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Objective assessment of acne

      Abstract

      A precise and reliable assessment of acne severity is unarguably the most essential clinical method when it comes to monitoring and choosing optimal treatment in the daily practice. Since the early 1960s, different severity assessment systems have been described in the literature. The two commonly used concepts are global gradings and lesion counting. Both systems have been controversially discussed as to which is more reliable and providing an objective outcome measurement tool; however, both have some subjectivity involved. More objective methods for assessing the severity of acne vulgaris include photography, fluorescence photography, polarized light photography, video microscopy, and multispectral imaging. Such techniques have limitations such as high cost, complex and sophisticated apparatus, and a sometimes time-consuming imaging process. There are newly developed technologies that could avoid the problems of inter- and intrarater subjectivity.
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      References

        • Zouboulis C.C.
        Acne as a chronic systemic disease.
        Clin Dermatol. 2014; 32: 389-396
        • Moradi-Tuchayi S.
        • Makrantonaki E.
        • Ganceviciene R.
        • et al.
        Acne vulgaris.
        Nat Rev Dis Primers. 2015; 1: 15029
        • Lehmann H.L.
        • Robinson K.A.
        • Andrews J.S.
        • et al.
        Acne therapy: a methodological review.
        J Am Acad Dermatol. 2002; 47: 231-240
        • Pochi P.E.
        • Shalita A.R.
        • Strauss J.S.
        • et al.
        Report of the Consensus Conference on Acne Classification, Washington, DC, March 24 and 25, 1990.
        J Am Acad Dermatol. 1991; 24: 495-500
        • Tan J.
        • Wolfe B.
        • Weiss J.
        • et al.
        Acne severity grading: determining essential clinical components and features using a Delphi consensus.
        J Am Acad Dermatol. 2012; 67: 187-193
        • Mekkes J.R.
        • Westhof W.
        Image processing in the study of wound healing.
        Clin Dermatol. 1995; 13: 401-407
        • Pillsbury D.M.
        • Shelley W.B.
        • Kligman A.M.
        Dermatology.
        W B Saunders, Philadelphia, PA1956: 810
        • James K.
        • Tisserand J.J.
        Treatment of acne vulgaris.
        GP. 1958; 18: 131-139
        • Witkowski J.A.
        • Simons H.M.
        Objective evaluation of demethylchlortetracycline hydrochloride in the treatment of acne.
        JAMA. 1966; 196: 397-400
        • Frank S.B.
        • Charles C
        Acne Vulgaris.
        Thomas, Springfield, IL1971: 12-13
        • Plewig G.
        • Kligman A.
        Acne: Morphogenesis and Treatment.
        Springer-Verlag, New York, NY1975: 162-163
        • Christiansen J.
        • Holm P.
        • Reymann F.
        Treatment of acne vulgaris with the retinoic acid derivative Ro 11-1430. A controlled clinical trial against retinoic acid.
        Dermatologica. 1976; 153: 172-176
        • Michaelson G.
        • Juhlin L.
        • Vahlquist A.
        Oral zinc sulphate therapy for acne vulgaris.
        Acta Derm Venereol. 1977; 57: 372
        • Cook C.H.
        • Centner R.L.
        • Michaels S.E.
        An acne grading method using photographic standards.
        Arch Dermatol. 1979; 115: 571-575
        • Burke B.M.
        • Cunliffe W.J.
        The assessment of acne vulgaris: the Leeds technique.
        Br J Dermatol. 1984; 111: 83-92
        • Samuelson J.S.
        An accurate photographic method for grading acne: initial use in a double-blind clinical comparison of minocycline and tetracycline.
        J Am Acad Dermatol. 1985; 12: 461-467
        • Lucky A.W.
        • Barber B.L.
        • Girman C.J.
        • et al.
        A multirater validation study to assess the reliability of acne lesion counting.
        J Am Acad Dermatol. 1996; 35: 559-565
        • Doshi A.
        • Zaheer A.
        • Stiller M.J.
        A comparison of current acne grading systems and proposal of a novel system.
        Int J Dermatol. 1997; 36: 416-418
        • O’Brian S.C.
        • Lewis J.B.
        • Cunliffe W.J.
        The Leeds revised acne grading system.
        J Dermatol Treat. 1998; 9: 215-220
        • Tan J.K.
        • Tang J.
        • Fung K.
        • et al.
        Development and validation of a comprehensive acne severity scale (CASS).
        J Cutan Med Surg. 2007; 11: 211-216
        • Hayashi N.
        • Akamatsu H.
        • Kawashima M.
        • et al.
        Establishment of grading criteria for acne severity.
        J Dermatol. 2008; 35: 255-260
        • Parish L.C.
        • Witkowski J.A.
        The acne scoreboard.
        Int J Dermatol. 1978; 17: 490-491
        • Witkowski J.A.
        • Parish L.C.
        The assessment of acne: an evaluation of grading and lesion counting in the measurement of acne.
        Clin Dermatol. 2004; 22: 394-397
        • Center for Drug Evaluation (CDER)
        Guidance for Industry—Acne Vulgaris: Developing Drugs for Treatment.
        US Department of Health and Human Services, Food and Drug Administration, Rockville, MD2005
        • Tan J.K.
        • Fung K.
        • Bulger L.
        Reliability of dermatologists in acne lesion counts and global assessments.
        J Cutan Med Surg. 2006; 10: 160-165
        • Streiner D.L.
        • Norman G.R.
        Health Measurement Scales: A Practical Guide to Their Development and Use.
        Oxford University Press, Oxford1989
        • Tan K.
        Current measures for the evaluation of acne severity.
        Expert Rev Dermatol. 2008; 3: 595-603
        • Robinson Jr., H.M.
        Photographic evaluation of therapeutic efficacy.
        Arch Dermatol. 1968; 97: 258-261
        • Leyden J.J.
        • Shalita A.
        • Thiboutot D.
        • et al.
        Topical retinoids in inflammatory acne: a retrospective, investigator-blinded, vehicle-controlled, photographic assessment.
        Clin Ther. 2005; 27: 216-224
        • Kollias N.
        • Stamatas G.N.
        Optical non-invasive approaches to diagnosis of skin diseases.
        J Investig Dermatol Symp Proc. 2002; 7: 64-75
        • Lucchina L.C.
        • Kollias N.
        • Phillips S.B.
        Quantitative evaluation of noninflammatory acne with fluorescence photography.
        J Invest Dermatol. 1994; 102: 560
        • Phillips S.B.
        • Kollias N.
        • Gillies R.
        • et al.
        Polarized light photography enhances visualization of inflammatory lesions of acne vulgaris.
        J Am Acad Dermatol. 1997; 37: 948-952
        • Rizova E.
        • Kligman A.
        New photographic techniques for clinical evaluation of acne.
        J Eur Acad Dermatol Venereol. 2001; 15: 13-18
        • Bae Y.
        • Nelson J.S.
        • Jung B.
        Multimodal facial color imaging modality for objective analysis of skin lesions.
        J Biomed Opt. 2008; 13: 064007
      1. Fuji H, Yanagisawa T, Mitsui M, et al. Extraction of acne lesion in acne patients from multispectral images. 30th Annual IEEE EMBS Conference; 20-24 August 2008; Vancouver, British Columbia, Canada. New York: IEEE; 2008:4078-4081.

