Physicians underutilize topical retinoids in the management of acne vulgaris: analysis of U.S. National Practice Data

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Abstract
Topical retinoids are effective in the treatment of acne, yet no current guidelines existed in the literature until recently recommending their use as an integral part of mild to moderate acne treatment.To assess whether underutilization of topical retinoids occurs in clinical practice.Weighted data on representative office visits with acne vulgaris diagnoses were analyzed using the National Ambulatory Medical Care Survey (NAMCS), from 1990 to 1999.Of the 54.2 million acne vulgaris visits, retinoids were prescribed at 35.3% visits. Dermatologists prescribed significantly more retinoids than non-dermatologists (39.4%' versus 23%). Dermatology visit was a significant predictor of topical retinoid prescription (RR: 2.27,95% CI: 1.63-3.17). Data suggest that prescribing retinoids for acne has been increasing over the past decade, primarily among dermatologists.There is a major difference between suggested treatment guidelines for acne and actual practice in the community. There is distinct under-utilization of topical retinoids for treatment of acne vulgaris by dermatologists and non-dermatologists.

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