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itemprop="name">Evidence review for risk factors for scarring due to acne vulgaris</span></h1><div class="subtitle">Acne vulgaris: management</div><p><b>Evidence review L</b></p><p><i>NICE Guideline, No. 198</i></p><p class="contrib-group"><h4>Authors</h4><span itemprop="author">National Guideline Alliance (UK)</span>.</p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2021 Jun</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-4147-6</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2021.</div></div><div class="bkr_clear"></div></div><div id="niceng198er14.s1"><h2 id="_niceng198er14_s1_">Risk factors for scarring due to acne vulgaris</h2><div id="niceng198er14.s1.1"><h3>Review question</h3><p>What are the risk factors for scarring resulting from acne vulgaris?</p><div id="niceng198er14.s1.1.1"><h4>Introduction</h4><p>Scarring as a result of acne can be severe and permanent, not only affecting the individual physically but also overall well-being. Recognising risk factors associated with scarring may help to prompt treatment and reduce frequency of the outcome.</p></div><div id="niceng198er14.s1.1.2"><h4>Summary of the protocol</h4><p>Please see <a class="figpopup" href="/books/NBK573051/table/niceng198er14.tab1/?report=objectonly" target="object" rid-figpopup="figniceng198er14tab1" rid-ob="figobniceng198er14tab1">Table 1</a> for a summary of the Population, Risk Factors and Outcome characteristics of this review.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng198er14tab1"><a href="/books/NBK573051/table/niceng198er14.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figniceng198er14tab1" rid-ob="figobniceng198er14tab1"><img class="small-thumb" src="/books/NBK573051/table/niceng198er14.tab1/?report=thumb" src-large="/books/NBK573051/table/niceng198er14.tab1/?report=previmg" alt="Table 1. Summary of the protocol." /></a><div class="icnblk_cntnt"><h4 id="niceng198er14.tab1"><a href="/books/NBK573051/table/niceng198er14.tab1/?report=objectonly" target="object" rid-ob="figobniceng198er14tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">Summary of the protocol. </p></div></div><p>For further details, see the review protocol in <a href="#niceng198er14.appa">appendix A</a>.</p></div><div id="niceng198er14.s1.1.3"><h4>Methods and process</h4><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>. Methods specific to this review question are described in the review protocol in <a href="#niceng198er14.appa">appendix A</a> and the <a href="/books/NBK573051/bin/niceng198er14_bm1.pdf">methods</a> document (supplementary document 1).</p><p>Declarations of interest were recorded according to <a href="https://www.nice.org.uk/about/who-we-are/policies-and-procedures" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NICE’s conflicts of interest policy</a>.</p></div><div id="niceng198er14.s1.1.4"><h4>Clinical evidence</h4><div id="niceng198er14.s1.1.4.1"><h5>Included studies</h5><p>Overall two articles (<a class="bibr" href="#niceng198er14.s1.1.ref1" rid="niceng198er14.s1.1.ref1">Tan 2010</a>, <a class="bibr" href="#niceng198er14.s1.1.ref2" rid="niceng198er14.s1.1.ref2">Tan 2017</a>) reporting results from the Canadian Acne Epidemiological Survey were included in this review. The included studies are summarised in <a class="figpopup" href="/books/NBK573051/table/niceng198er14.tab2/?report=objectonly" target="object" rid-figpopup="figniceng198er14tab2" rid-ob="figobniceng198er14tab2">Table 2</a>.</p><p>One article reported on the development of an acne scar scale (including the trunk and the face) and examined whether there is a correlation between the duration of acne and severity of acne scarring (<a class="bibr" href="#niceng198er14.s1.1.ref1" rid="niceng198er14.s1.1.ref1">Tan 2010</a>). The other included article described the frequency of acne scars in people consulting a dermatologist as well as their clinical profile and examined whether there is an association between potential risk factors (acne severity, time to effective treatment, relapsing acne and gender), and scarring due to acne (<a class="bibr" href="#niceng198er14.s1.1.ref2" rid="niceng198er14.s1.1.ref2">Tan 2017</a>).</p><p>See the literature search strategy in <a href="#niceng198er14.appb">appendix B</a> and study selection flow chart in <a href="#niceng198er14.appc">appendix C</a>.</p></div><div id="niceng198er14.s1.1.4.2"><h5>Excluded studies</h5><p>Studies not included in this review are listed, and reasons for their exclusion are provided in <a href="#niceng198er14.appk">appendix K</a>.</p></div></div><div id="niceng198er14.s1.1.5"><h4>Summary of clinical studies included in the evidence review</h4><p>Summaries of the studies that were included in this review are presented in <a class="figpopup" href="/books/NBK573051/table/niceng198er14.tab2/?report=objectonly" target="object" rid-figpopup="figniceng198er14tab2" rid-ob="figobniceng198er14tab2">Table 2</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng198er14tab2"><a href="/books/NBK573051/table/niceng198er14.