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Original Investigation
July 8, 2020

Quality of Life Assessed Using Skindex-16 Scores Among Patients With Acne Receiving Isotretinoin Treatment

Author Affiliations
  • 1Department of Dermatology, University of Utah, Salt Lake City
  • 2Department of Population Health Sciences, University of Utah, Salt Lake City
  • 3Department of Dermatology, Broward Health, Fort Lauderdale, Florida
  • 4Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
  • 5Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
  • 6Regional TeleHealth Services, Atlanta Veterans Affairs Health Care System, Atlanta, Georgia
  • 7Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania
  • 8Department of Internal Medicine, University of Utah, Salt Lake City
JAMA Dermatol. Published online July 8, 2020. doi:10.1001/jamadermatol.2020.2330
Key Points

Question  By what degree and time frame do patients with acne believe their quality of life improves while receiving isotretinoin?

Findings  In this case series study of 57 patients receiving isotretinoin for treatment of acne, the patients perceived rapid and significant improvements in how acne affects their quality of life, especially emotional improvements. Compared with baseline, more than 50% improvement was noticed by patients within 2 months.

Meaning  Isotretinoin is widely accepted as the most effective treatment for acne; these quality-of-life data may provide insight into how patients with acne perceive their response to isotretinoin treatment.


Importance  Acne is a common dermatologic condition and significantly affects psychosocial health and quality of life. An international task force recommended routine use of quality-of-life measures for clinic visits associated with acne management, but this has yet to translate into clinical practice.

Objective  To assess mean Skindex-16 scores over time among patients with moderate to severe acne receiving isotretinoin treatment.

Design, Setting, and Participants  A longitudinal, retrospective case series study of Skindex-16 data collected at monthly visits from 57 consecutive patients with acne receiving isotretinoin; data were collected and evaluated between November 23, 2016, and January 22, 2019. Continuous variables were compared using quantile regression. Multivariable linear mixed models evaluated mean (95% CI) score trajectory over time.

Main Outcomes and Measure  Skindex-16 scores, including normalized scores for the emotional, symptomatic, and functional aspects of having skin disease as well as an overall score.

Results  Fifty-seven patients (31 [54.4 %] males, with median [interquartile range] age of 17.2 [15.9-18.1] years) in this case series study completed the Skindex-16 at baseline and at least once during follow-up. Baseline Skindex-16 scores were similar by sex but worse with increasing age. Emotional impact was more bothersome to patients with acne requiring isotretinoin treatment than either symptoms or functioning. Improvements of greater than 50% in overall and Emotional domain scores were seen by month 2 of receiving isotretinoin treatment (eg, overall scores decreased from 39.4 to 17.5 by month 2; a decrease of 22.0; P < .001). Qualitatively, Skindex-16 scores reached their nadir between months 3 and 5; at month 4, overall Skindex-16 scores showed a 4.4-fold improvement (from 39.4 at baseline to 8.9; P < .001) and Emotional domain scores showed a 4.8-fold improvement (from 57.7 at baseline to 11.9; P < .001).

Conclusions and Relevance  The findings of this case series suggest that patients receiving isotretinoin treatment achieve greater than a 50% improvement in quality of life by month 2 and can expect approximately 4-fold to 5-fold improvements from baseline with a full course of isotretinoin. This study shows the potential of routine administration of quality of life measures to assess patient care in dermatology.

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