Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
JAMA Dermatol. 2020 Mar 1;156(3):296-302. doi: 10.1001/jamadermatol.2019.4668.
The qualitative grading of acne is important for routine clinical care and clinical trials, and although many useful systems exist, no single acne global grading system has had universal acceptance. In addition, many current instruments focus primarily on evaluating primary lesions (eg, comedones, papules, and nodules) or exclusively on signs of secondary change (eg, postinflammatory hyperpigmentation, scarring).
To develop and validate an acne global grading system that provides a comprehensive evaluation of primary lesions and secondary changes due to acne.
DESIGN, SETTING, AND PARTICIPANTS: This diagnostic study created a multidimensional acne severity feature space by analyzing decision patterns of pediatric dermatologists evaluating acne. Modeling acne severity patterns based on visual image features was then performed to reduce dimensionality of the feature space to a novel 2-dimensional grading system, in which severity levels are functions of multidimensional acne cues. The system was validated by 6 clinicians on a new set of images. All images used in this study were taken from a retrospective, longitudinal data set of 150 patients diagnosed with acne, ranging across the entire pediatric population (aged 0-21 years), excluding images with any disagreement on their diagnosis, and selected to adequately span the range of acne types encountered in the clinic. Data were collected from July 1, 2001, through June 30, 2013, and analyzed from March 1, 2015, through December 31, 2016.
Prediction performance was evaluated as the mean square error (MSE) with the clinicians' scores.
The scale was constructed using acne visual features and treatment decisions of 6 pediatric dermatologists evaluating 145 images of patients with acne ranging in age from 0 to 21 years. Using the proposed scale to predict the severity scores on a new set of 40 images achieved an overall MSE of 0.821, which is smaller than the mean within-clinician differences (MSE of 0.998).
By integrating primary lesions and secondary changes, this novel acne global grading scale provides a more clinically relevant evaluation of acne that may be used for routine clinical care and clinical trials. Because the severity scores are based on actual clinical practice, this scoring system is also highly correlated with appropriate treatment choices.
痤疮的定性分级对常规临床护理和临床试验很重要，尽管有许多有用的系统存在，但没有一种单一的痤疮全球分级系统被普遍接受。此外，许多现有的工具主要侧重于评估原发性病变（例如，粉刺、丘疹和结节）或专门评估继发性病变的迹象（例如，炎症后色素沉着过度、瘢痕形成）。
开发和验证一种痤疮整体分级系统，该系统可对原发性病变和痤疮引起的继发性病变进行全面评估。
设计、设置和参与者：这项诊断研究通过分析儿科皮肤科医生评估痤疮的决策模式，创建了一个多维痤疮严重程度特征空间。然后，基于视觉图像特征对痤疮严重程度模式进行建模，以将特征空间的维度降低到一个新颖的 2 维分级系统，其中严重程度级别是多维痤疮线索的函数。该系统由 6 名临床医生在一组新的图像上进行验证。本研究中使用的所有图像均来自于 150 名被诊断为痤疮的患者的回顾性、纵向数据集，涵盖了整个儿科人群（年龄 0-21 岁），不包括对其诊断有任何分歧的图像，并选择适当涵盖诊所中遇到的各种痤疮类型。数据于 2001 年 7 月 1 日至 2013 年 6 月 30 日收集，并于 2015 年 3 月 1 日至 2016 年 12 月 31 日进行分析。
预测性能通过与临床医生评分的均方误差（MSE）进行评估。
该量表是使用 6 名儿科皮肤科医生评估年龄从 0 至 21 岁的痤疮患者的 145 张图像的痤疮视觉特征和治疗决策构建的。使用建议的量表对 40 张新图像的严重程度评分进行预测，整体 MSE 为 0.821，小于临床医生内部差异的平均值（MSE 为 0.998）。
通过整合原发性病变和继发性病变，这种新型痤疮整体分级量表提供了一种更具临床相关性的痤疮评估方法，可用于常规临床护理和临床试验。由于严重程度评分基于实际临床实践，因此该评分系统与适当的治疗选择也高度相关。
