Patient Preferences for Acne Vulgaris Treatment and Barriers to Care: A Survey Study.

The associated direct and indirect costs of acquiring acne vulgaris (acne) treatment from a clinician may prohibit some patients from doing so. Barriers to care may also influence patient preferences for treatment, and while both over-the-counter (OTC) and prescription acne treatments are efficacious, preferences for OTC or prescription acne medications are not well established. We recruited 529 adult subjects from the United States through Amazon Mechanical Turk (MTurk), and subjects were surveyed about acne, their acne treatment preferences, and any barriers to care. A total of 450 subjects passed the attention check and were included in the analysis. Of respondents who had tried both OTC and prescription treatments (n=223), more respondents reported that they preferred prescription treatments (130/223, 58.3%), compared with OTC treatments (64/223, 28.7%); or no preference (29/223, 13.0%; P=0.00001). Almost half of all respondents also stated that they experienced barriers to accessing medical care for acne treatment (192/450 42.7%); cost and transportation were the top 2 factors. Considering how common barriers are, and their everchanging nature, some patients may benefit from a discussion of alternative non-prescription acne treatments, serving as a bridge to therapy or while patients are unable to reach a medical provider. J Drugs Dermatol. 2022;21(11):1191-1195. doi:10.36849/JDD.6940.

Parametric Acne Severity (PAS) Score and Lesion Counts From Multi-Modality Facial Image Analysis Correlates Strongly with Investigator Assessment.

Variability in acne lesion counting and assessing global severity necessitates large sample sizes that increase trial costs. Lack of standardized measures for these outcomes precludes the conduct of meta-analyses needed to compare efficacy of acne treatments. The goal of this study was to evaluate objective measures of lesion counts and global severity using analysis of multimodal photography. An algorithm for counting lesions was trained and validated in 30 acne subjects and compared to parallel assessments by 2 expert raters. A composite of photographic data representative of acne lesion topography, erythema, and C Acnes fluorescence was used to generate a Parametric Acne Severity (PAS) score. No relationship was identified between lesion counts and IGA. The correlation coefficients between raters and the algorithm when compared per view for the inflammatory and non-inflammatory lesion counts were 0.77 (P=0.001) and 0.85 (P=0.001), respectively. The correlation coefficient between the raters’ IGA grades and the PAS score was 0.82 (P<0.05). These data demonstrate that the lesion counting, and PAS are objective measures that strongly correlate with investigator assessments. Inclusion of these measure in clinical trials may reduce variability, standardize outcomes, and provide insights into treatment effects on photographic parameters associated with acne. J Drugs Dermatol. 2021;20(6):642-647. doi:10.36849/JDD.6165.

Asynchronous Teledermatology Assessment of Young Adult Acne Likely Concordant With In-Person Evaluation.

Telemedicine, defined as practicing medicine at a distance, has grown in popularity over the past ten years, as advances in consumer technology have permitted its expansion. Dermatology is a field that especially lends itself to this method of care, as many common dermatological diagnoses can be made upon visual inspection. With social distancing becoming the new standard in this age of COVID-19, telemedicine emerges as a key tool in continuing patient care without interruption. In this pilot study, we examine the reliability of acne vulgaris diagnostic assessments made via patient-taken photos compared to in-office assessments in patients between the ages of 16 and 23 with mild to moderate acne. Fourteen patient encounters were clinically examined for three outcomes: inflammatory lesions, noninflammatory acne lesions, and facial nodules. On the same day patient outcomes were counted and recorded in-person, patients were instructed to photograph their faces. These images were reviewed 8–12 weeks later by investigators for the same assessment. Initial findings suggest strong concordance between in-person and digital diagnosis, with a Spearman’s correlation coefficient of 0.96 across all lesion and nodule scores. These data support further research on the expansion and implementation of telemedicine for dermatology. J Drugs Dermatol. 20(4):432-435. doi:10.36849/JDD.5688.

