Feasibility and Reliability of the Spanish Version of the Leeds Revised Acne Grading Scale

Guerra-Tapia, A.; Puig-Sanz, L.; Conejo Mir, J.; Toribio-Pérez, J.; Iglesias, C.; Zsolt, I.

doi:10.1016/S1578-2190(10)70716-2

Article information

Abstract

Background

Although there are more than 25 acne grading systems, there is no consensus on which is most appropriate. Unification of the classifications is recommended in order to facilitate therapeutic decisions.

Objective

To assess the feasibility and reliability of the Spanish version of the Leeds revised acne grading (LRAG) scale in patients with acne vulgaris in Spain.

Patients and methods

We conducted a prospective, multicenter, observational study in Spain, including patients with acne affecting at least 1 of 3 regions: face, back, or chest. Patients were assessed using the LRAG scale and lesion counting. Changes in the scores were determined at 4-6 weeks, and were correlated with the lesion count. Physicians were asked 4 questions regarding difficulty using the scale and the time employed.

Results

A total of 259 sites of acne were assessed in 239 patients at 57 centers. The majority of physicians (89.5%) stated that the LRAG scale was not difficult to use. The mean administration time was 3.12 min. Cross-sectional validity (P<.012 for the face, P<.001 for the back and chest), longitudinal validity (P<.0001 for the face, back, and chest), and intraobserver and interobserver reliability (Cronbach α >0.8) were significant for inflammatory lesions in all regions. Sensitivity to change was demonstrated for lesions in all regions, based on the correlation between the difference in severity and the number of lesions recorded by the LRAG, and the difference in the lesion count between baseline and follow-up.

Conclusion

The Spanish version of the LRAG scale is a practical and reliable tool and is sensitive to change. It is a valid tool for the objective assessment of the severity of acne.

Keywords:

Acne vulgaris

Diagnosis of acne

Acne classification

Validation of scales

Resumen

Introducción

Se describen más de 25 métodos para valorar la gravedad del acné y, aunque no hay consenso sobre una escala, se recomienda unificar su clasificación para facilitar las decisiones terapéuticas.

Objetivos

Validar la factibilidad y fiabilidad de la escala revisada de gravedad de Leeds (LRAG) en pacientes con acné vulgar en España.

Material y métodos

Estudio observacional prospectivo multicéntrico español que evaluó mediante la escala LRAG y el recuento de lesiones a pacientes con acné en al menos una de tres localizaciones (cara, pecho o espalda). Se analizaron los cambios en la puntuación a las 5 ± 1 semanas y se correlacionaron con el recuento de lesiones. El clínico respondió 4 preguntas sobre dificultad y tiempo de uso de la escala.

Resultados

Fueron evaluadas 259 localizaciones de acné en 239 pacientes y en 57 centros asistenciales. El 89,5% [IC: 85-92,9%] de los médicos opinaron que la escala se usó sin dificultad y su tiempo medio de administración fue de 3,12 min. La validez transversal (p < 0,012 facial, p < 0,001 espalda y pecho), validez longitudinal (p < 0,0001) y fiabilidad intra e interobservador (alfa de Cronbach ≥ 0,8) de la escala fue significativa en todas las localizaciones. En relación a sensibilidad al cambio de la escala, las lesiones observadas en todas las localizaciones en el seguimiento dependen de la diferencia de gravedad registrada por la escala LRAG y el recuento de lesiones basales.

Conclusiones

La versión española de la escala LRAG es factible, fiable, sensible y constituye una herramienta válida para objetivar clínicamente la gravedad del acné.

Palabras clave:

Acné vulgar

Diagnóstico de acné

Clasificación de acné

Validación de escala

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