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The acne evaluation methodology reported by Cook et al is used in the "live" evaluation of acne patients and does not rely on photography to evaluate acne severity. The photographs serve two purposes. First, since "standard" photographs representative of various levels of acne severity have been developed, these can be used to instruct investigators and clinicians in the use of the grading scale. Second, if one wants a permanent record of the patient's acne condition, the photograph can be used to reconstruct and remind the practitioner of the progress the patient is making.This technique was not developed as a substitute for "live" evaluation. It was developed as a research tool that has proved useful in a practitioner's hands. While lesion counts may be important in evaluating certain acne types, this methodology is not without its inherent subjectivity. We have compared reproducibility among trained investigators using counts and
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