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figniceng198er14tab2" rid-ob="figobniceng198er14tab2"><img class="small-thumb" src="/books/NBK573051/table/niceng198er14.tab2/?report=thumb" src-large="/books/NBK573051/table/niceng198er14.tab2/?report=previmg" alt="Table 2. Summary of included studies." /></a><div class="icnblk_cntnt"><h4 id="niceng198er14.tab2"><a href="/books/NBK573051/table/niceng198er14.tab2/?report=objectonly" target="object" rid-ob="figobniceng198er14tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Summary of included studies. </p></div></div><p>See the full evidence tables in <a href="#niceng198er14.appd">appendix D</a>. No meta-analysis was conducted (and so there are no forest plots in <a href="#niceng198er14.appe">appendix E</a>).</p></div><div id="niceng198er14.s1.1.6"><h4>Quality assessment of included studies in the evidence review</h4><p>Since data from both papers are correlational or univariate, no grading of outcomes based on GRADE was undertaken. For reviews where GRADE is not used evidence statements are produced (see section below) which include a description of the overall risk of bias for each study (see also supplementary material 2 – methods). The detailed risk of bias analysis using the Quality in Prognostic Studies (QUIPS) checklist for all domains of each study is provided in the final column of the clinical evidence tables in <a href="#niceng198er14.appd">appendix D</a>.</p></div><div id="niceng198er14.s1.1.7"><h4>Economic evidence</h4><div id="niceng198er14.s1.1.7.1"><h5>Included studies</h5><p>A single economic search was undertaken for all topics included in the scope of this guideline but no economic studies were identified which were applicable to this review question. See the literature search strategy in <a href="#niceng198er14.appb">appendix B</a> and economic study selection flow chart in <a href="#niceng198er14.appg">appendix G</a></p></div><div id="niceng198er14.s1.1.7.2"><h5>Excluded studies</h5><p>No economic studies were reviewed at full text and excluded from this review.</p></div></div><div id="niceng198er14.s1.1.8"><h4>Economic model</h4><p>No economic modelling was conducted for this review question, because the committee agreed that other topics were higher priorities for economic evaluation.</p></div><div id="niceng198er14.s1.1.9"><h4>Evidence statements</h4><p>Due to the study designs no GRADE assessment was carried out and therefore evidence statements are included:
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<ul><li class="half_rhythm"><div>One study (N=973, moderate risk of bias) reported a weak correlation (Spearman rank correlation coefficient r=0.244) between the duration of acne and self-reported severity of acne scarring. The same study reported a very weak correlation (r=0.152) between the duration of acne and dermatologist-assessed severity of acne scarring.</div></li><li class="half_rhythm"><div>One study (N=1960, moderate risk of bias) reported a clinically important difference between severe or very severe acne (OR=6.5 [95% CI 5.1-8.1]), time to effective treatment of 3 or more years (OR=2.8 [95% CI 2.4-3.2]), experiencing a relapse in acne vulgaris (OR=1.4 [95% CI 1.2-1.5]) and the male gender (OR=1.8 [95% CI 1.6-2]) and acne scarring.</div></li></ul></p></div><div id="niceng198er14.s1.1.10"><h4>The committee’s discussion of the evidence</h4><div id="niceng198er14.s1.1.10.1"><h5>Interpreting the evidence</h5><div id="niceng198er14.s1.1.10.1.1"><h5>The outcomes that matter most</h5><p>The committee chose the risk of scarring due to acne vulgaris as the critical outcome because it is a known and frequent complication and it can substantially negatively affect a person’s physical and overall psychological well-being. Mitigation of risk factors may reduce the occurrence of acne scarring and therefore these negative effects. Due to the paucity of evidence, the committee decided to consider the outcome of severity of acne scarring as reported in <a class="bibr" href="#niceng198er14.s1.1.ref1" rid="niceng198er14.s1.1.ref1">Tan 2010</a> as a proxy measure of the association between the duration of acne vulgaris and risk of acne-related scarring.</p></div><div id="niceng198er14.s1.1.10.1.2"><h5>The quality of the evidence</h5><p>The quality of the studies relative to outcome was not assessed using an adaption of GRADE for prognostic reviews as the included studies only reported correlational or univariate estimates. Risk of bias was therefore assessed by study using the Quality in Prognostic Studies (QUIPS) checklist. Risk of bias of the studies was moderate. Biases were mainly related to studies not reporting the measures for risk factors and it was not clear from the latter study whether the reported effect estimates were adjusted for confounding by potential factors (that is it was unclear whether multivariable regression analysis was conducted or not).</p></div></div><div id="niceng198er14.s1.1.10.2"><h5>Benefits and harms</h5><p>The committee agreed that the evidence was very limited and not sufficient to make strong recommendations about the risk factors for scarring due to acne vulgaris. However, they agreed that it is important to provide some guidance to people with acne vulgaris and healthcare professionals as scarring can have a substantial and long-lasting physical and psychological impact.</p><p>The committee discussed the various actions that people with acne vulgaris can subject their acne lesions to such as picking, scratching, squeezing and scooping, which may lead to scarring. However, the committee noted the absence of evidence for these actions, and the lack of certainty about whether or not squeezing or scooping a lesion to release pus could be beneficial or harmful with regard to scarring. They agreed, using their knowledge and experience, to focus on persistent picking or scratching (which would cause greater damage to the skin), and recommended that people with acne vulgaris should be advised that persistent picking or scratching of acne lesions can increase the risk of scarring.