Quality of Life Assessed Using Skindex-16 Scores Among Patients With Acne Receiving Isotretinoin Treatment

Abstract

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.

Isotretinoin Induced Hyperlipidemia and Impact of Leptin Gene rs 7799039 Polymorphism in Safety of Acne Patients

“…30 Moreover, a recent retrospective study had reported an improvement in IGA after 2 month administration of oral isotretinoin and this study had expected approximately 4- to 5-fold improvements from baseline with a full course of isotretinoin. 31 …”

Patient-Reported Outcome Measures and Their Clinical Applications in Dermatology

“…PROMs provide a patient-centered perspective on treatment effectiveness and the importance of clear skin in dermatology [ 11 , 12 ]. For example, isotretinoin clinically meaningfully improves HRQL as measured by Skindex-16 [ 13 ]. PROMs can also help determine if prescribed medications are working properly (from the patient’s perspective) or causing significant side effects [ 14 ].…”

“…In a study comparing DLQI, Short Form 36 (SF-36), and EuroQOL 5D (EQ-5D), DLQI was most responsive to changes in psoriasis treatments [ 36 ]. Additionally, acne patients receiving isotretinoin are more affected mentally than physically, and changes over time can be observed using Skindex-16 [ 13 ].…”

“…At UUH Dermatology, PROM data has been used since 2017 to help track changes in dermatology patient symptoms and HRQL, enhance clinician–patient communication by providing insight into motivators for the patient visit, evaluate treatment effectiveness, and tailor treatment decisions [ 58 , 71 ]. Based on change management principles [ 72 ], to successfully implement PROMs, one needs to identify early adopters, communicate the vision with the team, empower others, create short-term wins, and consolidate improvements.…”

A non‐retinol retinoic acid receptor‐γ (RAR‐γ/NR1B3) selective agonist, tectorigenin, can effectively inhibit the ultraviolet A‐induced skin damage

“…The expression of RAR‐γ in the skin is more specific than that of the other subtypes. All‐trans retinoic acid (ATRA/tretinoin) is a commonly used RAR agonist in the clinical treatment of photoaging and skin inflammation‐related diseases, such as acne and psoriasis (di Masi et al, 2015; Mukherjee et al, 2006; Secrest et al, 2020). ATRA regulates proliferation, inflammation and immunity and promotes collagen production.…”