Failure to adhere to these general principles unquestionably produces many failures. It is necessary to stress the need for physicians to grade acne. Not only does this make management more logical but a not unfamiliar patient is the one who is convinced that he is no better, although the  physician thinks otherwise. If there is no objective method of measuring that improvement then in no way can the physician convince the patient that a change of therapy is not required. Recent experience has shown that the use of a grading system often convinces an apparently ungrateful patient, who is then  pleasantly surprised that there has in fact been distinct improvement.