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Acne%20vulgaris Diagnosis
Classification
Classification by Severity
- Usually overestimated by patient and underestimated by physician
| Mild* | Moderate** | Severe*** | |
| Comedones | <20 | 20-100 | >100 |
| Papules/Pustules | <15 | 15-50 | >50 |
| Nodules/Cysts | 0 | <5 | >5 |
| Total Lesion Count | <30 | 30-125 | >125 |
**Further subdivided into moderate papulopustular acne and moderate nodular acne
***Further divided into severe papulopustular acne, severe nodular acne, and conglobate acne
Other Considerations
- Grading schemes that rely on the above lesion counts are usually of greater use in clinical studies rather than clinical practice
- May be better to focus on the most severe lesions present
- Proper treatment of the most severe lesions usually covers all lesser lesions
History
- History of past treatments
- In most cases, there is no need to look for underlying cause, which may be found in patients >20 years old and in resistant acne cases
Physical Examination
- Diagnosis is usually confirmed based on the morphology of the lesions and their site of distribution
Types of Acne Lesions
- Comedonal (non-inflammatory)
- Closed (whitehead) or open (blackhead) lesions
- Papulopustular (inflammatory)
- Papule: Small bump <5 mm in diameter
- Pustule: Smaller bump with core of purulent material
- Nodular (inflammatory)
- Represents severe acne, manifested as nodules and deep pustules of >5 mm diameter
- Conglobate acne is a severe form of nodular acne where the lesions are firm, inflamed and painful measuring >10 mm
Site of Distribution
- Lesions typically concentrate in the centrofacial areas
- Forehead, nose, chin
- May eventually involve other areas containing sebaceous glands
- Face, ears, neck, chest, shoulders, back, scalp
Evaluation
Acne Grading Systems
- Currently there is no recommended universal grading/classifying system for acne
- Several scoring methods are being used by different associations, grading and lesion counting being the most commonly used methods
- Number of lesions, type of acne, disease severity, anatomical site/s, and propensity for scarring should be considered when determining acne score for management purposes
- Some scoring methods being used include the Echelle de Cotation des Lesions d’Acne (ECLA) or Acne Lesion Score Scale, Leeds technique, post acne hyperpigmentation index (PAHPI), Comprehensive Acne Severity System (CASS), and the Acne Quality of Life Scale (AQOL) among others
