Investigators Recommend 2 PROMs for Use in Acne Vulgaris

Zachary H. Hopkins, MD

A systematic review into the validity of several patient-reported outcome measures (PROM) concluded with the recommendation of 2 specific tools- Acne-Q and CompAQ- for patients affected by acne vulgaris.

For years, PROMs have been utilized by dermatologists to assess health-related quality of life (HRQoL) of affected patients and bolster clinical assessments.The dermatology field is replete with different PROMs, yet little is known regarding the content validity and various other measurement properties of many of them.

“As the breadth of available acne-specific, dermatology-specific, and generic HRQoL PROMs continues to grow, heterogeneity in outcome reporting in clinical research may result,” wrote study author Zachary H. Hopkins, of Broward Health Dermatology, Fort Lauderdale. “This heterogeneity can stifle efforts to synthesize research across studies by limiting the ability to conduct systematic reviews and meta-analyses.”

For this systematic review, and investigative team led by Hopkins set out to determine which HRQoL PROMs were most appropriate for acne research and clinical practice.

The team examined any full-text articles that had investigated development, pilot studies, or evaluation of 1 or more measurement properties related to PROM assessing HRQoL in patients with acne.Studies that only featured the PROM as an outcome measurement or where PROMs were included to validate a new or other PROM were excluded.

Based on the investigators’ interpretations, general HRQoL instruments were defined as those that were developed for use in patients with various medical conditions, while dermatology-specific HRQoL instruments were developed specifically for patients with dermatologic conditions. Acne-specific instruments were defined as those developed for use only among patients with acne and measuring acne-mediated HRQoL status.

In total, 21 patient-reported outcome measures were featured in the review.

Among these instruments, only 2- the Acne-Q and the CompAQ- featured sufficient evidence for content validity and internal structure, and received an “A” recommendation by Hopkins and colleagues.

The Acne-Q featured 63 items, all of which were divided into different scales for facial acne (15), chest and back acne (10 items), facial skin (12 items), appearance-related distress (10 items), symptoms (6 items), and scars (10 items).

Meanwhile, the CompAQ featured 5 domains and a total of 20 items, including psychological/emotional (4 items), social-judgement (4 items), social-interactions (4 items), treatment concerns (4 items), and symptoms (4 items).

A short form version of the CompAQ was also available for use in busier clinical settings, though the content and measurement properties were not assessed in the review.

Notably, no short-form HRQoL instruments for acne met the criteria established by the investigators, who deemed this “an important shortcoming”. However, the team believed that the available short forms for the CompAQ could possibly improve feasibility of use in a clinical practice environment.

“Further research is needed to better define content validity, other measurement properties such as responsiveness, and interpretability of PROMs used to assess HRQoL in patients with acne,” the team wrote.

The study, "Patient-Reported Outcome Measures for Health-Related Quality of Life in Patients With Acne Vulgaris," was published online in JAMA Dermatology.