Referral patterns and isotretinoin treatment of patients with acne vulgaris in a teaching hospital dermatology department over a 1-year period

Patients with acne vulgaris, a common and debilitating disorder, may have tried a variety of prescribed and over-the-counter preparations prior to referral to hospital. Often treatment will have included expensive antibiotics given for prolonged periods, the cost effectiveness of which is questionable. We studied prospectively the referral pattern of patients with acne vulgaris to a teaching hospital dermatology department over a 1-year period, the treatment in the community prior to referral, and the treatment pattern instigated by the hospital, We found that 88% of a total of 110 patients had been treated with systemic antibiotics for a period of up to 15 years prior to referral to a dermatologist, that 56% of general practitioners and 10% of patients had specifically requested treatment of their acne vulgaris with isotretinoin, that 82% of the referred patients were treated with their first course of isotretinoin, and that 4.5% of the referred patients required a further course of isotretinoin, We conclude that there is very considerable pressure on dermatologists to initiate treatment of acne vulgaris with isotretinoin from both general practitioners and the public, that treatment in the community is often expensive and inadequate, and that isotretinoin is an effective and relatively cost-effective treatment option for acne vulgaris.