</p><p>Although the evidence suggests that the severity of acne vulgaris and delaying treatment for it may be risk factors for scarring, there is substantial uncertainty as the studies did not control for the influence of other factors. Despite this, the committee agreed that the identification of these as risk factors for scarring due to acne vulgaris was consistent with their knowledge and experience and therefore agreed that people should be made aware of these potential links so that they can take this into account when choosing a treatment option. They noted that these two factors are not mutually exclusive and interpreted the delay in treatment may not necessarily lead to scarring in mild to moderate acne but would be a more of a risk when severe acne is not treated quickly enough.</p><p>Due to the limited evidence and the impact that scarring can have on people’s self-esteem and mood the committee decided to prioritise this topic for a research recommendation (see <a href="#niceng198er14.appl">appendix L</a>).</p></div><div id="niceng198er14.s1.1.10.3"><h5>Cost effectiveness and resource use</h5><p>No relevant economic evidence was identified. The committee agreed that identifying risk factors for scaring and offering relevant advice to people with acne vulgaris may potentially prevent scarring and/or help identify and manage scarring at earlier stages. Prevention and early management of scarring can lead to improved outcomes and potential cost-savings, as it may reduce the need for more costly interventions further down the care pathway.</p></div></div><div id="niceng198er14.s1.1.11"><h4>Recommendations supported by this evidence review</h4><p>This evidence review supports recommendations 1.2.4 and 1.5.6 and a research recommendation on risk factors for scarring in the guideline.</p></div><div id="niceng198er14.s1.1.rl.r1"><h4>References</h4><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="niceng198er14.s1.1.ref1"><p id="p-82">
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<strong>Tan 2010</strong>
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</p>TanJKL, TangJ, FungKet al. Development and validation of a scale for acne scar severity (SCAR-S) of the face and trunk. Journal of Cutaneous Medicine and Surgery2010, 14:156–160 [<a href="https://pubmed.ncbi.nlm.nih.gov/20642983" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20642983</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng198er14.s1.1.ref2"><p id="p-83">
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<strong>Tan 2017</strong>
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</p>TanJ, KangS, LeydenJ. Prevalence and risk factors of acne scarring among patients consulting dermatologists in the USA. Journal of Drugs in Dermatology2017, 16:97–102 [<a href="https://pubmed.ncbi.nlm.nih.gov/28300850" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28300850</span></a>]</div></p></li></ul></div></div></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng198er14.appa"><h3>Appendix A. Review protocol</h3><p id="niceng198er14.appa.et1"><a href="/books/NBK573051/bin/niceng198er14-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Review protocol for review question: What are the risk factors for scarring resulting from acne vulgaris?</a><span class="small"> (PDF, 246K)</span></p></div><div id="niceng198er14.appb"><h3>Appendix B. Literature search strategies</h3><p id="niceng198er14.appb.et1"><a href="/books/NBK573051/bin/niceng198er14-appb-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Literature search strategy for review question: What are the risk factors for scarring resulting from acne vulgaris?</a><span class="small"> (PDF, 168K)</span></p></div><div id="niceng198er14.appc"><h3>Appendix C. Clinical evidence study selection</h3><p id="niceng198er14.appc.et1"><a href="/books/NBK573051/bin/niceng198er14-appc-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Clinical study selection for review question: What are the risk factors for scarring resulting from acne vulgaris?</a><span class="small"> (PDF, 101K)</span></p></div><div id="niceng198er14.appd"><h3>Appendix D. Evidence tables</h3><p id="niceng198er14.appd.et1"><a href="/books/NBK573051/bin/niceng198er14-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Evidence tables for review question: What are the risk factors for scarring resulting from acne vulgaris?</a><span class="small"> (PDF, 160K)</span></p></div><div id="niceng198er14.appe"><h3>Appendix E. Forest plots</h3><div id="niceng198er14.appe.s1"><h4>Forest plots for review question: What are the risk factors for scarring resulting from acne vulgaris?</h4><p>This section includes forest plots only for outcomes that are meta-analysed. No meta-analysis was conducted for this review question and so there are no forest plots.</p></div></div><div id="niceng198er14.appf"><h3>Appendix F. GRADE tables</h3><div id="niceng198er14.appf.s1"><h4>GRADE tables for review question: What are the risk factors for scarring resulting from acne vulgaris?</h4><p>Since data from the included studies are correlational or univariate, no grading of outcomes with GRADE was undertaken.