A retrospective assessment and comparison of the effectiveness of benzoyl peroxide; the combination of topical niacinamide, gallic acid, and lauric acid; and the combination of benzoyl peroxide and erythromycin in acne vulgaris.

Acne vulgaris is a chronic inflammatory skin disease that mostly develops during adolescence and continues throughout adulthood. It affects the face, the main location of cosmetic appearance. Despite many developments in acne treatment, various combination therapies are needed to create the best option. Ninety patients were included in this study. We used the global acne grading system (GAGS) and the lesion counting and photographic standards that were used by Hayashi et al., to assess acne severity. The patients were randomly divided into three groups as group 1 (using only 5% BPO, twice a day), group 2 (using only the combination of 5% BPO + 3% erythromycin, twice a day), and group 3 (using only the combination of 4% niacinamide + 1% gallic acid + 1% lauric acid, twice a day). Thirty patients were included in each group. The scores were evaluated at weeks 0, 2, 4 and 8, and compared with each other. As a result of the study, all three treatment types were found to be effective. The combination of 4% niacinamide + 1% gallic acid + 1% lauric acid can be used as an alternative topical treatment for acne vulgaris to prevent resistance against topical antibiotics and the side effects of some other treatments.

Who Is Accountable When Patients Do Not Achieve Successful Treatment for Their Acne?

Acne vulgaris (AV) is a very common inflammatory facial disorder that is complex in its pathophysiology, heterogenous in clinical presentation, and affects children and adults of all ethnicities, races, and skin types.

Using Network Oriented Research Assistant (NORA) Technology to Compare Digital Photographic With In-Person Assessment of Acne Vulgaris.

Importance: Teledermatology has undergone exponential growth in the past 2 decades. Many technological innovations are becoming available without necessarily undergoing validation studies for specific dermatologic applications. Objective: To determine whether patient-taken photographs of acne using Network Oriented Research Assistant (NORA) result in similar lesion counts and Investigator's Global Assessment (IGA) findings compared with in-person examination findings. Design, Setting, and Participants: This pilot reliability study enrolled consecutive patients with acne vulgaris from a single general dermatology practice in Los Angeles, California, who were able to use NORA on an iPhone 6 to take self-photographs. Patients were enrolled from January 1 through March 31, 2016. Each individual underwent in-person and digital evaluation of his or her acne by the same dermatologist. A period of at least 1 week separated the in-person and digital assessments of acne. Interventions: All participants were trained on how to use NORA on the iPhone 6 and take photographs of their face with the rear-facing camera. Main Outcomes and Measures: Reliability of patient-taken photographs with NORA for acne evaluation compared with in-person examination findings. Acne assessment measures included lesion count (total, inflammatory, noninflammatory, and cystic) and IGA for acne severity. Results: A total of 69 patients (37 male [54%] and 32 female [46%]; mean [SD] age, 22.7 [7.7] years) enrolled in the study. The intraclass correlation coefficients of in-person and photograph-based acne evaluations indicated strong agreement. The intraclass correlation coefficient for total lesion count was 0.81; for the IGA, 0.75. Inflammatory lesion count, noninflammatory lesion count, and cyst count had intraclass correlation coefficients of 0.72, 0.72, and 0.82, respectively. Conclusions and Relevance: This study found agreement between acne evaluations performed in person and from self-photographs with NORA. As a reliable telehealth technology for acne, NORA can be used as a teledermatology platform for dermatology research and can increase access to dermatologic care.

[Reliability and Validity of a Simplified Version of Acne-specific Quality of Life Assessment Instrument in Han Populations in Sichuan].

