An image-based scoring system as an alternative to face-to-face examination for acne vulgaris to deliver follow-up care: A comparative study

Background: AV is a chronic disease with flares and remissions requiring regular follow-ups. Image-based lesion counting (LC) is useful when in-person consultations are not possible, like the COVID- 19 pandemic. Objective: The aim of this study is to validate the proposed scoring system for teledermatology consultation and compare it with face to face. Materials and Methods: The face was divided into three zones which was further divided by drawing the imaginary lines from fixed points. AV (Grade 1 and 2) lesions were counted by co-investigator in person at baseline, first, and second follow-up visits. The images of the same were evaluated and scored by the principal investigator. Acne scores obtained were compared and statistically analyzed. Results: Two hundred cases were enrolled. Mean acne scores for in-person were 945.37, 647.57, and 550.81 and for teledermatology 1044.99, 718.79, and 654.36 for baseline, 1st, and 2nd follow-up, respectively. The mean decrease from baseline, 1st and 2nd follow-up, independent sample t-test and correlation analysis was significant in both groups (P = 0.001). Limitations: AV grade 3 and 4 are not included. Conclusion: During the 1st follow-up, a decrease in acne scores was observed, along with consistency in the scores between the evaluators. Image-based lesion counting is a promising approach. The proposed scoring system can be used for both modes of consultation-face-to-face and teledermatology.