</p></div></div><div id="niceng198er14.appg"><h3>Appendix G. Economic evidence study selection</h3><p id="niceng198er14.appg.et1"><a href="/books/NBK573051/bin/niceng198er14-appg-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Economic evidence study selection for review question: What are the risk factors for scarring resulting from acne vulgaris?</a><span class="small"> (PDF, 172K)</span></p></div><div id="niceng198er14.apph"><h3>Appendix H. Economic evidence tables</h3><div id="niceng198er14.apph.s1"><h4>Economic evidence tables for review question: What are the risk factors for scarring resulting from acne vulgaris?’</h4><p>No economic evidence was identified which was applicable to this review question.</p></div></div><div id="niceng198er14.appi"><h3>Appendix I. Economic evidence profiles</h3><div id="niceng198er14.appi.s1"><h4>Economic evidence profiles for review question: What are the risk factors for scarring resulting from acne vulgaris?</h4><p>No economic evidence was identified which was applicable to this review question.</p></div></div><div id="niceng198er14.appj"><h3>Appendix J. Economic analysis</h3><div id="niceng198er14.appj.s1"><h4>Economic analysis for review question: What are the risk factors for scarring resulting from acne vulgaris?</h4><p>No economic analysis was conducted for this review question.</p></div></div><div id="niceng198er14.appk"><h3>Appendix K. Excluded studies</h3><div id="niceng198er14.appk.s1"><h4>Excluded clinical and economic studies for review question: What are the risk factors for scarring resulting from acne vulgaris?</h4></div><div id="niceng198er14.appk.s2"><h4>Clinical studies</h4><p id="niceng198er14.appk.et1"><a href="/books/NBK573051/bin/niceng198er14-appk-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (133K)</span></p></div><div id="niceng198er14.appk.s3"><h4>Economic studies</h4><p>No economic evidence was identified for this review.</p></div></div><div id="niceng198er14.appl"><h3>Appendix L. Research recommendations</h3><p id="niceng198er14.appl.et1"><a href="/books/NBK573051/bin/niceng198er14-appl-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Research recommendations for review question: What are the risk factors for scarring resulting from acne vulgaris?</a><span class="small"> (PDF, 121K)</span></p></div></div></div><div class="fm-sec"><div><p>Final</p></div><div><p>Evidence review underpinning recommendations 1.2.4 and 1.5.6 and a research recommendation in the NICE guideline</p><p>These evidence reviews were developed by the National Guideline Alliance which is a part of the Royal College of Obstetricians and Gynaecologists</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2021.</div><div class="small"><span class="label">Bookshelf ID: NBK573051</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/34424629" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">34424629</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobniceng198er14tab1"><div id="niceng198er14.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">Summary of the protocol</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK573051/table/niceng198er14.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng198er14.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_niceng198er14.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_niceng198er14.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">People with acne vulgaris</td></tr><tr><th id="hd_b_niceng198er14.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Risk factors</th><td headers="hd_b_niceng198er14.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Risk factors associated with scarring might include:
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<ul><li class="half_rhythm"><div>Acne relapse</div></li><li class="half_rhythm"><div>Acne severity</div></li><li class="half_rhythm"><div>Acne type (e.g. conglobate, fulminans)</div></li><li class="half_rhythm"><div>Delaying treatment</div></li><li class="half_rhythm"><div>Distribution of acne</div></li><li class="half_rhythm"><div>Duration of acne</div></li><li class="half_rhythm"><div>Ethnicity</div></li><li class="half_rhythm"><div>Family history of acne scarring</div></li><li class="half_rhythm"><div>Gender</div></li><li class="half_rhythm"><div>Severe picking of squeezing behaviours (aka: acne excoriée; ‘pickers acne’)</div></li></ul></td></tr><tr><th id="hd_b_niceng198er14.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_niceng198er14.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<b>Critical</b>
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<ul><li class="half_rhythm"><div>Risk of scarring due to acne</div></li></ul>
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</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng198er14tab2"><div id="niceng198er14.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of included studies</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK573051/table/niceng198er14.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng198er14.tab2_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng198er14.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Study</th><th id="hd_h_niceng198er14.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Population</th><th id="hd_h_niceng198er14.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Risk factors</th><th id="hd_h_niceng198er14.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Diagnostic criteria for scarring</th><th id="hd_h_niceng198er14.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Outcomes</th></tr></thead><tbody><tr><td headers="hd_h_niceng198er14.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng198er14.s1.1.ref1" rid="niceng198er14.s1.1.ref1">Tan 2010</a>
