Acne Classification Research Articles

ETLoViT: an acne diagnose approach using vision-transformers and model ensembling

Acne, a widespread skin condition predominantly affecting teenagers, presents intricate challenges in its diagnosis. Recent advances in deep learning, machine learning, and image processing methods have made it possible to diagnose acne automatically and effectively. However, achieving higher acne classification accuracy is still one of the concerns with these methods. Therefore, this paper introduces a group of trained models based on transfer learning that is applied to Vision Transformer extracted features (ETLoViT). These models are trained using two innovative deep-learning methods: the Vision Transformer (ViT) and model ensembling for acne image classification. The ViT approach harnesses the power of the attention module to extract acne features efficiently. These extracted features are subsequently run through different transfer learning models, such as MobileNetV2, VGG16, and InceptionResNetV2. The predicted results were subsequently combined for classification. The proposed model (ETLoViT) is compared with standing deep learning models, and the outcomes demonstrate that the proposed (ETLoViT) model consistently performs better, achieving an astounding 96% classification accuracy.

Grading system of acnes vulgaris

Background: Acne vulgaris is an inflammatory disease of the pilosebaceous unit, consisting of comedones, papules, pustules, nodules, and cysts. With the complexity of polymorphic nature, acne vulgaris is inherently difficult to assess and the measurement and grading of this condition is a recognized challenge for clinicians. This article presents a comprehensive preview of acne severity assessment according to timelines to give an overview of methods used to measure acne severity. Methods: A systematic search of the literature was performed to identify publications describing acne classification methods. Many combinations of search terms were used with the help of search engines consisting of Pubmed, Google Scholar, Uptodate, and Medscape. Results: 31 documents were retrieved, of which seven articles were removed because the full-text copy could not be found. After reviewing the content of 24 documents, 12 were excluded as they did not focus on acne outcome instruments, did not present a novel approach, did not focus on assessment of physical symptoms, or were not reported in the English language. Finally, 12 methods were included in the review. Conclusion: Acne vulgaris is a common disease, the diversity of classification is useful and allows clinicians to choose a variety of assessment and investigation methods. Key words: acne vulgaris - assessment - classification - evaluation - severity - scale.

Revisiting the question of assessment by severity and classification of acne

The paper presents an analysis of different variants of acne classifications and the assessment of acne severity, carried out by the working group of the RODVK Committee for Classifications in Dermatovenereology. There is a division of acne vulgaris according to age and severity. Assessing the severity of acne is important for choosing the correct prescriptions in daily practice and for the evaluation of treatment outcomes. Most of existing acne grading systems are based either on a global grading of severity or on calculating the number of lesions in a variety of anatomic locations. For clinical practice of dermatovenereologists, as well as for educational and scientific purposes, the working group proposed to supplement the acne classification based on severity grading with counting the number of the lesions, and to take into account localization, rash prevalence and scarring when determining the acne severity.

Dermoscopy, Reflectance Confocal Microscopy and Optical Coherence Tomography Features of Acne: A Systematic Review.

Noninvasive imaging techniques have recently outlined precise microscopic features of acne elementary lesions and accurate quantifications for disease severity staging and therapeutical efficacy follow-up. The aim of this review is to systematically describe current applications of dermoscopy, reflectance confocal microscopy (RCM), and optical coherence tomography (OCT) in acne vulgaris assessment and management. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. We included studies conducted on human subjects with elementary lesions of acne vulgaris, reporting assessment of the lesions with dermoscopy, RCM, and/or OCT. At present there are few large studies regarding acne and noninvasive imaging techniques, representing the main limitation of this review. Clinical examination represents the first line in acne diagnosis and treatment. However, dermoscopy, RCM, and OCT are further tools that can improve acne classification, monitoring of treatment, and pathophysiologic characterization. In the near future, dermoscopy, RCM, and OCT could become routinely used for the evaluation of acne vulgaris to provide a deeper knowledge of the disease and to guide the clinician in the prescription of tailored treatment protocols based on each patient’s characteristics.

