Is Adult Female Acne Driving Dermatology Visits, and Are We Treating It Effectively?

🔍 Key Finding Adult females visit dermatologists for acne 2.5 times more often than adult males, and while tetracycline antibiotics remain the most common treatment, spironolactone prescriptions have risen substantially since 2012, becoming the top treatment for women aged 30-39. This highlights a potential shift towards antiandrogen therapies for adult female acne.

🔬 Methodology Overview

• Design: Retrospective database analysis.
• Data Source: National Ambulatory Medical Care Survey (NAMCS) data from 2002-2016.
• Patient Population: Females aged 13 years and older with a diagnosis of acne.
• Variables: Demographics (age, sex, race, ethnicity, insurance type, region), healthcare utilization (dermatology visits vs. other specialties), and prescribed acne medications (tetracycline antibiotics, spironolactone, combined oral contraceptives, topical tretinoin, topical antibiotics).
• Analysis: Descriptive statistics (percentages) and chi-squared tests for categorical comparisons. Trends in prescriptions over time were also analyzed.

📊 Results

• Higher proportion of dermatology visits for acne in adult females: 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).
• Acne prevalence across female age groups: Among all dermatology office visits by females, a diagnosis of acne was made at 44.4% of visits for ages 20-29, 22.9% for ages 30-39, 12.4% for ages 40-49, and 1.8% for ages 50+.
• Dermatology as primary care setting: Most female patients (ages 13+) with a diagnosis of acne were seen in a dermatology practice (70.6% of all visits).
• Tetracycline antibiotics most prescribed: Tetracycline-class antibiotics were the most prescribed therapy within all age groups of females with acne (22.9% of visits by all females).
• Rise in spironolactone prescriptions: A substantial increase in spironolactone prescriptions was observed from 2012-2016, becoming the second most prescribed treatment for females ages 20-29 and the most prescribed for females ages 30-39 and 50+.
• Combination birth control usage: Females ages 20-29 received combination birth control at higher rates (8.8%) than any other age group.

💡 Clinical Impact Adult females visit dermatologists for acne at significantly higher rates than adult males, highlighting a need for targeted therapies. The increasing use of spironolactone suggests a shift towards anti-androgen therapies, but further research is needed to optimize treatment strategies and reduce reliance on broad-spectrum antibiotics.

🤔 Limitations

• The study period (2002-2016) may not reflect current practice patterns due to updated 2016 guidelines.
• Systemic agent use may vary based on specialty/practice provider type.
• Systemic agents (e.g., spironolactone, combination birth control pills) may be prescribed for indications other than acne.
• Isotretinoin use could not be reliably studied due to inconsistent data representation.

✨ What It Means For You This study highlights the substantial burden of acne in adult females and the increasing trend towards spironolactone use, suggesting a shift in treatment paradigms. Clinicians should consider antibiotic stewardship and the potential benefits of antiandrogenic agents like spironolactone when treating adult female acne, particularly given the high antibiotic failure rates and potential for resistance. Further research is needed to investigate the pathogenesis of adult female acne and compare the effectiveness of different treatment modalities.

Reference Chang J, Nock MR, Cohen JM, Bunick CG. 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. PLoS ONE. 2023;18:e0290763. https://doi.org/10.1371/journal.pone.0290763