Comparative Evaluation of Video Recording, Tangential, and Room Light Photography in Acne Scar Severity Assessment

BACKGROUNDAccurate assessment of acne scarring is essential for diagnosis, treatment planning, and outcome evaluation.

OBJECTIVETo compare the Global Skin Assessment (GSA), Physician's Assessment of Skin Surface Roughness (PSSR), and Échelle d'évaluation clinique des cicatrices d'acné (ECCA) scores of patients' images recorded by room light photography (RLP), tangential light photography (TLP), and video recording (VR) with dermatological examination (DE) which was accepted as the reference standard method for further analysis.

METHODSMedical and imaging records of 27 patients (48.1% female; mean age 25.2 ± 5.3 years) were reviewed. Agreement for GSA and PSSR was analyzed using weighted kappa coefficients. Intraclass correlation coefficients (ICC) were calculated for continuous ECCA scores. Bland–Altman analyses were performed to evaluate systematic bias and limits of agreement.

RESULTSFor GSA, RLP demonstrated weak-to-moderate agreement (κ ≈ 0.59), TLP showed strong agreement (κ ≈ 0.88–0.91), and VR achieved almost perfect agreement (κ up to 1.000) with DE. Similar findings were observed for PSSR, with minimal agreement for RLP (κ = 0.285) and strong to almost perfect agreement for TLP (κ = 0.863) and VR (κ = 0.965). ICC values for ECCA scores indicated poor agreement for RLP (0.365), good agreement for TLP (0.852), and excellent agreement for VR (0.975). Bland–Altman analysis revealed the lowest bias and narrowest limits of agreement for VR (−2.96), compared with TLP (−12.59) and RLP (−50.19).

CONCLUSIONFor patients with acne scars, obtaining video recordings to capture images that most closely resemble DE findings would be the most appropriate approach before treatment and during follow-up. If video recording is not feasible, photographing under tangential light should be preferred as an alternative.

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