Only 2 Acne-Specific PROMs Receive ‘A’ Rating for Measuring Quality of Life

Of 10 patient-reported outcome measures studied, only 2 received an ‘A’ rating for sufficient content validity and internal structure.

Two patient-reported outcome measures (PROMs), the Acne-Q and CompAQ, received an A recommendation for use for measuring acne-associated quality of life, according to a recent study published in JAMA Dermatology.

Both instruments were found to be appropriate for facial and truncal acne in adults and adolescents.

A systematic review of previous studies was conducted to examine health-related quality of life (HRQOL) PROMs for use in adolescents and adults by identifying development and validation studies and evaluating methodological quality and quality of evidence.

Methodological quality was assessed based on the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) criteria.

After conducting a literature search, 47 met criteria for inclusion and 7 additional reports on PROM development were included. The study identified and assessed 10 different acne-specific PROMS. In addition, there were 6 dermatology-specific PROMS assessed in acne and 5 genergic PROMS studied in acne.

The findings showed that the Acne-Q and CompAQ, had sufficient evidence for content validity and internal structure to receive an A recommendation for use. However, responsiveness was not assessed in the Acne-Q, and evidence for reliability and construct validity were found to be low. Similarly, the CompAQ has not been assessed for responsiveness or reliability.

The study found no short-form HRQoL instruments for acne that met criteria for recommendation. The authors suggested this as a shortcoming, noting that short-form instruments can be rapidly deployed in a clinical setting with a lower likelihood of survey fatigue.

The remaining acne-specific measures studied received a B rating “for not having high-quality evidence for insufficient measurement properties or enough evidence for recommendation.” No acne-specific instrucment received a C rating.

The Skindex-29 was the only dermatology-specific instrument with sufficient overall content validity; however, lack of acne-specific data on the internal structure available for evaluation prevented an A recommendation.

Of the acne-specific measures studied:

  • The Acne Quality of Life Index (A-Qol) and Acne Severity and Impact Scale (ASIS) had inconsistent ratings with respect to content validity, precluding an A rating
  • The Acne Disability Index (ADI) and Cardiff Acne Disability Index (CADI) were found to have inadequate PROM development and insufficient scores for content validity
  • The Assessment of the Psychological and Social Effects of Acne (APSEA) was found to have inadequate PROM development.
  • The Acne Quality of Life Scale (AQOL) received a grade reflecting poor development design and insufficient content validity.

The authors suggest that the evidence for the ADI, CADI, AQOL, and APSEA are more limited and should not be used without further investigation. However, the authors suggest that the Acne-QoL and ASIS could be considered if additional content validity were performed.

Additionally, important measurement properties have not been studied sufficiently for all instruments. The authors suggest further research is to better define content validity, responsiveness, and interpretability of PROMs used to assess HRQOL in patients with acne.

The study faced limitations. The authors noted that the COSMIN framework has been criticized for its focus relative lack of modern measurement theory benchmarks, subjectivity and dependency on reviewer expertise, lack of evidence surrounding risk of bias checklist items and grading procedures, and poor inter-reviewer reliability.


Zachary HH, Diane T, Haya AH, et al. Patient-reported outcome measures for health-related quality of life in patients with acne vulgaris: A Systematic Review of Measure Development and Measurement Properties. JAMA Dermatology. Published June 22, 2022. doi:10.1001/jamadermatol.2022.2260

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