CG-HAF: An Interpretable Global-Local Lesion-Burden Fusion Framework for Ordinal Acne Severity Grading in Agentic Skincare Support

Ordinal acne severity grading requires distinguishing visually similar neighboring grades while jointly weighing holistic facial appearance and localized lesion burden - evidence that most existing approaches collapse into a single opaque representation. We introduce CG-HAF, a global-local fusion framework that instead keeps this evidence explicit: averaged holistic severity probabilities from independently trained classifiers are combined with structured lesion-burden descriptors from an object detector (lesion count, detection confidence, lesion area) into a compact representation, from which a lightweight, interpretable classifier produces the final grade. On a widely used benchmark, this fusion yields a clear, statistically supported improvement over global-evidence-only baselines, with the largest gains on the most severe cases. Testing on an independent dataset with a different grading standard shows that strong within-dataset performance does not transfer automatically, and a follow-up diagnostic attributes much of this gap to mismatched grading criteria rather than detection failure alone. These findings support interpretable global-local fusion as an effective strategy for ordinal acne grading while highlighting criterion alignment as key to cross-dataset portability, with a further illustration of how the resulting severity signal can support transparent, non-diagnostic decision-making in skincare applications.