Adelman Madeline J, Sivesind Torunn E, Weber Isaac, Bosma Grace, Hochheimer Camille, Karimkhani Chante, Schilling Lisa M, Barbieri John S, Dellavalle Robert P
Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, MI, United States.
School of Medicine, University of Missouri, Columbia, MO, United States.
JMIR Dermatol. 2023 Aug 21;6:e42883. doi: 10.2196/42883.
Guidelines established by the American Academy of Dermatology recommend oral antibiotics as first-line therapy for mild, moderate, and severe acne. However, it is recommended to minimize the duration of oral antibiotic use, and there is increasing support for other systemic agents for acne.
We sought to characterize the use of oral antibiotics and isotretinoin for the treatment of acne in the pediatric and young adult population aged 10 through 20 years and the adult population aged 21 to 45 years from 2011 to 2019.
We conducted a retrospective, observational cohort study using electronic data from the enterprise data warehouse of the University of Colorado Anschutz Medical Campus and its affiliates, with data in the format of the Observational Health Data Sciences and Informatics (OHDSI) Observational Medical Outcomes Partnership (OMOP) common data model. Categorical values (sex, race, and ethnicity) were compared using chi-square tests, and continuous variables (age) were compared using 2-tailed t tests.
Our cohort of 15,704 patients was composed of mostly White (12,776/15,704, 81.4%), non-Hispanic or Latino (13,307/15,704, 84.7%), and female (11,093/15,704, 70.6%) patients. Among the 4605 male patients in the eligible cohort, 1810 (39%) received an oral antibiotic treatment, in comparison to 3109 (28%) of the 11,093 eligible women (P<.001). Among the 4605 men who were eligible for treatment with isotretinoin in this population, 988 (21.5%) received a course of isotretinoin, compared to only 10.4% (1159/11,093) eligible women (P<.001). Male patients were 1.67 times more likely to have received an antibiotic prescription (odds ratio [OR] 1.67, 95% CI 1.55-1.79) and over twice as likely to have received an isotretinoin prescription (OR 2.34, 95% CI 2.13-2.57) than female patients.
Minocycline was the most frequently prescribed antibiotic for the treatment of acne in this study cohort. From 2015 to 2019, there was no significant change in the number of antibiotic prescriptions over time. Men were significantly more likely to receive both oral antibiotics and isotretinoin than female patients. Multiple factors could be contributing to this discrepancy, including the burden of iPLEDGE, additional systemic treatment options for female patients, and the difference in acne severity across sexes. We could not determine the difference in severity of acne between male and female patients in our cohort, and further research is needed to ascertain the variation across sexes.
美国皮肤科协会制定的指南推荐口服抗生素作为轻、中、重度痤疮的一线治疗方法。然而，建议尽量缩短口服抗生素的使用时间，并且越来越多的人支持使用其他治疗痤疮的全身性药物。
我们试图描述2011年至2019年期间10至20岁的儿童和青年以及21至45岁的成年人使用口服抗生素和异维A酸治疗痤疮的情况。
我们进行了一项回顾性观察队列研究，使用科罗拉多大学安舒茨医学校区及其附属机构企业数据仓库中的电子数据，数据采用观察性健康数据科学与信息学（OHDSI）观察性医疗结局合作组织（OMOP）通用数据模型的格式。分类变量（性别、种族和民族）使用卡方检验进行比较，连续变量（年龄）使用双尾t检验进行比较。
我们的15704名患者队列主要由白人（12776/15704，81.4%）、非西班牙裔或拉丁裔（13307/15704，84.7%）和女性（11093/15704，70.6%）患者组成。在符合条件的队列中的4605名男性患者中，1810名（39%）接受了口服抗生素治疗，而在11093名符合条件的女性患者中，这一比例为3109名（28%）（P<0.001）。在该人群中符合异维A酸治疗条件的4605名男性中，988名（21.5%）接受了异维A酸疗程治疗，而符合条件的女性中只有10.4%（1159/11093）接受了治疗（P<0.001）。男性患者接受抗生素处方的可能性是女性患者的1.67倍（优势比[OR]1.67，95%CI 1.55-1.79），接受异维A酸处方的可能性是女性患者的两倍多（OR 2.34，95%CI 2.13-2.57）。
米诺环素是本研究队列中治疗痤疮最常用的抗生素。2015年至2019年期间，抗生素处方数量随时间没有显著变化。男性比女性患者更有可能接受口服抗生素和异维A酸治疗。多种因素可能导致这种差异，包括iPLEDGE的负担、女性患者的其他全身性治疗选择以及男女痤疮严重程度的差异。我们无法确定队列中男性和女性患者痤疮严重程度的差异，需要进一步研究以确定性别差异。