OBJECTIVES: To assess the reliability and validity of a simplified version of acne-specific quality of life (Acne-Qol-19) instrument in Han populations in Sichuan province. METHODS: Acne-Qol-19 was administered to 264 acne patients. Internal consistency, split-half reliability, content validity, criterion validity and construct validity (factor analysis) of Acne-Qol-19 were assessed. RESULTS: The Acne-Qol-19 obtained a Cronbach's α of 0.953 and split-half reliability of 0.902 (Spearman-Brown). Its content validity was well confirmed by dermatologists. The Acne-Qol-19 result was strongly associated (r =#-0.745) with Cardiff acne disabled index (CADI) (P <0.001). Confirmatory factor analysis yielded standardized loading of 0.853-0.944 on self-perception, 0.865-0.945 on role-social dimension, 0.383-0.898 on role-emotional dimension, and 0.612-0.867 on acne symptoms (P <0.01). CONCLUSION: Acne-Qol-19 has good validity and reliability in Han populations in Sichuan.

Objective assessment of acne.

A precise and reliable assessment of acne severity is unarguably the most essential clinical method when it comes to monitoring and choosing optimal treatment in the daily practice. Since the early 1960s, different severity assessment systems have been described in the literature. The two commonly used concepts are global gradings and lesion counting. Both systems have been controversially discussed as to which is more reliable and providing an objective outcome measurement tool; however, both have some subjectivity involved. More objective methods for assessing the severity of acne vulgaris include photography, fluorescence photography, polarized light photography, video microscopy, and multispectral imaging. Such techniques have limitations such as high cost, complex and sophisticated apparatus, and a sometimes time-consuming imaging process. There are newly developed technologies that could avoid the problems of inter- and intrarater subjectivity.

Management of acne vulgaris with hormonal therapies in adult female patients.

Acne vulgaris is a very common condition affecting up of 93% of adolescents. Although rare, this disease may persist in adulthood. In adult women with acne (those older than 25 years old), this condition is particularly relevant because of the refractory to conventional therapies, which makes acne a challenge for dermatologists in this group of patients. In order to its potential risk for chronicity and the involvement of visible anatomical sites such as face and upper torso, acne has been associated with a wide spectrum of psychological and social dysfunction such as depression, anxiety, suicidal ideation, somatization, and social inhibition. In particular, adult women with acne have been shown to be adversely impacted by the effect of acne on their quality of life. For the last four decades, dermatologists have used hormonal therapies for the management of acne vulgaris in adult women, which are considered a rational choice given the severity and chronicity of this condition in this group of patients. The aim of this work is to review the hormonal drugs for management of acne.

Characterizing the relationship between free drug samples and prescription patterns for acne vulgaris and rosacea.

IMPORTANCE: Describing the relationship between the availability of free prescription drug samples and dermatologists' prescribing patterns on a national scale can help inform policy guidelines on the use of free samples in a physician's office. OBJECTIVES: To investigate the relationships between free drug samples and dermatologists' local and national prescribing patterns and between the availability of free drug samples and prescription costs. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study investigating prescribing practices for acne, a common dermatologic condition for which free samples are often available. The settings were, first, the offices of nationally representative dermatologists from the National Disease and Therapeutic Index (an IMS Health Incorporated database) and, second, an academic medical center clinic without samples. Participants were ambulatory patients who received a prescription from a dermatologist for a primary initial diagnosis of acne vulgaris or rosacea in 2010. MAIN OUTCOMES AND MEASURES: National trends in dermatologist prescribing patterns, the degree of correlation between the availability of free samples and the prescribing of brand-name medications, and the mean cost of acne medications prescribed per office visit nationally and at an academic medical center without samples. RESULTS: On a national level, the provision of samples with a prescription by dermatologists has been increasing over time, and this increase is correlated (r = 0.92) with the use of the branded generic drugs promoted by these samples. Branded and branded generic drugs comprised most of the prescriptions written nationally (79%), while they represented only 17% at an academic medical center clinic without samples. Because of the increased use of branded and branded generic drugs, the national mean total retail cost of prescriptions at an office visit for acne was conservatively estimated to be 2 times higher (approximately $465 nationally vs $200 at an academic medical center without samples). CONCLUSIONS AND RELEVANCE: Free drug samples can alter the prescribing habits of physicians away from the use of less expensive generic medications. The benefits of free samples in dermatology must be weighed against potential negative effects on prescribing behavior and prescription costs.

