Acne

Acne patients will see improvements in two months with isotretinoin, QoL scores show


Dermatologists can use a Patient Reported Outcome (PRO) measure to assure people with acne that they will likely see a significant improvement in quality of life within two months, a new study shows.

While early trials of the anti-acne drug assessed clinical outcomes such as numbers of cysts, these may not equate with patient-related outcomes such as emotional quality of life, according to US researchers.

They therefore assessed the impact of isotretinoin using a verified PRO tool – Skindex-16 scores for emotional, symptomatic, and functional aspects as well as overall quality of life – in 57 young patients starting treatment for moderate to severe acne.

The Skindex-16 scores showed improvements of greater than 50% at the second monthly visit after starting isotretinoin treatment.

The overall QoL scores decreased from 39.4 to 17.5 by month 2, and there was a similar 22-point decrease in emotional domain QoL scores at month 2.

Improvements in QoL scores reached their maximum level at months 3 and 5, showing a 4.4-fold improvement  (77%) in overall scores (from 39.4 at baseline to 8.9; P < .001) and Emotional domain scores showing a 4.8-fold improvement (from 57.7 at baseline to 11.9; P < .001).

Improvements in QoL shown by the Skindex-16 scores were seen regardless of age and sex. However, multivariable analysis did suggest that older patients and those with more severe acne experienced a more significant, negative effect on their QOL from acne.

The study authors said their findings showed that tools such as Skindex-16 and perhaps DLQI could have a role in measuring outcomes of acne treatment in the way they are perceived as relevant by the patient.

“Our findings have real-world implications by providing dermatologists with practical information to frame expectations with patients. Increased awareness of expected results helps to improve adherence,” they wrote.

“A simple statement such as ‘you can expect a 50% improvement in how you feel about your acne by our second follow-up visit,’ provides accurate information to help patients understand that isotretinoin will likely work for them but not immediately.

Dermatologists could also use graphs or charts of the expected responses to illustrate the timeline effect, they suggested.

PROs such as Skindex-16 may also help identify patients at risk of poorer outcomes, they said, noting that previous studies had found that low pretreatment scores in males and high pretreatment scores in females were associated with poorer adherence to acne treatments.

The findings are published in JAMA Dermatology.

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