Acne Classification with Gaussian Mixture Model based on Texture Features

This paper presents an acne detection method on face images using a Gaussian Mixture Model (GMM). First, the skin area in the face image is segmented based on color information using the GMM. Second, the candidates of the acne region are then extracted using a Laplacian of Gaussian-based blob detection strategy. Then, texture features are extracted from acne candidates using either a Gabor Filter or Gray Level Co-occurrence Matrix (GLCM). Lastly, these features are then utilized as input in the GMM for verifying whether these regions are acne or not. In our experiment, the proposed method was evaluated using face images from ACNE04 dataset. Based on the experiment, it is found that the best classification results were obtained when GLCM features in the Cr-YCbCr channel are applied. In addition, the proposed method has competitive performance compared to K-Nearest Neighbor (KNN).

Proposal for a 4-type Classification of Acne: An Evidence-Based Review of the Literature

Background:Proper evidence-basedclassification and grading of a disease such as acne are important in guiding medical practitioners to properly diagnose diseases and treat patients.Objective:This is a review of the present classification of acne in order to delineate modified approaches of acne treatment.Methods:The available literature was reviewed, including searches from 7 databases based on the terms “classification of acne vulgaris and pathophysiology”, according to evidence-based medicine using the Cochrane risk of bias tool.Results:From a total of 10,121 studies on acne classification, 51 full-text articles were assessed and 13 studies were included after screening for acne classification.Conclusion:The European-evidence-based guideline (EDF) classification fits best. We propose a modified classification in 4 categories to improve the management of each stage of acne.

Etiology, pathogenesis, classification and clinical picture of acne vulgaris. Modern view of the problem

The article reviews contemporary data on epidemiology, classification, pathogenesis of acne. The classification according to the ICD-10, clinical classification of acne by G. Plewig and M. Kligman, classification of acne according to the type of lesion are given and explained. The role of different cytokines imbalance described and data on changing understanding of the role of P. acnes in acne pathogenesis are provided.

The impact of acne and facial post-inflammatory hyperpigmentation on quality of life and self-esteem of newly admitted Nigerian undergraduates.

BackgroundAcne and facial post-inflammatory hyperpigmentation are relatively common clinical conditions among adolescents and young adults, and inflict psychosocial injuries on sufferers.ObjectiveTo document the psychosocial and self-esteem implications of acne and facial hyperpigmentation on newly admitted undergraduates.Materials and methodsA cross-sectional survey was conducted among 200 undergraduates. Demographics and clinical characteristics were obtained and acne was graded using the US Food and Drug Administration 5-category global system of acne classification. Participants completed the Cardiff Acne Disability Index (CADI) and the Rosenberg self-esteem scale (RSES), and data were analyzed using SPSS 20.ResultsMean age of acne onset was 16.24 ± 3.32 years. There were 168 (84.0%) cases categorized as almost clear, 24 (12.0%) as mild acne, 4 (2.0%) as moderate acne and 4 (2.0%) as severe acne. Acne with facial hyperpigmentation, compared to acne without hyperpigmentation, was associated with significant level of anxiety in 30 participants (26.5% vs 10.3%, p=0.004) and emotional distress in 40 (35.4% vs 10.3%, p<0.001). Acne severity correlated with total CADI score but not with total RSES score. Quality of life (QoL) was significantly reduced among acne patients with facial hyperpigmentation (1.77±1.62, vs 1.07±1.02, p<0.001) compared to those without hyperpigmentation. Acne and facial hyperpigmentation was associated with social life interference, avoidance of public facilities, poor body image and self-esteem and perception of worse disease. There was no association between gender and QoL but acne was related to a reduction of self-worth. Low self-esteem was present in 1.5%, and severe acne was associated with an occasional feeling of uselessness in the male gender.ConclusionAcne with facial hyperpigmentation induces poorer QoL and self-esteem is impaired only in severe acne. Beyond the medical treatment of acne, dermatologists should routinely assess the QoL and give attention to treatment of facial post-inflammatory hyperpigmentation among people of color.

