Comparative analysis of prescribing patterns of tetracycline class antibiotics and spironolactone between advanced practice providers and physicians in the treatment of acne vulgaris

Temporal Trends in the Use of Systemic Medications for Acne From 2017 to 2020

This cross-sectional study uses data from the Truven MarketScan Commercial Claims Database for 2017 through 2020 to assess prescribing patterns for systemic acne treatments.

Acne accounts for an almost 2.5-fold higher proportion of dermatology visits among adult females compared to adult males in the United States: A study of the national ambulatory medical care survey from 2002-2016

BACKGROUND

Acne vulgaris affects a significant number of females into adulthood. Juvenile acne and adult acne have different presentations and potentially distinctive pathogeneses. However, patterns in treatments specifically related to the adult female population have previously not been studied.

METHODS

Retrospective database analysis of healthcare utilization and medications prescribed for acne using the National Ambulatory Medical Care Survey (NAMCS) data from 2002-2016 was performed.

RESULTS

After age 20, acne accounted for an almost 2.5-fold higher proportion of dermatology visits among females compared to males (10.1% vs. 4.1%, P < 0.001). Tetracycline-class antibiotics were the most prescribed therapy within all age groups of females between 2002-2016. However, there was also a substantial rise in prescriptions of spironolactone beginning in 2012.

CONCLUSION

A significantly greater proportion of dermatology visits by adult females are for acne in comparison to adult males. Tetracycline-class antibiotics remain the most prescribed therapy in adult age groups despite a potentially different pathogenesis of adult acne. Therefore, there is a need for further studies comparing the effectiveness of therapies specifically for adult female acne.

Patient Perspectives on the Lived Experience of Acne and Its Treatment Among Adult Women With Acne: A Qualitative Study

Introduction

Acne often persists into adulthood in women. However, few studies have specifically explored the lived experience of acne in adult populations.

Objective

To examine the lived experience of acne and its treatment among a cohort of adult women.

Design, Setting, and Participants

A qualitative analysis was conducted from free listing and open-ended, semistructured interviews of patients at a large academic health care system (University of Pennsylvania Health System) and a private practice (Dermatologists of Southwest Ohio). Fifty women 18 to 40 years of age with moderate to severe acne participated in interviews conducted between August 30, 2019, and December 31, 2020.

Main Outcomes and Measures

Free-listing data from interviews were used to calculate the Smith S, a measure of saliency for each list item. Semistructured interviews were examined to detect themes about patient perspectives regarding their acne and its treatment.

Results

Fifty participants (mean [SD] age, 28 [5.38] years; 24 [48%] White) described acne-related concerns about their appearance that affected their social, professional, and personal lives, with many altering their behavior because of their acne. Depression, anxiety, and social isolation were commonly reported. Participants described successful treatment as having completely clear skin over time or a manageable number of blemishes. Many participants described frustration with finding a dermatologist with whom they were comfortable and with identifying effective treatments for their acne.

Conclusions and Relevance

The results of this qualitative study suggest that women with acne have strong concerns about appearance and experience mental and emotional health consequences and disruption of their personal and professional lives. In addition, many patients describe challenges finding effective treatments and accessing care. Future trials to understand the optimal treatment approaches for women with acne are needed to improve outcomes in this population.

New Acne Therapies and Updates on Use of Spironolactone and Isotretinoin: A Narrative Review

Acne vulgaris is a chronic inflammatory skin disease with a multifactorial pathogenesis. Although a variety of acne treatments are available, limitations of current therapies include tolerability, antimicrobial resistance, and costs and patient burden associated with monitoring. This narrative review focuses on emerging treatments and updates on the management of acne. Clascoterone, sarecycline, trifarotene, and novel lotion formulations of tretinoin and tazarotene have been evaluated in clinical trials and provide new options for treatment. Emerging data on the safety and efficacy of spironolactone and isotretinoin challenge current conventions and suggest a need to reconsider drug monitoring guidelines and risk prevention systems. Additional head-to-head data are needed to confirm these novel treatments' utility in treating acne.