White Patients are Less Likely to Visit Dermatologist for Acne Treatment

Non-Hispanic White patients visit dermatologists less frequently for acne treatment, but when they do, they are likely to receive more medications, says a new University of Pennsylvania study.

The study investigated the race- and sex-associated differences in acne prescriptions and found Black patients to have higher incidences of skin conditions, including acne. However, compared to Caucasian patients, they were less likely to receive extensive medications and lengthy treatments. The breakout was commonly treated with topical retinoids and antibiotics. The White patients, on the other hand, almost always required oral antibiotics, diuretics (spironolactone) and vitamin derivatives (isotretinoin).

Acne vulgaris is the most common skin condition in the world. It can affect anyone between 15-40 years of age. However, it is prevalent in adolescents given the age-related hormonal shifts. The exact cause of acne is unknown but hormones (androgen) are said to play a role. Androgens surge in puberty in both girls and boys and make the oil glands larger so they produce more sebum (oil). Acne erupts when sebum clogs the skin pores and bacteria invade.

Among adults, women are affected more with 12-22 percent of U.S. women having acne as compared to just three percent of men. The most likely cause of acne in adult women is pregnancy, genetics, hormonal disorder, stress and excessive use of cosmetics.

However, acne breakouts are not uniform in all women, they come with a racial and ethnic disparity. Black, Latin and Asian women are more likely to have acne than Caucasian women. The most common site of acne in Black women is hairline which is impacted by hair-grooming products. Further, the acne breakout is not that simplistic in such women since it commonly worsens and ends up in hyperpigmentation. The post-inflammatory skin darkening and scars (keloids) are extremely difficult to treat which further slows down the healing process.

Acne treatment is associated with certain risks in darker skin because inflammation can recur and worsen the pigmentation and keloids.

There has been limited research comparing ethnic and racial disparity among patients with acne. The study provides unique clues about clinical presentation and prescription variations among patients of different backgrounds.

To understand the situation better, researchers at University of Pennsylvania recruited over 29,000 patients with acne and studied the ethnic, racial and sex-based disparity in treatment. All patients had at least one symptom that met the international standards and classifications of disease and been seeking medical treatment for the last one year.

The findings suggested that Caucasian patients suffer fewer acne flares as compared to the Black population but receive a different treatment regimen when they visit the dermatologist. Their prescriptions mostly contained a combination of oral medications as compared to topical medications prescribed mostly to Black patients.

The study also found that acne patterns varied between men and women, with men requiring isotretinoin more frequently than women. This is because men have coarser and thicker skin with larger sebaceous glands. Isotretinoin shrinks these glands reducing the secretions and clogging of skin pores. It produces quicker and better clinical improvement.

It was also noticed that Medicaid patients, despite possessing medical coverage, were less likely to visit dermatologist for acne treatment.

The study, published in JAMA Dermatology on February 5th,  provides an important insight into the sociodemographic patterns of acne and its treatment. It highlights the underuse of systemic therapies in racial minorities.

Question: Is this the correct clinical practice?

We need more studies to identify the disparity and understand the reasons behind it.

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