Evaluation of the effects of acne vulgaris on quality of life in Turkey by using TAQLI.

Acne vulgaris (AV) is a chronic, inflammatory skin disease that may cause various psychiatric and/or psychological problems. In this study, we aimed to determine the effect of AV on the quality of life in the Turkish population using the Turkish Acne Quality of Life Index (TAQLI). A total of 960 patients with AV who attended the dermatology department were included in the study. Acne severity was determined using the global acne classification system. TAQLI was used to evaluate the effect of acne on quality of life. The 960 patients consisted of 673 (70.1%) females and 287 (29.9%) males. There were 536 (55.8%) patients under the age of 20, 386 (40.2%) aged 20-30, and 38 (4.0%) over 30. Acne duration varied between 1 and 20years, and the mean duration was 2.95±2.53years. The mean TAQLI value of all patients was 20.8±9.5. The mean TAQLI value was statistically significantly higher in female patients, in patients with an acne duration of more than 2years, and in those with very severe acne. However, no statistically significant difference was found between the age groups. We observed that the quality of life in patients with AV was affected, and this effect was more significant in female patients, patients with severe acne and longer acne duration. We believe that the psychiatric/psychological effects should be followed up closely in this group of patients.

Translation, cultural adaptation and validation for Brazilian Portuguese of the Cardiff Acne Disability Index instrument.

BACKGROUNDThe Cardiff Acne Disability Index was originally developed in English for measuring quality of life of acne patients. Considering the psychosocial impact of this disease, it is important to have instruments culturally and linguistically validated for use in Brazilian adolescents.OBJECTIVETo translate the Cardiff Acne Disability Index into Brazilian Portuguese, culturally adapt it, and verify its reliability and validity in adolescent patients with acne.METHODSIn the first step, the Cardiff Acne Disability Index was translated and validated linguistically to Brazilian Portuguese in accordance with international guidelines published. In the second step, the validation of the Cardiff Acne Disability Index into Brazilian Portuguese instrument was performed, when patients aged from 12 to 20 years with acne were selected. The participants were interviewed to collect demographic data, submitted to the classification of acne by the Global Acne Grading System and invited to respond the Cardiff Acne Disability Index into Brazilian Portuguese version and DLQI (>16 years) or CDLQI (≤16 years). The internal consistency of Cardiff Acne Disability Index into Brazilian Portuguese was assessed by Cronbach’s alpha coefficient and concurrent validity was measured by the Spearman correlation coefficient and Student ‘s t-test for paired samples.RESULTSThe study included 100 adolescents. The Cardiff Acne Disability Index into Brazilian Portuguese version showed good reliability and internal consistency (Cronbach’s alpha = 0.73). The concurrent validity of the scale was supported by a strong and significant correlation with CDLQI / DLQI instruments (rs=0.802;p<0.001).CONCLUSIONSCardiff Acne Disability Index into Brazilian Portuguese version is a reliable, valid and valuable tool to measure the impact of acne on quality of life in adolescent patients.

Study of lipid profile in adult women with acne.

ObjectiveThe aim of this study was to establish the lipid profile of female patients with acne in the Acne-in-Adult-Women Ambulatory Care Clinic in order to observe the prevalence of dyslipidemia in those patients.MethodsThis is a retrospective transversal study that evaluated the medical records of 416 patients who attended at the Acne-in-Adult-Women Ambulatory Care Clinic, at the Dermatology Department, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil, in the year 2012. Relevant data included age and clinical classification of acne. The lipid profile was analyzed according to the results of laboratory tests ordered during outpatient visits, which included total and fractionated cholesterol levels and triglycerides.ResultsThe epidemiological study sample was of 219 patients, with ages ranging from 21 to 61 years (mean of 32.23 years). The predominant clinical grade was papule-pustule acne (grade II) with 156 patients (71%). Regarding the lipid profile of the patients, there was a high increase in total cholesterol levels in 17.35% of the cases. High-density lipoprotein levels were low in 11.42% of the patients, with normal prevalence in 194 subjects. Low-density lipoprotein levels were normal in most patients (60.27%). Very-low-density lipoprotein values were normal in almost all patients (94.06%) and increased in only 13 patients (5.94%). Only 18 patients presented high levels of triglycerides (8.22%).ConclusionThe conclusion was that patients with grades II and III acne are more likely to have total cholesterol and low-density lipoprotein altered. A correct and early diagnosis can be an important measure for the prevention of the metabolic syndrome in these patients.