        • Kim J.E.
        • Lee O.S.
        • Choi J.
        • et al.
        The efficacy of stereoimage optical topometry to evaluate depressed acne scar treatment using cultured autologous fibroblast injection.
        Dermatol Surg. 2011; 37: 1304-1313
        • Choi K.M.
        • Kim S.J.
        • Baek J.H.
        • et al.
        Cosmetic efficacy evaluation of an anti-acne cream using the 3 D image analysis system.
        Skin Res Technol. 2012; 18: 192-198
        • Patwardhan S.V.
        • Kaczvinski J.R.
        • Joa J.F.
        • et al.
        Auto-classification of acne lesions using multimodal imaging.
        J Drugs Dermatol. 2013; 12: 746-756
        • Lucchina L.C.
        • Kollias N.
        • Gillies R.
        • et al.
        Fluorescence photography in the evaluation of acne.
        J Am Acad Dermatol. 1996; 35: 58-63
        • Lee W.L.
        • Shalita A.R.
        • Poh-Fitzpatrick M.B.
        Comparative studies of porphyrin production in Propionibacterium acnes and Propionibacterium granulosum.
        J Bacteriol. 1978; 133: 811-815
        • McGinley K.J.
        • Webster G.F.
        • Leyden J.J.
        Facial follicular porphyrin fluorescence: correlation with age and density of Propionibacterium acnes.
        Br J Dermatol. 1980; 102: 437-441
        • Pagnoni A.
        • Kligman A.M.
        • Kollias N.
        • et al.
        Digital flurorescence photography can assess the suppressive effect of benzoyl peroxide on Propionibacterium acnes.
        J Am Acad Dermatol. 1999; 41: 710-716
        • Okoro E.O.
        • Bulus N.G.
        • Zouboulis C.C.
        Study of facial sebum levels and follicular red fluorescence in patients with acne vulgaris in Nigeria.
        Dermatology. 2016; 232: 156-161
        • Muccini J.A.
        • Kollias N.
        • Phillips S.B.
        • et al.
        Polarized light photography in the evaluation of photoaging.
        J Am Acad Dermatol. 1995; 33: 765-769
        • Do T.T.
        • Zarkhin S.
        • Orringer J.S.
        • et al.
        Computer-assisted alignment and tracking of acne lesions indicate that most inflammatory lesions arise from comedones and de novo.
        J Am Acad Dermatol. 2008; 58: 603-608
        • Ramli R.
        • Malik A.S.
        • Hani A.F.
        • et al.
        Acne analysis, grading and computational assessment methods: an overview.
        Skin Res Technol. 2012; 18: 1-14
        • Chiang A.
        • Hafeez F.
        • Maibach H.I.
        Skin lesion metrics: role of photography in acne.
        J Dermatol Treat. 2014; 25: 100-105
        • Xu L.
        • Jackowski M.
        • Goshtasby A.
        • et al.
        Segmentation of skin cancer images.
        Image Vis Comput. 1999; 17: 65-74
        • Schmid-Saugeon P.
        • Guillod J.
        • Thiran J.P.
        Towards a computer-aided diagnosis system for pigmented skin lesions.
        Comput Med Imaging Graph. 2003; 27: 65-78
      2. Masood NA, Mashali HM, Mohamed AS. Color segmentation for skin lesions classification. Cairo International Biomedical Engineering Conference; 18-20 December 2008; Cairo, Egypt. 2008:1-4.

        • Wild T.
        • Prinz M.
        • Fortner N.
        • et al.
        Digital measurement and analysis of wounds based on colour segmentation.
        Eur Surg. 2008; 40: 5-10
        • Sowa M.G.
        • Kuo W.C.
        • Ko A.C.
        • et al.
        Review of near-infrared methods for wound assessment.
        J Biomed Opt. 2016; 21: 091304
        • Marotz J.
        • Siafliakis H.
        • Kulcke S.F.
        First results of a new hyperspectral camera system for chemical based wound analysis.
        Wound Med. 2015; 10-11: 17-22
        • Spencer D.A.
        The Focal Dictionary of Photographic Technologies.
        Focal Press, Waltham, MA1973: 454