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Biases in Acne Treatment Still Exist for Minority Patients

Non-Hispanic black patients were less likely to be treated with systemic acne medications, despite being more likely to see a dermatologist, according to the findings of a recent study that revealed several racial, sex, and insurance-based disparities in the treatment of acne.

While prior studies have shown racial and ethnic disparities in health care use for a variety of dermatologic diseases, “our understanding of the associations of race/ethnicity, sex, and other factors with health care use and treatment for acne remains limited,” the researchers said.

In the retrospective cohort study, the researchers analyzed electronic health record data of 29,928 patients with acne from January 1, 2007 to June 30, 2017. A total of 19,127 patients were female (63.9%) and 20,310 were white (67.9%). The researchers used multivariable regression to quantify the associations between basic patient demographic and socioeconomic characteristics and the outcomes of health care use and treatment for acne during 1 year of follow-up.

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Non-Hispanic black patients were more likely to be seen by a dermatologist compared with non-Hispanic white patients (odds ratio [OR] 1.20; 95% CI, 1.09-1.31), the researchers said. However, non-Hispanic black patients received fewer prescriptions for acne medications (incidence rate ratio 0.89; 95% CI, 0.84-0.95), they added. Specifically, these patients were more likely to be treated with topical retinoids and topical antibiotics (OR 1.25; 95% CI, 1.14-1.38), but less likely to receive a prescription for oral antibiotics (OR 0.80; 95% CI, 0.72-0.87), spironolactone (OR 0.68; 95% CI, 0.49-0.94), and isotretinoin (OR 0.39; 95% CI, 0.23-0.65) compared with non-Hispanic white patients.

In addition, the researchers found male patients were more likely to receive an isotretinoin prescription compared with female patients (OR 2.44; 95% CI, 2.01-2.95).

The researchers also observed that patients with Medicaid were less likely to see a dermatologist (OR 0.46; 95% CI, 0.41-0.52), or to be prescribed topical retinoids (OR 0.82; 95% CI, 0.73-0.92), oral antibiotics (OR 0.87; 95% CI, 0.79-0.97), spironolactone (OR 0.50; 95% CI, 0.31-0.80), or isotretinoin (OR 0.43; 95% CI, 0.25-0.75) compared with patients with commercial insurance.

“Our findings suggest the presence of racial/ethnic, sex, and insurance-based disparities in health care use and treatment for acne and raise particular concern for undertreatment among racial/ethnic minority and female patients,” the researchers concluded.

“Further study is needed to confirm our findings, provide understanding of the reasons for these potential disparities, and develop strategies to ensure equitable care for patients with acne,” they added.


Barbieri JS, Shin DB, Wang S, Margolis DJ, Takeshita J. Association of race/ethnicity and sex With differences in health care use and treatment for acne [published online February 05, 2020].  JAMA Dermatol. doi:10.1001/jamadermatol.2019.4818

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