

Evidence-based recommendations for the diagnosis and treatment of pediatric acne.

INTRODUCTION: Acne vulgaris is one of the most common skin conditions in children and adolescents. The presentation, differential diagnosis, and association of acne with systemic pathology differs by age of presentation. Current acknowledged guidelines for the diagnosis and management of pediatric acne are lacking, and there are variations in management across the spectrum of primary and specialty care. The American Acne and Rosacea Society convened a panel of pediatric dermatologists, pediatricians, and dermatologists with expertise in acne to develop recommendations for the management of pediatric acne and evidence-based treatment algorithms. METHODS: Ten major topic areas in the diagnosis and treatment of pediatric acne were identified. A thorough literature search was performed and articles identified, reviewed, and assessed for evidence grading. Each topic area was assigned to 2 expert reviewers who developed and presented summaries and recommendations for critique and editing. Furthermore, the Strength of Recommendation Taxonomy, including ratings for the strength of recommendation for a body of evidence, was used throughout for the consensus recommendations for the evaluation and management of pediatric acne. Practical evidence-based treatment algorithms also were developed. RESULTS: Recommendations were put forth regarding the classification, diagnosis, evaluation, and management of pediatric acne, based on age and pubertal status. Treatment considerations include the use of over-the-counter products, topical benzoyl peroxide, topical retinoids, topical antibiotics, oral antibiotics, hormonal therapy, and isotretinoin. Simplified treatment algorithms and recommendations are presented in detail for adolescent, preadolescent, infantile, and neonatal acne. Other considerations, including psychosocial effects of acne, adherence to treatment regimens, and the role of diet and acne, also are discussed. CONCLUSIONS: These expert recommendations by the American Acne and Rosacea Society as reviewed and endorsed by the American Academy of Pediatrics constitute the first detailed, evidence-based clinical guidelines for the management of pediatric acne including issues of special concern when treating pediatric patients.

Subjective facial skin type, based on the sebum related symptoms, can reflect the objective casual sebum level in acne patients.

BACKGROUND: The relationship between the subjective skin type and the casual sebum level was not fully clarified. OBJECTIVES: To investigate the characteristics of subjective skin type and to find the relationship between the subjective skin types and the skin type-related symptoms, casual sebum level, along with the objective skin type. METHODS: Seven hundred and nine patients, clinically diagnosed with acne, were included. The questionnaire and the casual sebum level measurement were performed. The determining symptoms of each subjective skin type were investigated. The 95% confidence interval of casual sebum level of each subjective skin type was calculated. RESULTS: The most frequent subjective skin type was the combination type. The dryness, tightness, and oiliness can be conclusive symptoms in determining the subjective skin type. The mean and the 95% confidence interval of the casual sebum level was highest in the oily skin type, followed by the combination, normal, and dry skin type. CONCLUSION: We found that the subjective skin type was determined by the skin type-related symptoms. The 95% confidence intervals of the casual sebum level of each subjective skin type were established. Based on the skin type-related symptoms, the casual sebum level of acne patients can be estimated.

[An investigational study of acne treatment in France]. / Enquête sur la prise en charge des patients acnéiques en France.

BACKGROUND: Acne is one of the main reasons for dermatological consultation. Management may seem standardized, in particular for mild to moderate juvenile facial acne, where topical treatments are used for mild cases and topical treatments associated with systemic antibiotics are used for moderate cases. The aim of this investigational study was to evaluate current treatment approaches for mild to moderate acne patients by French dermatologists in private practice. METHODS: During this study, more than 252 dermatologists practising in over 144 French cities were asked about their preferred treatments (other than isotretinoin) for young acne patients. A questionnaire containing information about patient characteristics, disease severity and the prescribed therapy was completed by dermatologists at baseline and 2 months later. RESULTS: In total, 3145 acne patients were analyzed. This study showed that in 53% of cases, dermatologists prescribed several topical treatments (up to three) associated with one or several systemic therapies (up to three), in addition to a cosmetic product. In 51% of cases, dermatologists prescribed only application of a dermatological cosmetic product for patients with very mild acne; in 41% of cases, a single treatment, especially a topical treatment, was prescribed for patients with mild acne, and in 59 and 64% of cases, two treatments (a combination of local and systemic therapy) were prescribed respectively for patients with moderate and severe acne. CONCLUSION: This study demonstrated the complexity of management of acne patients by dermatologists, particularly in the case of mild to severe acne. Most notably, such therapeutic complexity raises the question of compliance, a key factor in successful treatment.