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</p>
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<p>Cross-sectional</p>
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<p>Canada</p>
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</td><td headers="hd_h_niceng198er14.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>N=973</p>
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<p>Participants with acne scars
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<ul><li class="half_rhythm"><div>Participant-reported: n=710/973 (73%)</div></li><li class="half_rhythm"><div>Dermatologist-reported:
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<dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>-</dt><dd><p class="no_top_margin">Facial acne scars n=846/973 (87%)</p></dd></dl><dl class="bkr_refwrap"><dt>-</dt><dd><p class="no_top_margin">Acne scarring at the chest n=369/973 (38%)</p></dd></dl><dl class="bkr_refwrap"><dt>-</dt><dd><p class="no_top_margin">Acne scarring at the back n=496/973 (51%)</p></dd></dl></dl></div></li></ul>
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Participants with no acne scars n=263/973 (27%)</p>
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</td><td headers="hd_h_niceng198er14.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Duration of acne</div></li></ul>
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</td><td headers="hd_h_niceng198er14.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Participants reporting of acne scarring;</div></li><li class="half_rhythm"><div>Acne severity evaluation by a dermatologist using a 6-category global system based on a global evaluation scale modified for acne scarring (SCAR-S)<sup>a</sup></div></li></ul>
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</td><td headers="hd_h_niceng198er14.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Severity of acne scarring (reported as Spearman rank correlation coefficient, <i>r</i>):
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<ul><li class="half_rhythm"><div>Participant reported</div></li><li class="half_rhythm"><div>Dermatologist reported</div></li></ul></td></tr><tr><td headers="hd_h_niceng198er14.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>
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<a class="bibr" href="#niceng198er14.s1.1.ref2" rid="niceng198er14.s1.1.ref2">Tan 2017</a>
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</p>
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<p>Prospective cohort</p>
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<p>Canada</p>
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</td><td headers="hd_h_niceng198er14.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>N=1960</p>
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<p>Participants with atrophic acne scars, n=843</p>
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<p>Acne severity:
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<ul><li class="half_rhythm"><div>Almost clear/mild n=276/843 (33%)</div></li><li class="half_rhythm"><div>Moderate n=310/843 (37%)</div></li><li class="half_rhythm"><div>Severe/very severe n=216/843 (26%)</div></li><li class="half_rhythm"><div>No facial acne n=41/843 (5%)</div></li></ul>
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Participants with no acne scars, n=1117</p>
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<p>Acne severity:
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<ul><li class="half_rhythm"><div>Almost clear/mild n=712/1117 (64%)</div></li><li class="half_rhythm"><div>Moderate n=302/1117 (27%)</div></li><li class="half_rhythm"><div>Severe/very severe n=66/1117 (6%)</div></li><li class="half_rhythm"><div>No facial acne n=37/1117 (3%)</div></li></ul></p>
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</td><td headers="hd_h_niceng198er14.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Acne severity (severe/very severe vs other severities)</div></li><li class="half_rhythm"><div>Time to effective treatment (≥3 years; <3 years)</div></li><li class="half_rhythm"><div>Relapsing acne (yes; no)</div></li><li class="half_rhythm"><div>Gender (male; female)</div></li></ul>
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</td><td headers="hd_h_niceng198er14.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Census completed by participating office-based dermatologists for all potential participants over a 5-day period</div></li></ul>
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</td><td headers="hd_h_niceng198er14.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Risk of scarring due to acne reported as odds ratio</div></li></ul>
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</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>a</dt><dd><div id="niceng198er14.tab2_1"><p class="no_margin">SCAR-S: Global Scale for Acne Scar Severity; scale ranges from score of 0 (Clear - No visible scars from acne) to 5 (Very severe - Entire area covered with prominent atrophic or hypertrophic scars).</p></div></dd></dl></dl></div></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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