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To the Editor.—
Cook et al presented a photographic method of evaluating acne patients in the May Archives (115:571-575, 1979). They proposed a procedure for observing patients in clinical study groups. It would be a mistake to replace the current standard of lesion counts with their system for many reasons. Photographic evaluation is inherently more subjective than an actual count. Color changes in the skin can influence the scoring in either direction. Clearing lesions, healing excoriations, and darkening of the skin following sun exposure would all affect a photographic system of grading. Black patients in particular would be poorly scored by that system but pose no problem when lesion counts are used. Is there some reason why no black patients are described by Cook et al in the photographic standards?Palpation, which is important in "scoring" acne, is impossible to do with a picture. The authors argue that "Counting the
Witkowski JA, Pairsh LC, Guin JD. Acne Grading Methods. Arch Dermatol. 1980;116(5):517-518. doi:10.1001/archderm.1980.01640290027005