Development and validation of a comprehensive acne severity scale

J Cutan Med Surg. 2007 Nov-Dec;11(6):211-6. doi: 10.2310/7750.2007.00037.


Background: Although more than 25 acne grading systems exist, only 2 are inclusive of truncal acne. There is neither a gold standard nor a consistently used standardized system.

Purpose: Our purpose was to develop and validate an acne grading system incorporating severity at the face, chest, and back.

Methods: We developed a comprehensive acne severity scale (CASS) by modifying a preexisting facial acne scale, the Investigator Global Assessment, to include truncal acne. The validity and responsiveness of CASS grades were correlated with Leeds scores at baseline and after 6 months of standard acne treatment.

Results: Spearman correlations were significant between Leeds and CASS grades for the face (0.823), chest (0.854), and back (0.872), respectively (p < .001). After 6 months of therapy, changes in these scores were also significantly correlated (p < .001) at all three sites.

Conclusion: Concurrent validity of CASS is demonstrated by a very strong correlation with Leeds grading. CASS is simpler to use than the Leeds system and more appropriate for translation of research trial results to clinical practice.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Acne Vulgaris / diagnosis*
  • Acne Vulgaris / pathology
  • Acne Vulgaris / therapy
  • Back
  • Canada
  • Face
  • Follow-Up Studies
  • Health Surveys
  • Humans
  • Retrospective Studies
  • Severity of Illness Index*
  • Thorax
  • Treatment Outcome