The purpose of this study was to evaluate the comprehension of terms and pictures representing various acne lesions to be potentially used in a Patient Self-Rated Acne Severity questionnaire. Sixty-two subjects of various ages, ethnicities, and educational levels with various dermatologic conditions participated in an interview. Utilizing a standard survey improvement probing technique, subjects were asked to describe terms and pictures of various acne lesions. Each response was graded as consistent, inconsistent, or too general to determine consistency with physicians’ vocabulary. For 5 of the 9 terms, the majority of responses were inconsistent or too general. These included “blemishes” (60%, n = 40), “bump filled with pus” (64%, n = 33), “pus” (53%, n = 40), “whitehead” (71%, n = 41), and “cyst” (82%, n = 33). A significant number of respondents described “whitehead” as a pustule (22%), “cyst” as a tumor/growth (24%), and “bump filled with pus” as a whitehead (15%). The terms for which the majority of responses were consistent included: “acne bumps” (72%, n = 40), “scabs” (67%, n = 40), “blackhead” (60%, n = 40), and “scarring” (52%, n = 40). For 4 of the 6 pictures, the majority of responses were consistent with the lesion depicted. These included: scars (80%, n = 41), post-inflammatory hyperpigmentation (76%, n = 21), cyst (73%, n = 62), and papule (71%, n = 40). The 2 pictures for which the majority of responses were inconsistent or too general were those of pustules (83%, n = 62) and open and closed comedones (51%, n = 41). Of note, 32% of all subjects described a picture of pustules as whiteheads. Furthermore, when shown a picture of comedones, 39% described only blackheads while 10% described both blackheads and whiteheads. Comparison of pictures versus terms revealed that pictures were more accurate than terms in conveying scars (43% vs 15%) and cyst (50% vs 5%) while the term was better than the picture in conveying pustules (60% vs 6%). No significant difference between picture and term was shown for comedones. These results suggest that patients’ language may be different from that used by physicians and/or understanding of acne lesions may be limited. Both terms and pictures were limited in accurately conveying acne lesions with one possibly better than the other depending on the lesion. Further work will study whether comprehension improves employing word descriptions combined with predefined pictures.