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The BASI


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#1 willow569

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Posted 13 October 2008 - 10:15 AM

What do you think? It makes more sense to me than how acne severity is currently classified. In this new system you can be graded mild to severe for any form of acne lesions. So, a person could have severe comedonal acne or mild nodular acne (an example would be a person with just one nodule. Right now, that is still classified as a severe form of acne).


Making the grade: New acne severity index helps doctors assess lesions

Oct 1, 2008
By: Ilya Petrou, M.D.
Dermatology Times



A new acne grading system, known as the Bikowski Acne Severity Index (BASI), is assisting physicians to better grade these lesions.

"This innovative acne grading system not only allows a more precise grading of acne lesions, but also allows the practitioner to more accurately document the changes seen in patients for study purposes, as well as keep more exact medical records," says Joseph Bikowski M.D., F.A.A.D., director of the Bikowski Skin Care Center in Sewickley, Pa.


The BASI follows suit with the PASI (Psoriasis Area and Severity Index) and the EASI (Eczema Area and Severity Index), known for their clarity and international uniformity.

The BASI system determines acne severity based upon the type, number and location of acne lesions.

Type

Lesions are classified by type as grade I (comedone — open or closed), grade II (papule), Grade III (pustule) and grade IV (nodule).

If the nodule is present long enough, it can become an enclosed and encapsulated cyst, and the goal is to treat the nodule before it becomes a cyst.

Number

The number of lesions is classified as mild (1-10 lesions), moderate (11-20 lesions) and severe (greater than 20 lesions).

Dr. Bikowski says that these numbers are based on his clinical experience and observation of acne patients over the last 30 years.

Location

When addressing the location of acne lesions, Dr. Bikowski divides anatomical areas into units.

When speaking of facial acne, for example, he divides the face into five separate anatomical units — forehead, left and right cheek, nose, and chin — because in acne, sometimes certain anatomical units are not affected.

Once separated into units, types of lesions are assessed and counted in each anatomical area.

"For example, severe grade I acne of the forehead would be greater than 20 open and/or closed comedones of the forehead unit. A moderate grade II or III acne of the chin would be 11 to 20 papules and pustules. A mild grade IV acne of the cheek is one nodule.

"This is actually mild acne if only one nodule and nothing else is present," Dr. Bikowski tells Dermatology Times.

Effectiveness

According to Dr. Bikowski, there are four reasons to better document the severity of acne lesions in patients:

1. The quality of medical charting and, hence, the quality of medical care is better due to the more precise system the BASI uses. Dr. Bikowski says that most physicians do not take photographs of the patients' acne and, therefore, have no before-and-after images to compare. The BASI system can better quantify and qualify the acne lesions from visit to visit, yielding a much more precise medical record.

2. As with all diseases and conditions, physicians need to better document acne at each visit for legal reasons.

3. Insurance companies usually will reimburse physicians only if there is accurate documentation, so the more documentation and the more accurate the detail of the documentation, the better the chance for problem-free reimbursement for services rendered.

4. According to Dr. Bikowski, the systems currently used in documenting acne are insufficient. A universal standardized objective system when documenting the number, distribution and types of acne lesions is needed and crucial when evaluating the efficacy of drugs in medical trials.

Dr. Bikowski also says the older grading systems that are still being used — the Pillsbury, Shelly, Kligman, the Cook, and the Burke & Cunliffe grading systems — lack objectivity, are less accurate and, therefore, can be open to interpretation.

The BASI system will have all physicians "on the same page" when defining the severity of acne lesions in patients, he adds.

"I think that this system is simple and easy to do, and it makes better sense out of all the terminology we have been using in the past with other grading systems.

"The BASI helps you manage each individual patient objectively and more effectively," Dr. Bikowski says.
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#2 Wynne

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Posted 11 April 2009 - 01:03 AM

This is an excellent tool for differentiating acne severity. Big old bump. biggrin.gif

#3 willow569

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Posted 11 April 2009 - 08:56 AM

Glad to see this bumped up again! I should check to see if there has been any additional research on the BASI...

#4 ben100604

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Posted 15 July 2009 - 03:55 PM

Sounds a good system to me. Although, personally, I've never had my acne officially graded by a derm. Does it happen?

#5 Wynne

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Posted 25 June 2010 - 08:03 PM

QUOTE (ben100604 @ Jul 15 2009, 05:55 PM) <{POST_SNAPBACK}>
Sounds a good system to me. Although, personally, I've never had my acne officially graded by a derm. Does it happen?

Yes, but the current grading system would give someone a severe grading for just one cyst. The BASI wouldn't do that. It would grade it as Mild Grade IV.

Bump again as this is so helpful. tongue.gif And interesting.

#6 joris

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Posted 18 July 2010 - 08:35 AM

wait what are nodules? I dont get it any more. Link plz?

#7 Wynne

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Posted 18 July 2010 - 08:37 AM

QUOTE (joris @ Jul 18 2010, 10:35 AM) <{POST_SNAPBACK}>
wait what are nodules? I dont get it any more. Link plz?

http://www.acne.org/whatisacne.html Scroll down a bit for descriptions and images.

#8 joris

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Posted 18 July 2010 - 08:41 AM

lol just checked it out before i saw this post, i mostly have nodules and pastules i guess. The nodules cant be pushed out as described. The pastules do great when i do, puss plus a sort of harder white comes out and it clears in days.

How is the grading system for nodules when is it sever etc?

#9 Wynne

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Posted 18 July 2010 - 08:58 AM

That's explained above.
Type
grade IV (nodule).
Number
The number of lesions is classified as mild (1-10 lesions), moderate (11-20 lesions) and severe (greater than 20 lesions).
Location
When speaking of facial acne, for example, he divides the face into five separate anatomical units — forehead, left and right cheek, nose, and chin — because in acne, sometimes certain anatomical units are not affected.


#10 spectacled_owl

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Posted 18 July 2010 - 09:23 AM

Wow the original post is almost 2 years old and I've never heard acne severity described in this way. Too bad because it makes more sense. Even my derm has never rated my acne in any way. Although she did say that it was bad enough for Accutane because I had scarring, but that's it.

I think I would have mild grade I forehead acne, mild grade III cheek acne and mild grade II chin acne. Right now anyway.

I'm also glad I re-read acne types, because I was calling papules and pustules the same thing.

#11 joris

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Posted 19 July 2010 - 03:27 AM

ye i know wynne but the 1 nodule thing confused me... But ty