Isotretinoin Improves Quality of Life for Patients With Acne

Aaron Secrest, MD, PhD

Patients with acne who receive isotretinoin treatment achieve greater than 50% improvement in the quality of life by month 2.

Further, the findings of the new study suggest those who received such treatment can expect approximately four-fold to five-fold improvements in quality of life from baseline with a full course of isotretinoin. Based on the results, there may be new insights into how patients with acne perceive their response to isotretinoin treatment.

Aaron Secrest, MD, PhD, and a team of colleagues conducted a longitudinal, retrospective case series to investigate the change in Skindex-16 scoring during the isotretinoin treatment course for patients with acne. The investigators collected scores at baseline and at monthly follow-up visits. Other data included patient age, sex, weight, acne type, acne severity based on an acne investigator global assessment, presence of scarring, and daily isotretinoin doses.

To be included, patients were at least 12 years old with acne and completed a baseline Skindex-16 prior to initiating isotretinoin treatment and at least 1 additional Skindex-16 while receiving treatment. Patients were seen at a suburban, community-based, academic dermatology clinic between November 23, 2016, and January 22, 2019. All patients received an electronic tablet during their visit to take the Skindex-16. Scores were uploaded automatically to the provider’s electronic health record and immediately available for review by the dermatologist.

Skindex-16 scores assessed how symptoms, emotions, and functioning from the skin affected the quality of life of patients with acne. The overall score consisted of an average of the 3 domain scores on a 0-100 scale, with 0 indicating the skin condition had no impact on the quality of life and 100 represented the maximum impact on the quality of life for the worse.

The primary outcome was the change in mean Skindex-16 score for the overall group over time. Secondary outcomes included change in the mean domain scores, along with interactions between scores and patients’ sex and age and the impact of demographic or disease characteristics with Skindex-16 scores.

Overall, 57 patients completed Skindex-16 at baseline and at least once during a follow-up visit (baseline overall Skindex-16 score per patient: mean, 40.5; range reported as absolute numbers, 2-80). A majority of the patients (54%) were male with a median age of 17.2 years old.

Females received a higher initial and final weight-based daily isotretinoin dose. At baseline, overall scores were similar by sex but worse with increasing age.

Among both sexes, the emotional domain subscore was highest and the largest component of the overall score. The emotional domain scores were seen by month 2 of receiving isotretinoin treatment. Overall scores decreased from 39.4 to 17.5 by month 2, a decrease of 22 (P <.001).

Skindex-16 scores reached their lowest point between months 3-5. At month 4, overall scores showed a more than four-fold improvement from 39.4 at baseline to 8.9 (P <.001), while emotional domain scores showed a near five-fold improvement from 57.7 at baseline to 11.9 (P <.001).

The study, “Quality of Life Assessed Using Skindex-16 Scores Among Patients With Acne Receiving Isotretinoin Treatment,” was published online in JAMA Dermatology.