Postacne scarring--a quantitative global scarring grading system.
BACKGROUND: There is no global quantitative grading system for assessing the disease load and global severity of disease in a patient with postacne scarring. AIMS: The purpose of this article is to provide a quantitative grading system that would allow more objective communication between practitioners of a patient's global disease severity and between investigators, educators, and proceduralists of the efficacy of grade-specific operative interventions or therapies. PATIENTS/METHODS: We describe a global scoring system that we have found clinically useful to assess disease load and severity of acne scarring and illustrate the reproducibility of this system in a small prospective study. Photographs of 21 patients were assessed independently by four observers, two of whom were physicians and the other two nurses. RESULTS: A quantitative global acne scarring grading system is presented. No substantial difference among acne scarring scores was seen between observers, with inter-rater agreement within four score points in 19 of the 21 patient-photos assessed. CONCLUSIONS: A global acne scarring grading system is presented that would allow investigators, educators, and proceduralists to compare their cases more accurately and to have a more objective discussion of the efficacy of operative interventions or therapies. This scoring system is shown to be reproducible among observers independent of medical background, suggesting that patients can be assigned scores equally by physicians and nurses.