Role of Photography in Acne Metrics*

Dec 1, 2013 | Contact Author | By: Audris Chiang, University of California, Irvine; Farhaan Hafeez, Yale University School of Medicine; and Howard I. Maibach, MD, University of California School of Medicine, San Francisco
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Title: Role of Photography in Acne Metrics*
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Abstract: To optimally treat acne, an accurate severity assessment is required1 and while visual assessments have relied on text descriptions, lesion counting and photographic methods, an ideal grading system would be more accurate and reproducible. Further, its ease of use, and time and monetary costs are also important. Here, the authors consider different approaches for improved acne assessments using photography.

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A Chiang, F Hafeez and HIi Maibach, Role of photography in acne metrics, Cosm & Toil 128(12) 860-863 (Dec 2013)

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*Adapted with permission from A. Chiang, F. Hafeez and H.I. Maibach, Skin lesion metrics: Role of photography in acne, J Dermatological Treatment, Epub ahead of print, DOI: 10.3109/09546634.2013.813010 (Jul 1, 2013)

To optimally treat acne, an accurate severity assessment is required and while visual assessments have relied on text descriptions, lesion counting and photographic methods, an ideal grading system would be more accurate and reproducible. Further, its ease of use, and time and monetary costs are also important. Here, the authors consider different approaches for improved acne assessments using photography.

Cook Grading

Decades ago, Cook et al. proposed an innovative acne grading method—the first photographic standard. Since the size and redness of lesions are not considered by enumeration, lesion counting is not as simple as it seems, and variance can be great. Therefore, to develop a precise, user-friendly and inter-grader consistent system that is capable of documentation for retrospective verification, Cook proposed an overall acne severity scale of 0–8, with reference photos and text descriptions illustrating grades 0, 2, 4, 6 and 8. Both sides of the face were simultaneously photographed by positioning the face parallel to a front-surface mirror, and a set of five reference photographs that elicited the most consistent 2–4–6 response by trained graders and panelists was selected.

This grading scheme was then used in a trial involving three treatment groups having: placebo capsules and topical placebo, oral tetracycline and topical placebo, or topical tetracycline and placebo capsules. The greatest correlation found between two judges, who assessed overall severity grades one week prior to treatment and eight weeks after treatment, were 0.785 and 0.891, respectively. Other trials confirmed that grading overall severity provided a measurement of efficacy that was more consistent between graders and more sensitive to differences between treatments than lesion counts.

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Footnotes [Maibach 128(12)]

a Picture Window Pro 4.0 software is a product of Digital Light and Color, www.dl-c.com.

b The PRIMOS 3D Compact system is manufactured by GF Messtechnik GmbH, www.gfm3d.com.

Biography: Farhaan Hafeez

Farhaan Hafeez is a fourth year medical student at the Yale University School of Medicine, where he is a Farr Scholar. He pursued a research fellowship at the University of California, San Francisco, where he worked with Maibach to study percutaneous penetration to develop novel topical therapies for dermatological diseases.

Biography: Audris Chiang

Audris Chiang earned her bachelor’s degree in computer science and economics from the University of California at Berkeley in 2010. She has worked under the supervision of Maibach at Surge Labs, University of California, San Francisco, since 2011. She is currently a medical student at the University of California, Irvine.

Biography: Howard I. Maibach, MD, University of California, San Francisco

Howard I. Maibach, MD, is a professor of derma­tology at the University of California School of Medicine, San Francisco. His labor­atory has been interested in and has published exten­sively on derm­ato­pharma­cology and dermatotoxicology.

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