TABLE 19.

DSS Qualitative Acne Scar Grading (Modified from the Qualitative Global Acne Scar Grading system)

GRADE	LEVEL	CHARACTERISTICS	EXAMPLES
0 (pseudoscars)	Macular dyspigmentation only	Erythematous macules, postinflammatory hyperpigmentation, hypopigmented macules	Erythematous macules, postinflammatory hyperpigmentation, hypopigmented macules
1	Mild	Mild rolling, soft popular	Mild rolling, soft popular
2	Moderate	More significant rolling, shallow box car, mild–moderate hypertrophic/papular scars	More significant rolling, shallow box car, mild–moderate hypertrophic/papular scars
3	Severe	Deep box car, ice pick, bridges and tunnels, gross atrophy, dystrophic scars, significant hypertrophy/keloid	Deep box car, ice pick, bridges and tunnels, gross atrophy, dystrophic scars, significant hypertrophy/keloid
Note: Grades 1 to 3 scars can be erythematous, hyper- or hypopigmented, but grading is based on the extent of atrophy/hypertrophy rather than on color.