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Br J Dermatol. 2019 Apr 12. doi: 10.1111/bjd.18005. [Epub ahead of print]

Development of a new patient-reported outcome measure to evaluate treatments for acne and acne scarring: the ACNE-Q.

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Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
Department of Dermatology, Weill Cornell Medicine, New York, NY, U.S.A.
Ancaster Dermatology Centre, Hamilton, ON, Canada.
Modus Outcomes, Letchworth Garden City, U.K.
Brigham and Women's Hospital & Harvard Medical School, Boston, MA, U.S.A.



Psychosocial concerns represent important outcomes in studies of treatments for acne and acne scarring. Also important, but largely overlooked, is the concept of appearance.


To design an acne-specific patient-reported outcome measure for acne and acne scarring.


We used a mixed-methods approach. Phase I involved 21 patient interviews that were audio-recorded, transcribed and coded. Concepts were identified and developed into scales that were refined through 10 cognitive interviews and input from 16 clinical experts. Phase II involved data collection at hospital and community-based dermatology clinics in Canada and the U.S.A. Eligible participants were aged 12 years and older with acne and/or acne scars on the face, chest and/or back. Rasch Measurement Theory (RMT) analyses were performed to examine psychometric properties.


Phase I led to the development of seven scales that measure appearance of facial skin, acne (face, chest and back) and acne scars, acne-specific symptoms and appearance-related distress. In phase II, 256 patients completed the ACNE-Q. RMT analysis provided evidence that the items of each scale worked together conceptually and statistically. Most participants scored within the range of measurement for each scale (81·9-93·1%). Reliability was high, with person separation index values and Cronbach alpha values > 0·90 for the appearance scales, ≥ 0·87 for appearance-related distress and ≥ 0·75 for symptoms. Worse scores on appearance scales correlated with worse symptom scores and more appearance-related distress.


The ACNE-Q is a rigorously developed instrument that can be used to measure appearance and other patient-centred concerns.


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