Not Going by the Acne Label

Acne medication adherence by young Medicaid patients is less than 12 percent

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Zits and pimples can make even the most confident of individuals conscious about their looks. Despite this, teens and young adults with acne might not take medicines for the condition as instructed.

Less than 12 percent of young acne patients enrolled in Medicaid adhered to medication regimens to get rid of their pimples, a recently published study found.

Combining topical medicines that reduce oil production with an antibiotic medicine might be a good choice for young acne patients given the costs and outcomes, according to the researchers.

"Follow acne medicine instructions carefully."

Xi Tan, from the Department of Clinical, Social and Administrative Sciences at the University of Michigan, led a team of researchers investigating how often patients with acne adhered to their medicine. They also looked at the healthcare costs of acne medications and how those medications were used.

The study included more than 24,000 patients from January 2005 to December 2007. Almost 90 percent of the patients were under 18 years of age.

Patients were listed in the Marketscan Medicaid Database, which tracks healthcare claims across the US. The researchers followed patients during the first three months after being prescribed an acne medicine.

The researchers tracked the number of acne-related outpatient visits, acne medication adherence and total acne-related healthcare costs.

The researchers found that less than 12 percent of patients were adherent to acne medications on average.

Adherence rates were linked to a patient's age, gender, side illnesses, number of medicine refills and the number of medication classes used.

"Intuitively, we might expect a condition which has such a visible manifestation to have very high adherence to the prescribed therapy," said Jason Poquette, BPharm, RPh, a registered pharmacist and dailyRx Contributing Expert. "This, however, did not turn out to be the case as less than 12 percent of the patient population in this study were adherent."

In general, boys adhered more to acne medications than girls, though researchers said that the differences might vary across medicine classes and formulations.

Patients adhered to oral retinoids more than any other type of acne medication. Patients taking oral retinoids were 57 percent adherent to their medication.

At the same time, patients adhered less to oral antibiotics and topical retinoids. Side effects or slower results from the oral antibiotics could be why adherence was lower for this kind of medication, according to Dr. Poquette.

And though topical retinoids are effective, he said that they often make the skin condition appear worse before improvement begins.

"The higher rate of adherence to oral retinoids might be explained by the fact that they are typically reserved for more severe or resistant cases," Dr. Poquette said. "Such patients would have a greater incentive for contributing to the treatment success."

Using oral antibiotics decreased the number of outpatient visits for acne-related matters by about 51 percent after controlling for medication use behavior.

The researchers said that adherence rates could be tied with "the more intensive, extended treatment received or by the presence of more severe conditions in these higher adherent patients."

"Our study demonstrates that adherence to acne drugs is associated with increased acne-related health utilization and costs," the researchers wrote in their report.

"We also found that, after controlling for medication use behavior, having acne drug refills did not significantly increase acne-related health utilization but did increase costs substantially," they wrote.

The researchers noted they still are not sure of the cause behind the adherence rates. They also did not look at the indirect costs, clinical information of acne severity and any other illness related to the study.

In addition, patients who adhered to the over-the-counter medicines might also have gotten better without visiting the doctor.

The study, supported by Galderma Laboratories, LP, and the Center for Dermatology Research, was published in the April issue of the American Journal of Clinical Dermatology.

One of the authors received grants from a number of pharmaceutical companies and stock options from Photomedex. Another author is also a consultant and speaker for various pharmaceutical companies.

Reviewed by: 
Review Date: 
April 23, 2013
Last Updated:
November 12, 2013