Predictive value of obsessive compulsive symptoms involving the skin on quality of life in patients with acne vulgaris.

Acne is one of the most common dermatological diseases, and obsessive compulsive disorder is among the most frequent psychiatric conditions seen in dermatology clinics. Comorbidity of these conditions may therefore be expected. The aim of this study was to measure obsessive compulsive symptoms and quality of life in patients with acne vulgaris, compare them with those of healthy control subjects, and determine whether there is any predictive value of obsessive compulsive symptoms for quality of life in patients with acne. Obsessive compulsive symptoms and quality of life measurements of 146 patients with acne vulgaris and 94 healthy control subjects were made using the Maudsley Obsessive Compulsive Questionnaire and Short Form-36 in a cross-sectional design. Patients with acne vulgaris had lower scores for physical functioning, physical role dysfunction, general health perception, vitality, and emotional role dysfunction. They also had higher scores for checking, slowness, and rumination. The only predictor of physical functioning and vitality dimensions of health-related quality of life in these patients was rumination score. Obsessive compulsive symptoms in patients with acne vulgaris are higher than in controls, and this may correlate with both disease severity and quality of life for patients.

Acne analysis, grading and computational assessment methods: an overview.

INTRODUCTION: This paper presents a comprehensive review of acne grading and measurement. Acne is a chronic disorder of the pilosebaceous units, with excess sebum production, follicular epidermal hyperproliferation, inflammation and Propionibacterium acnes activity. Most patients are affected with acne vulgaris, which is the prevalent type of acne. Acne vulgaris consists of comedones (whitehead and blackhead), papules, pustules, nodules and cysts. OBJECTIVES: To review and identify the issues for acne vulgaris grading and computational assessment methods. To determine the future direction for addressing the identified issues. METHODS: There are two main methods of assessment for acne severity grading, namely, lesion counting and comparison of patient with a photographic standard. For the computational assessment method, the emphasis is on computational imaging techniques. RESULTS: Current acne grading methods are very time consuming and tedious. Generally, they rely on approximation for counting lesions and hence the assessment is quite subjective, with both inter and intra-observer variability. It is important to accurately assess acne grade to evaluate its severity as this influences treatment selection and assessment of response to therapy. This will further help in better disease management and more efficacious treatment. CONCLUSION: Semi-automated or automated methods based on computational imaging techniques should be devised for acne grade assessment.

Usage and equity of access to isotretinoin in New Zealand by deprivation and ethnicity.

AIMS: Oral isotretinoin, for severe acne, was until March 2009 fully funded in New Zealand only if the prescription was written by a vocationally registered dermatologist. This funding restriction was argued on the basis of complexity of management and an appreciable risk of teratogenicity if given during pregnancy or within a month of conception. However, this funding restriction had the potential to create inequitable access barriers. This study was an audit examining the use of isotretinoin by deprivation level and ethnicity, in order to examine potential inequities in use. METHOD: Dispensed prescription data for funded isotretinoin, for the year ending June 2008, held in a national repository was analysed using simple descriptive methods based on ethnicity and deprivation level. The same analysis was carried out for cyproterone acetate with ethinyloestradiol, another acne pharmaceutical available on prescription with no funding restrictions. There was demographic data on 60% of prescriptions based on the health identification number NHI. RESULTS: People living in more deprived areas (as defined by NZDep Index) were less likely to use isotretinoin, as were Maori and Pacific people. The association with deprivation level was not present for cyproterone acetate with ethinyloestradiol, although disparities in use by ethnicity remained. CONCLUSIONS: Given there is no evidence for lower rates of acne for Maori and Pacific people, the reasons may include financial and other barriers.