The relationship between the second to fourth digit ratio and acne vulgaris

Although the pathophysiology of acne vulgaris (AV) is not clear, androgens are thought to play an important role in its development through either an increased level of circulating androgens or end-organ sensitivity. The ratio of the length of the second and fourth digit (2D:4D) has been hypothesized to reflect prenatal androgen exposure and/or an individual's sensitivity to androgens, with a low 2D:4D ratio suggesting high prenatal androgen exposure. Interestingly, the prenatal androgen peak time period coincides with both the development of the sebaceous gland and digits. To determine the relationship between digit ratio and AV. Vernier caliper was used to take digit measurements of both patients and controls. Acne severity was assessed by using the International Consensus Conference on Acne Classification System. Data of 251 patients with AV (67.7% female) and 120 healthy controls (72.5% female), aged 16-40years, were analysed. The 2D:4D ratios of female patients with AV were significantly lower than healthy females in both hands. However, there was no significant difference between male acne cases and controls. Acne severity was positively correlated with the left 2D:4D ratios and mean 2D:4D ratio, whereas the duration of acne was negatively correlated with the right 2D:4D ratios in females. Our results support the anatomical evidence of in utero androgen exposure and/or an individual's sensitivity to androgens in patients with AV and suggest that the 2D:4D ratio might be a predictor of acne development, duration, and severity grade, at least in female patients.

Propionibacterium acnes (P. acnes) resistance and antibiotic use in patients attending Australian general practice

Antibiotic resistance in the community, including transfer between bacteria, is a growing concern for clinicians. Acne is commonly treated in general practice, sometimes with antibiotics. The aim of this study is to measure the rate of carriage of antibiotic resistant Propionibacterium acnes 10 years apart in general practice and the relationship of resistance to type of treatment, as well potential effects on other flora. Patients (N = 215) with acne presenting to Australian Capital Territory and south-eastern New South Wales general practices were swabbed for P. acnes in 1997-1998 and 2007. Clinical details were collected with questionnaires. In 2007 swabs were also taken for Staphylococcus aureus and Streptococcus pneumoniae. GP's diagnostic classification of acne was tested using a set of standard photographs. Resistant P. acnes was isolated from 20 patients (9%) and the proportion that was resistant was the same in 1997-1998 and in 2007. Antibiotic use, particularly topical, was associated with P. acnes resistance. Resistance rates declined with the time elapsed since ceasing antibiotics. Use of retinoids was associated with a decreased chance of growing P. acnes (P = 0.008) but not with decreased resistance. Simultaneous resistance with S. aureus was not detected, but only in 30 patients was S. aureus isolated. P. acnes resistance was similar in 1997-1998 and in 2007.The chance of a patient carrying a resistant strain of P. acnes is significantly greater with recent exposure to antibiotics, and clinicians should limit prescribing where possible. Resistance disappears rapidly after ceasing antibiotics. Cross resistance with other organisms was not detected in this study.

Alexithymia and Acne Vulgaris: A Case Control Study

ObjectiveTo assess relationship between alexithymia and acne vulgaris in young people.MethodsA hundred and eleven subjects between 15 and 25 years of age referred to out-patient clinic of dermatology with acne and 78 subjects applied to family physician for complaints other than acne were included in patient and control groups of the study, respectively. A questionnaire to determine demographic characteristics, an acne classification to determine severity of acne and Toronto Alexithymic Scale (TAS) to assess alexithymia were used.ResultsThe mean scores of TAS were 52.7±10.8 and 51.7±10.7 in patient and control groups, respectively. Alexitymia was determined in 23.4% of the subjects in acne group and in 24.4% of control group. No significant differences were found between groups in terms of alexithymia, intermediate alexitymia and three-factors of TAS.ConclusionAlexithymia does not appear to be related to acne vulgaris.

