Disparities in Acne Prescribing Patterns Highlight Structural and Racial Gaps

Based on recent research, treatment access for acne appears to vary markedly across patient populations—even within a single academic health system.

A retrospective chart review conducted at the University of Southern California analyzed differences in acne treatment prescriptions not only across private (PS) and safety-net (SNS) outpatient dermatology clinics, but also by race and ethnicity. And it revealed notable discrepancies not explained by disease severity.

Study Design and Population Overview

The study reviewed records from 1,355 adult patients diagnosed with acne between December 2018 and December 2019. Patients were seen at either Keck Medical Center (private system) or Los Angeles County General Medical Center (safety-net system); both were staffed by the same group of physicians.

The cohort was diverse in that 66.6% were female, 20.7% identified as Hispanic/Latino, and 100% of SNS patients were non-White. Acne severity was comparable across groups, with 74.8% of patients classified as having mild to moderate acne.

Prescribing Patterns by Health System

Despite similar acne severity, patients in the SNS received fewer prescriptions for both topical and systemic acne treatments. Here are the key findings:

• SNS patients were less frequently prescribed azelaic acid, combination benzoyl peroxide/clindamycin or benzoyl peroxide/adapalene, sulfacetamide, topical dapsone, and salicylic acid (p < 0.001).
• Oral therapies such as spironolactone, antibiotics, and isotretinoin were also less commonly prescribed to SNS patients (p < 0.001).
• In contrast, SNS patients were more likely to be prescribed oral contraceptive pills and more frequently recommended procedural treatments (p < 0.001).

Notably, 60.3% of SNS patients reported no prior use of over-the-counter acne products compared to 47.9% in the PS (p < 0.001).

Racial and Ethnic Differences in Treatment

When stratified by race and ethnicity, treatment differences persisted across both hospital systems, as outlined below:

• Non-White patients were less often prescribed topical retinoids (36.5% vs. 40.2%, p = 0.003) and benzoyl peroxide/clindamycin (12.8% vs. 20.1%, p = 0.003) than White patients, despite similar acne severity.
• Systemic treatments such as isotretinoin and spironolactone were less frequently prescribed to non-White patients, while oral antibiotics and contraceptives were more common (p < 0.001).
• Hispanic/Latino patients, who had higher rates of moderate to severe acne (14.4% vs. 9.4%, p = 0.041), were less likely to be prescribed systemic therapies overall (50.8% vs. 59.1%, p = 0.023), including lower prescriptions for spironolactone and oral antibiotics.

Procedural Therapies and Language Barriers

The last key finding involved procedural treatments. These were recommended more frequently in the SNS, which predominantly served Hispanic/Latino and Spanish-speaking populations (p = 0.011).

However, within this SNS group, non-Hispanic/Latino patients who preferred English as their primary language were more likely to be offered these procedures (p = 0.002).

Limitations and Considerations

With these findings in mind, it’s important to note that this study’s retrospective, single-institution design introduces some limitations. First, acne severity was determined via clinical records rather than standardized scoring, and both initial and follow-up visits were included without stratification.

Additionally, the patient population may not represent broader demographics, and the racial and ethnic categorizations used may not capture nuances among underrepresented groups.

But even with these limitations, the observed differences in acne treatment across healthcare systems and racial/ethnic groups highlight concerning disparities that warrant further investigation into drivers of treatment access and utilization, alongside strategies to ensure equitable, evidence-based acne care.

Reference:

Syder NC, Hurtado ACM, Saizan A, Gonzalez M, Rodman J, Elbuluk N. Prescribing patterns for treatment of acne vulgaris: a retrospective chart review at an urban public and private hospital. Arch Dermatol Res. 2025;317(1):424. doi:10.1007/s00403-025-03900-0