Cook et al developed a grading system to determine the severity of acne, using photographic standards to help make interpretations consistent. The scale can help monitor the patient over time and determine the effectiveness of interventions. The authors are from the Proctor and Gamble Company in Cincinnati.
Parameters:
(1) comedones (blackheads or whiteheads; raised nonerythematous areas at the opening of a hair follicle)
(2) papules (raised, circular areas of skin that are red and show no visible pus)
(3) macules (discolored red spots on the skin, not raised, not containing pus, characteristic of an involuted inflammatory lesion)
(4) pustules (superficial inflammatory lesions with white or yellow pus)
(5) overall severity (global measure)
|
Number and Distribution of Comedones. Papules, and Macules |
Grade |
|
none OR (few, small and hard to identify) |
0 |
|
few and easily recognized |
1 |
|
about 10% of face involved, easily recognized, most of face clear |
2 |
|
quarter to a third of face involved |
3 |
|
about 40% |
4 |
|
half the face involved |
5 |
|
about two thirds of face covered |
6 |
|
about three quarters of face covered |
7 |
|
most of face covered |
8 |
|
entire face covered with lesions (> 95%) |
9 |
from Table 1, page 571
where:
• The use of percentages is not part of the original scheme. Use of qualitative terms is harder to implement.
Pustules are counted and largest lesions measured. I will use (none, very few, occasional, some, many, numerous, extensive) to approximate the number.
|
Overall Severity |
Grade |
|
none or rare (for example 3 small comedones or papules, scattered); no pustules |
0 |
|
|
1 |
|
very few pustules; perhaps 36 papules and/or comedones; no big or prominent lesions; lesions are barely visible when 2.5 meters away |
2 |
|
|
3 |
|
red lesions and inflammation, more lesions intermediate between 2 and 6; recognizable when 2.5 feet away |
4 |
|
|
5 |
|
numerous comedones; pustules may up to 2 cm; lesions readily apparent at 2.5 feet away |
6 |
|
|
7 |
|
conglobrata, sinus or cystic acne; highly inflammatory acne covering most of face; pustules extending to neck and chin |
8 |
from Table 2, page 571
Attempting to map the individual grades to the overall severity:
|
Overall Severity |
Grade |
|
all Grade 0; no pustules |
0 |
|
all <= Grade 1; no pustules |
1 |
|
all <= Grade 2; rare pustules |
2 |
|
all <= Grade 3; few pustules |
3 |
|
all <= Grade 4; occasional pustules |
4 |
|
all <= Grade 5; some pustules |
5 |
|
all <= Grade 6; many pustules, some large |
6 |
|
all <= Grade 8; many pustules |
7 |
|
maximum Grade 9; extensive numbers of pustules; severe acne lesions |
8 |
Specialty: Dermatology, Infectious Diseases, Pedatrics, Otolaryngology
