Coprescription of Isotretinoin and Systemic Corticosteroids for Acne: An Analysis of the National Ambulatory Medical Care Survey

Abstract

Introduction: Isotretinoin treatment has been linked to flares of severe acne, which can be managed by the coadministration of systemic corticosteroids or prevented by beginning with a low dose of isotretinoin. To our knowledge, there are no estimates in the literature on the frequency of coprescription of isotretinoin and systemic corticosteroids. Objectives: We sought to quantify the estimated frequency of coprescription of isotretinoin and systemic corticosteroids and assess trends of the use of isotretinoin with systemic corticosteroids for acne as they relate to age, sex, race, insurance, and provider specialty. Methods: Data from the National Ambulatory Medical Care Survey (NAMCS) from 2003 to 2015, National Hospital Ambulatory Medical Care Survey Hospital Outpatient Departments (NHAMCS-OPD) from 2003 to 2011, and National Hospital Ambulatory Medical Care Survey Hospital Emergency Departments (NHAMCS-ED) from 2003 to 2014 were aggregated for this analysis. The number of prescriptions for isotretinoin and/or systemic corticosteroids was estimated by specialty (for NAMCS) and by survey type (for NHAMCS-OPD and NHAMCS-ED). Results: Among all first visits to a physician for acne (n=18,914,096), approximately 3.9 percent prescribed isotretinoin, 0.24 percent prescribed corticosteroids, and the remaining 96 percent prescribed neither drug. This was comparable to estimates for first visits to a dermatologist for acne (n=13,920,913), where approximately 4.2 percent prescribed isotretinoin, 0.32 percent prescribed corticosteroids, and the remaining 95 percent prescribed neither medication. Conclusion: Currently, isotretinoin and systemic corticosteroids are rarely prescribed together.