Isotretinoin improves acne linked to gender-affirming care, but barriers impede treatment
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Key takeaways:
- In patients receiving masculinizing gender-affirming care, isotretinoin was successful in improving acne.
- More than 40% of patients discontinued care due to logistical reasons, cost or pharmacy issues.
Isotretinoin is generally effective and well tolerated for acne treatment in patients receiving masculinizing gender-affirming care, but barriers can impede treatment success, according to a study.
“Approximately 30% of transmasculine individuals receiving testosterone treatment will develop acne, with 15% having moderate to severe disease,” John Barbieri, MD, MBA, assistant professor at Harvard Medical School, director of the advanced acne therapeutics clinic at Brigham and Women’s Hospital, co-chair of the AAD Acne Guidelines Work Group and a member of Healio’s Peer Perspective Board, told Healio. “This acne can be associated with clinically significant depression and anxiety. Identifying effective treatments for this acne, such as isotretinoin, is an important part of comprehensive care.”
A multicenter, retrospective case series of 55 patients (mean age, 25.4 years; white, n = 36) was conducted to evaluate the efficacy of isotretinoin in this population.
The median isotretinoin course was 6 months with a median cumulative dose of 132.7 mg/kg.
Improvement was reported in 48 patients in the study, with 26 achieving acne clearance.
In 22 patients who received a cumulative dose less than 120 mg/kg, 16 had improvement and five achieved clearance. In the 33 patients who received cumulative doses above 120 mg/kg, 21 achieved clearance.
Adverse events included dryness (n = 44), joint pain (n = 8) and headache (n = 6), with eczema and muscle pain being reported by five patients.
Despite positive efficacy results, more than 40% of patients discontinued treatment, with many of them citing cost, pharmacy issues, adverse effects, scheduling or logistical reasons or concerns associated with wound healing following gender-affirming surgery as the reasons.
“Isotretinoin might play an underappreciated role in gender-affirming care to address acne associated with masculinizing hormonal therapy,” Barbieri said. “However, there is a need for care coordination and interventions to address barriers to therapy to improve access and clinical outcomes.”