IMPORTANCEAcne is a common dermatologic condition and significantly affects psychosocial health and quality of life. An international task force recommended routine use of quality-of-life measures for clinic visits associated with acne management, but this has yet to translate into clinical practice.OBJECTIVE To assess mean Skindex-16 scores over time among patients with moderate to severe acne receiving isotretinoin treatment. DESIGN, SETTING, AND PARTICIPANTSA longitudinal, retrospective case series study of Skindex-16 data collected at monthly visits from 57 consecutive patients with acne receiving isotretinoin; data were collected and evaluated between November 23, 2016, and January 22, 2019. Continuous variables were compared using quantile regression. Multivariable linear mixed models evaluated mean (95% CI) score trajectory over time.MAIN OUTCOMES AND MEASURE Skindex-16 scores, including normalized scores for the emotional, symptomatic, and functional aspects of having skin disease as well as an overall score.RESULTS 4 %] males, with median [interquartile range] age of 17.2 [15.9-18.1] years) in this case series study completed the Skindex-16 at baseline and at least once during follow-up. Baseline Skindex-16 scores were similar by sex but worse with increasing age. Emotional impact was more bothersome to patients with acne requiring isotretinoin treatment than either symptoms or functioning. Improvements of greater than 50% in overall and Emotional domain scores were seen by month 2 of receiving isotretinoin treatment (eg, overall scores decreased from 39.4 to 17.5 by month 2; a decrease of 22.0; P < .001). Qualitatively, Skindex-16 scores reached their nadir between months 3 and 5; at month 4, overall Skindex-16 scores showed a 4.4-fold improvement (from 39.4 at baseline to 8.9; P < .001) and Emotional domain scores showed a 4.8-fold improvement (from 57.7 at baseline to 11.9; P < .001). CONCLUSIONS AND RELEVANCEThe findings of this case series suggest that patients receiving isotretinoin treatment achieve greater than a 50% improvement in quality of life by month 2 and can expect approximately 4-fold to 5-fold improvements from baseline with a full course of isotretinoin. This study shows the potential of routine administration of quality of life measures to assess patient care in dermatology.

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Biologic therapy is associated with better outcomes for moderate to severe psoriasis compared to systemic or topical therapies. Do prescription patterns in a national expenditure database identify gaps in financial assistance and equity in optimal care delivery? To determine the degree to which adults below the federal poverty level (FPL) are prescribed biologics, we performed a retrospective cross-sectional study using pooled data from the Medical Expenditure Panel Survey (MEPS). A prescription was defined by a biologic Multum Lexicon code linked to a psoriasis ICD code. Demographics and biologic prescriptions were compared between psoriasis patients below versus at or above the FPL using weighted-subject designs. We identified 1,437,792 yearly-weighted patients with active psoriasis (1,356 total unweighted) between 2007 and 2018, of whom 123,392 were below the FPL (166 total unweighted). Psoriasis patients below the FPL were less likely to be prescribed biologics for psoriasis than psoriasis patients at or above the FPL (5% vs 12%, p¼0.01). In addition, they were more likely to be black (p¼0.02), be formerly or never married (p<0.001), have public or no insurance (p<0.001), have no degree (p¼0.02), and self-report poor/fair physical or mental health (p<0.001). Finally, psoriasis patients below the FPL taking biologics had lower median biologic medication expenditures per person than psoriasis patients at or above the FPL taking biologics ($6,511 vs. $12,152, p¼0.003). Biologics are not prescribed equally among all socioeconomic cohorts, notably across racial and socioeconomic strata such as black patients and patients with no degree. Further studies are needed to identify the financial assistance programs that best address the persistent hurdles to equity in the delivery of holistic care in the United States.