University of Western Ontario and Windsor Clinical Research Inc., Deptartment of Mathematics and Statistics, University of Windsor, Windsor, Ontario Windsor Program, Schulich School of Medicine and Dentistry, University of Western Ontario, Ontario, Canada Director of Medical Affairs, Stiefel Laboratories, Montreal, Quebec, Canada.
J Eur Acad Dermatol Venereol. 2013 Mar;27(3):e414-9. doi: 10.1111/j.1468-3083.2012.04692.x. Epub 2012 Aug 28.
Few global acne grading systems include individualized assessments of chest and back as well as face. The Leeds revised acne grading system is based on photographic images while the Comprehensive Acne Severity Scale (CASS) is based on textual descriptions. There exists an unmet need for a global scale based on both text and photos.
Our objective was to evaluate the correspondence of severity grades from descriptive text (CASS grades) for each Leeds image.
Twenty-three dermatologists independently graded 56 photos of face, chest and back of varying acne severity using CASS. Photographs were randomly presented from the The Leeds revised acne grading system (n = 31) and from acne patients of the corresponding author (n = 25). For each Leeds photo, rater responses for CASS grades were transformed into median, coefficient of variation and percentiles.
High rater agreement (≥75%) was observed for Leeds facial inflammatory 2 (CASS 3), 4 (CASS 4), 6 (CASS 4), 9-12 (all CASS 5); Leeds facial comedonal A (CASS 2); Leeds chest 7 and 8 (both CASS 5); and Leeds back 7 and 8 (both CASS 5). Lowest coefficients of variance were observed in Leeds facial inflammatory 4, 9, 10, 11; Leeds facial comedonal A; Leeds chest 7 and 8; and Leeds back 8. Conclusions Leeds photos, by inadequately portraying facial acne grades 1 (almost clear) and 2 (mild) and back and chest grades 1-4 (almost clear to severe), cannot accurately represent the spectrum of severity in a six-category global acne scale. Accordingly, there is a current need for images that correspond to a categorical acne scale.
很少有全球性的痤疮分级系统包括对胸部和背部以及面部的个体化评估。利兹修订痤疮分级系统基于照片图像，而综合痤疮严重程度分级系统（CASS）则基于文字描述。目前需要一种基于文字和照片的全球性分级系统。
我们的目的是评估每个利兹图像的描述性文字（CASS 分级）的严重程度等级的一致性。
23 名皮肤科医生使用 CASS 独立评估了 56 张不同严重程度的面部、胸部和背部的照片。照片随机来自利兹修订痤疮分级系统（n=31）和作者相应的痤疮患者（n=25）。对于每张利兹照片，评估者对 CASS 分级的反应转化为中位数、变异系数和百分位数。
观察到利兹面部炎症 2 级（CASS 3 级）、4 级（CASS 4 级）、6 级（CASS 4 级）、9-12 级（均为 CASS 5 级）；利兹面部粉刺 A 级（CASS 2 级）；利兹胸部 7 级和 8 级（均为 CASS 5 级）；以及利兹背部 7 级和 8 级（均为 CASS 5 级）的高评估者一致性（≥75%）。利兹面部炎症 4 级、9 级、10 级、11 级；利兹面部粉刺 A 级；利兹胸部 7 级和 8 级；以及利兹背部 8 级的变异系数最低。
利兹照片不能准确地代表一个六级全球痤疮分级系统中的严重程度谱，因为它们不能充分地描绘面部痤疮 1 级（几乎无）和 2 级（轻度）以及背部和胸部 1-4 级（几乎无到重度）的等级。因此，目前需要与分类痤疮分级相对应的图像。
