If dermatologists select treatment based on severity, how do they determine severity? In acne, overall acne severity as determined by dermatologists is most highly associated with maximal regional acne grade, total scar grade, and the patient’s emotional response to acne, according to a study published in the Journal of Cutaneous Medicine and Surgery (Sept. 2015; 19(5):464-469).
“While there are various measures to evaluate acne severity—both clinical and patient-reported—it has been unclear how these aggregate and contribute to overall severity and, therefore, acne treatment recommendations in actual practice,” said Dr. Jerry Tan, lead author, who is a dermatologist in Windsor, Ont. and an adjunct professor of dermatology at Western University in London, Ont.
In order to clarify the relationship between dermatologist- and patientreported acne severity measures and treatment recommendations, Dr. Tan and colleagues including Drs. Frey, Knezevic, Poulin, Lynde, Gulliver, Gupta, Sebalt, Thomas and Sapra conducted an investigation aimed at evaluating the effects of dermatologist- and patient-reported measures on acne treatment recommendations by dermatologists.
Factors associated with treatment recommendations
“This was an observational standard care study conducted in the offices of seven participating dermatologists across Canada,” Dr. Tan said.
During the study, acne patients were evaluated with patient-reported quality of life and dermatologist reported measures of primary and secondary (scar) acne severity using three assessment approaches: maximal regional grade, total grade, and facial grade.
Findings from the study revealed that the factors most highly associated with acne treatment recommendations were patient emotions, maximal regional acne severity, and total acne scar grade. Better acne-specific quality of life was negatively related to acne treatment recommendation intensity, while all three grading approaches were positively related to acne treatment recommendations.
“Acne treatment recommendations are influenced by clinician reported acne grading and scar severity from multiple sites [face, back, and chest] and some patient-reported outcomes,” said Dr. Tan.
“The pattern of contributing variables in acne treatment recommendations varies based on the duration of disease.”
Clinical measures had greater influence while patient-reported measures had less influence on treatment recommendations.
“Our findings suggest that clinicians should evaluate all affected areas [face, chest and back] for active acne and scarring as they contribute to treatment selection. Furthermore, duration of disease and
impact on patient quality of life should play an important part in treatment,” Dr. Tan said.