| Reference | Year | Grade of evidence | Classification/Grading of acne | Discussion |
|---|---|---|---|---|
| Zaenglein et al [11]. | 2016 | A | No universal acne grading/classifying system can be recommended | • Systematic review that was conducted by a multidisciplinary team, including 17 experts in the field of acne, 1 general practitioner, 1 pediatrician, and 1 patient • systematic search of evidence for 20 years and 242 abstracts were reviewed |
| Nast A. et al [12]. European evidence-base guideline |
2016 | A | Defined according to a global assessment • Comedonal acne: few comedones or no inflammatory lesions • Mild to moderate papulopustular acne (inflammatory lesions) • Severe papulopustular acne (inflammatory lesions) and moderate nodular acne (nodules or cysts) • severe nodular/conglobate acne(nodules or cysts) |
• Systematic review that was developed in accordance with the standard operating procedures of the European Dermatology Forum • systematic search of evidence of 5 years and results of 154 studies (28 from updated search) were compiled by the experts with regard to clinical relevance |
| Chee Leok GOH et al [13]. South-East Asia guideline |
2015 | C | Defined according to a global evaluation of the severity of acne lesions • Mild: few to several papules and pustules, no nodule • Moderate: several to many papules and pustules, few to many nodules • Severe: numerous or extensive papules and pustules, many nodules |
• 13 leading dermatologists from six countries in SEA (Hong Kong, India, Japan, Korea, Malaysia, the Philippines, Singapore, Taiwan, Thailand and the USA) adopt the ACC grading system for classification and selection of treatment for acne patients • simple to use |
| Dréno et al [14]. Global Evaluation Acne (GEA) scale |
2011 | C | Defined according to a global evaluation of the severity of acne lesions • Grade 0: Clear. No lesion • Grade 1: Almost clear. Almost no lesions (a few scattered open or closed comedones and very few papules) • Grade 2: Mild (easily recognizable: less than half of the face is involved. A few open or closed comedones and a few papules and pustules) • Grade 3: Moderate (more than half of the face is involved; many papules and pustules; many open or closed comedones; one nodule may be present) • Grade 4: Severe (entire face is involved, covered with many papules and pustules, open or closed comedones and rare nodules) • Grade 5: Very severe (highly inflammatory acne covering the face with the presence of nodules) |
• Developed by 7 expert dermatologists in the field of acne • small number of subjects (22 patients) • Difficult to recognize all the details of grading system • Training is needed for accurate grading |
| Hayashi et al. [24] | 2008 | C | Defined according to the number of inflammatory eruptions on half of the face • Mild: 0-5 • Moderate: 6-20 • Severe: 21–50 • Very severe: >50 |
• Evidence-based classification that was developed by groups of dermatologists from 13 Universities and 3 independent expert dermatologists in Japan • Large number of subjects (244 patients) • Using lesion counting, lesion identification and patient’s photography • Only inflammatory eruptions were involved in grading |
| Sinclair et al [15]. | 2005 | C | Defined according to the most severe lesions • Grade 1: Comedones only • Grade 2: Inflammatory papules present in addition to the comedones • Grade 3: Pustules present in addition to any of the above • Grade 4: Nodules, cysts, conglobate lesions or ulcers present in addition to any of the above |
• Consensus of a group of about 40 experts in the field of acne, mainly South African dermatologists • Sponsored by Galderma • No lesion count |