Acne treatment constitutes one of the most frequent reasons for dermatological consultation. In many cases, the recommendations set forth in medical guidelines become obsolete over time, subsequent to their publication. For this reason, Dr. Cristina Eguren Michelena has updated the daily practice of dermatologists in the management of this condition, going beyond the standard information found in product package inserts.
Use of isotretinoin, antibiotics
In his presentation titled “Real-World Use of Isotretinoin, Antibiotics, and Contraceptives in Acne”—delivered during the session “Therapeutics in Inflammatory Pathology: From Package Insert to Consultation” (held this Saturday, the 21st, as part of the AEDV’s 1st Virtual Autumn Congress 2020)—he presented data derived from a 10-question survey completed by 304 dermatologists.
“In my presentation, I sought to illustrate what actually happens in clinical practice, as opposed to what is stipulated in the product’s technical specifications. Gaining a realistic perspective on dermatologists’ practices serves as an invaluable aid for one’s own individual practice,” Dr. Eguren Michelena explained to the AEDV website.
That The Guides and Actual Practice
A common issue is that clinical guidelines often lag significantly behind actual clinical practice; consequently, in many cases, the recommendations they offer do not align with what practitioners actually do in their day-to-day work. So, what are the most common approaches to treating acne? And when is the dosage recommended in the product’s technical specifications actually followed?
For instance, the technical specifications for isotretinoin state that this medication is indicated for the treatment of severe forms of acne—such as nodular or conglobate acne—that carry a risk of permanent scarring.
I generally use this medication in cases of less severe acne, employing lower doses, as well as to treat other conditions such as rosacea, seborrhea, or papules associated with frontal fibrosing alopecia. A survey conducted on this subject reveals that many dermatologists adopt a similar approach: 97% of them acknowledge using this medication for indications other than those listed in its technical specifications.
The survey reveals that 90% of dermatologists use isotretinoin off-label—that is, outside the indications specified in the product information sheet—to treat moderate acne and rosacea; 65% for facial papules associated with frontal fibrosing alopecia; 45% for mild acne and seborrhea; 30% for anti-aging purposes; and 20% for seborrheic dermatitis and other indications.
“The dosage employed varies depending on the indication, but, generally speaking, many dermatologists tend to use either lower doses or those explicitly mentioned in the product information sheet,” notes this dermatologist, who highlights the considerable variability existing among different medical recommendations.
Analytical control and monitoring
Discrepancies also exist between the recommendations set forth in guidelines regarding blood tests and the actual practice of dermatologists. 99% of dermatologists prescribe blood tests; among them, only 3% request an initial analysis followed by monthly monitoring; 50% request an analysis at the start of treatment as well as a follow-up test—without prescribing further examinations if the latter yields normal results; and 46% request an analysis at the start of treatment and at every follow-up consultation. These discrepancies are not limited to the divergence between guidelines and dermatologists’ practice; they also vary from one clinical guideline to another.