Inter‐observer agreement on acne severity based on facial photographs

The three-grade acne classification (mild, moderate, severe) is widely used to define the licensed indications of acne treatments, and for therapeutic decision-making in clinical practice, but its reproducibility has never been assessed. Ten photographs of facial acne were scored independently by eight experts using the three-grade acne classification. We conducted a descriptive analysis of the results, based on graphical representation of the scores for each photograph. Inter-observer agreement on acne severity based on the three-grade acne classification was very poor. The classical three-grade acne classification is poorly reproducible. A new rating tool accompanied by a clinical description of each severity level would be extremely useful.

Mulheres adultas com acne: aspectos comportamentais, perfis hormonal e ultra-sonográfico ovariano

OBJETIVOS: abordar os aspectos comportamentais, o perfil androgênico e as alterações ultra-sonográficas ovarianas de uma amostra de mulheres adultas com acne. MÉTODOS: estudo de série de casos envolvendo uma amostra de 60 mulheres, escolhidas por conveniência. As pacientes foram submetidas a exame clínico, dosagens hormonais e ultra-sonografia para avaliação da morfologia ovariana. Na análise estatística, foi aplicado o Teste de Fischer para análise de correlação entre as variáveis. RESULTADOS: a média de idade foi de 26,5 anos. Todas as pacientes referiram atitudes e sentimentos negativos em relação à acne, sendo os mais freqüentes ansiedade (88,3%) e manipulação constante das lesões (88,3%). O grau de acne mais observado foi o grau II (48,3%). Foram identificados níveis de androgênios fora da faixa de normalidade em 63,3%, com elevação mais freqüente do, dehidroepiandrosterona (57,6%). O padrão ultra-sonográfico mais observado foi o microcístico (74,6%). CONCLUSÕES: as formas clínicas leves de acne predominaram nas mulheres estudadas. Ainda assim, essas apresentaram, com grande freqüência, atitudes e sentimentos negativos em relação à doença. Foram identificados, ainda, modificação dos níveis séricos dos androgênios, bem como do padrão de normalidade do exame ultra-sonográfico.

Classification of acne

Dermatologists need guidelines to correctly evaluate skin diseases, assess their severity and choose appropriate medication. There is considerable controversy concerning the establishment of a universal classification for acne. The main acne grading scales found in the literature are presented in this article.

Recent findings in the epidemiologic evidence, classification, and subtypes of acne vulgaris

Acne affects between 40 to 50 million individuals in the United States. Recent findings regarding the multifactorial pathogenesis of acne have facilitated a reexamination of the classification of acne and acne-related disorders. Disorders without a microcomedo as the initial pathologic condition are no longer classified as “acne.” Research has also identified that the clinical characteristics of acne vary with age, pubertal status, gender, and race. These findings may have implications for the clinical management of acne and acne-related disorders. (J Am Acad Dermatol 1998;39:S34-7.)

Pustular acne.

Pustules from 92 new cases of pustular acne and gram-negative folliculitis were cultured in aerobic medium for superimposed bacterial infection. During the treatment of 1,561 new patients with papular acne with tetracycline and topical clindamycin and antibacterial soaps, an additional 10 developed pustules. The majority showed in vitro resistance to ampicillin. The effective treatment was co-trimoxazole and topical gentamicin. A new classification of acne with practical therapeutic use is needed.

Pustular Acne

Abstract: Pustules from 92 new cases of pustular acne and grarri‐negative folliculitis were cultured in aerobic medium for superimposed bacterial infection. During the treatment of 1,561 new patients with papular acne with tetracycline and topical clindamycin and antibacterial soaps, an additional 10 developed pustules. The maiority showed in vitro resistance to ampicillin. The effective treatment was co‐trimoxazole and topical gentamicin. A new classification of acne with practical therapeutic use is needed.