Acne analysis, grading and computational assessment methods: an overview.

INTRODUCTION: This paper presents a comprehensive review of acne grading and measurement. Acne is a chronic disorder of the pilosebaceous units, with excess sebum production, follicular epidermal hyperproliferation, inflammation and Propionibacterium acnes activity. Most patients are affected with acne vulgaris, which is the prevalent type of acne. Acne vulgaris consists of comedones (whitehead and blackhead), papules, pustules, nodules and cysts. OBJECTIVES: To review and identify the issues for acne vulgaris grading and computational assessment methods. To determine the future direction for addressing the identified issues. METHODS: There are two main methods of assessment for acne severity grading, namely, lesion counting and comparison of patient with a photographic standard. For the computational assessment method, the emphasis is on computational imaging techniques. RESULTS: Current acne grading methods are very time consuming and tedious. Generally, they rely on approximation for counting lesions and hence the assessment is quite subjective, with both inter and intra-observer variability. It is important to accurately assess acne grade to evaluate its severity as this influences treatment selection and assessment of response to therapy. This will further help in better disease management and more efficacious treatment. CONCLUSION: Semi-automated or automated methods based on computational imaging techniques should be devised for acne grade assessment.

Acne life cycle: the spectrum of pediatric disease.

Acne is no longer simply a diagnosis based on the appearance of characteristic lesions on the skin of adolescents. The presentation of acne differs across age groups, and the population of younger pediatric patients with acne continues to grow. This article addresses the changing epidemiology and demographics of acne, with specific emphasis on the 7- to 11-year-old acne patient population; the differences and similarities between pediatric acne and adolescent acne; age-based acne epidemiology; and current perspectives on acne etiology.

[Feasibility and reliability of the Spanish version of the Leeds Revised Acne Grading Scale]. / Factibilidad y fiabilidad de la versión española de la escala revisada de gravedad de Leeds (LRAG) para pacientes con acné.

BACKGROUND: Although there are more than 25 acne grading systems, there is no consensus on which is most appropriate. Unification of the classifications is recommended in order to facilitate therapeutic decisions. OBJECTIVE: To assess the feasibility and reliability of the Spanish version of the Leeds revised acne grading (LRAG) scale in patients with acne vulgaris in Spain. PATIENTS AND METHODS: We conducted a prospective, multicenter, observational study in Spain, including patients with acne affecting at least 1 of 3 regions: face, back, or chest. Patients were assessed using the LRAG scale and lesion counting. Changes in the scores were determined at 4-6 weeks, and were correlated with the lesion count. Physicians were asked 4 questions regarding difficulty using the scale and the time employed. RESULTS: A total of 259 sites of acne were assessed in 239 patients at 57 centers. The majority of physicians (89.5%) stated that the LRAG scale was not difficult to use. The mean administration time was 3.12min. Cross-sectional validity (P<.012 for the face, P<.001 for the back and chest), longitudinal validity (P<.0001 for the face, back, and chest), and intraobserver and interobserver reliability (Cronbach α >0.8) were significant for inflammatory lesions in all regions. Sensitivity to change was demonstrated for lesions in all regions, based on the correlation between the difference in severity and the number of lesions recorded by the LRAG, and the difference in the lesion count between baseline and follow-up. CONCLUSION: The Spanish version of the LRAG scale is a practical and reliable tool and is sensitive to change. It is a valid tool for the objective assessment of the severity of acne.