Pilot study for the evaluation and adaptation of a Four Item-Acne-Scar Risk Assessment Tool (4-ASRAT): a resource to estimate the risk of acne-induced scars

Abstract

Background: Acne-induced scarring is associated with a similar burden as acne, i.e. diminished quality of life, and may be avoided if patients receive appropriate and timely acne treatment. In 2017, a four item-Acne-Scar Risk Assessment Tool (4-ASRAT) was designed by Tan et al. to categorise patients with acne into lower-risk or higher-risk for acne scarring. Its applicability outside the initial study population (France, Brazil and United States) remains to be determined. Methods: A study protocol was developed to create a systematic approach for validating and adapting 4-ASRAT to different populations, Ecuador in this case. The protocol was reviewed by 11 local and international dermatologists and pilot-tested in an Ecuadorian population using a sample of 10 participants who currently had or had had acne. Feedback from the pilot study was used to improve the study protocol. The results of the pilot study are included here, and the final study protocol is available as extended data. Results: The protocol proved to be applicable. Images taken of participants were a valuable resource for dermatological evaluation about the presence or absence of acne scars. Tangential light is necessary for this evaluation. Although dermatological assessments varied, we concluded that assessment by three local dermatologists for each participant was adequate for reaching a consensus on the presence or absence of acne scars. Conclusions: Considering the morbidity related to acne and acne scars, tools designed as prevention that alert patients about risk of developing scarring are necessary. The proposed protocol shows a feasible way of validating and adapting 4-ASRAT to different populations.

Identifying gaps and providing recommendations to address shortcomings in the investigation of acne sequelae by the Personalising Acne: Consensus of Experts panel

“…A risk assessment tool for acne scarring is under development by another group, which could help alert patients to the risk of scar development and has the potential to be a valuable public health measure, given the considerable associated morbidity. 33 …”

Risk factors for acne scarring in Ecuador

“…Once enrolled in the study, participants completed a survey that was developed based on the seventeen risk factors identified by Tan et al [ 7 ] and included questions addressing potential risk factors specific to the Ecuadorian population as determined by means of a Delphi expert consensus consulting registered Ecuadorian dermatologists. Each participant entered the photobooth and had three facial photographs taken following the standards stated in the pilot study publication [ 8 ]. The photographs of each participant were evaluated by three dermatologists who fulfilled a set of inclusion and exclusion criteria to participate in the study.…”

“…Some of the most relevant inclusion criteria for the reviewing dermatologists were that they had practiced dermatology for more than five years, that they had seen more than 35 patients with acne in the last year, and that they had at least one publication related to acne in a scientific journal. More details about the methods can be found in the publication of the pilot study that has been previously published [ 8 ].…”

“…A detailed explanation of self-assessments of acne scarring can be found in our previous publication [ 8 ].…”

“…Study variables included: demographic variables (participant age, sex, ethnicity, region of residence), acne-related variables (acne severity (according to the participants themselves and the dermatologists), family history of acne scarring, age when acne first appeared, location of acne (face, neck, back, chest), duration of acne, squeezing and picking behaviors, acne scars (according to the participants themselves and the dermatologists), other types of scars, over the counter acne treatments, consultation of a dermatologist, prescribed acne treatments, if prescribed treatment was completed, treatment results), lifestyle behaviors (smoking status, fat diet), physical characteristics (weight, oily skin), and psychological or emotional stress. A detailed explanation of self-assessments of acne scarring can be found in our previous publication [8].…”