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GAGS (Acne)

Global Acne Grading System: Quantitative assessment of anatomical acne severity.

Forehead

Factor: 2

Right Cheek

Factor: 2

Left Cheek

Factor: 2

Nose

Factor: 1

Chin

Factor: 1

Chest & Upper Back

Factor: 3

Ready to Grade

Select the most severe lesion type for each anatomical region to calculate the global acne score.

Guidelines & Evidence

Verified

Last Review: 2026-07-17

When to Use

When to Use

Objective, quantitative assessment of acne vulgaris severity based on lesion type and anatomic location.
Tracking disease progression and response to topical or systemic therapy over time.
Standardization of acne severity in clinical trials.
Justifying escalation of therapy (e.g., initiating oral isotretinoin for severe or refractory cases).

How it Works

Scoring Components

The body is divided into six locations with predefined factor multipliers: Nose (1), Chin (1), Forehead (2), Right Cheek (2), Left Cheek (2), Chest/Back (3).
Severity Weight is graded based on the most severe lesion present in that area: Comedone (1), Papule (2), Pustule (3), Nodule (4).
Local Score = Area Factor × Severity Weight.
Global Score = Sum of all Local Scores (Max possible score: 44).

Clinical Pearls

Severity Scale

1 - 18: Mild
19 - 30: Moderate
31 - 38: Severe
> 39: Very Severe

Clinical Pearls

GAGS emphasizes the significance of truncal acne by assigning the highest factor multiplier (3) to the chest and back.
Because the severity weight relies only on the single most severe lesion in a region, it does not fully account for the total lesion count. A patient with 50 papules scores the same in that region as a patient with 1 papule.
For granular lesion counting required by some trial endpoints, the Investigator Global Assessment (IGA) or simple lesion counts may be preferred.

Next Steps

Treatment Thresholds

01
Mild (1-18): Initiate topical retinoids ± topical antimicrobials (benzoyl peroxide, clindamycin).
02
Moderate (19-30): Consider adding oral antibiotics (e.g., doxycycline) or hormonal therapy (spironolactone, OCPs) to the topical regimen.
03
Severe/Very Severe (>30): Strongly consider oral isotretinoin, especially if scarring is present or psychosocial impact is high.

The Evidence

Primary Reference

A therapeutic hierarchy for acne vulgaris: a customized medical approach.

Doshi A et al. • J Am Acad Dermatol.. 1997;37(5 Pt 1):761-4. Developed the GAGS as a quantitative tool to stratify severity and guide sequential therapeutic decisions.

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External Links

Origins & History

The Global Acne Grading System (GAGS) was developed in 1997 by Dr. A. Doshi and colleagues to create a comprehensive, area-weighted evaluation of acne severity that could dictate a step-wise therapeutic hierarchy.

Last Comprehensive Review: 2026-07-17

In Recent Clinical News

Scanning Medical Journals

No new significant updates or guidelines matching this topic were found today. We will check again soon.