Acne management in Norway: general practitioner and dermatologist prescriptions (2012-2019), a nationwide overview

Background Acne is common and associated with negative psychosocial health and risk of permanent skin alterations. General practitioners (GPs) prescribe the main portion of antibiotics used for acne. Increased isotretinoin prescription by GPs can potentially reduce overall antibiotic use, but prescription practice andtrends are unknown.

Aim We aimed to examine acne treatment in Norway and quantify prescription and initiation of isotretinoin and tetracyclines.

Design & setting Data was collected from the Norwegian Prescription Database and the National GP Claims Register.

Method All patients aged 12 – 39 who received an acne diagnosis or were prescribed acne medication in Norway 2012 – 2019 were included. Linear regression was used to explore time trends.

Results In total, 316,075 patients were included (63% female). Yearly prevalence of systemic treatment increased from 1.9 in 2012 to 2.4% in 2019; isotretinoin increased by+123%, tetracyclines by+4% as measured in defined daily doses. Topical treatment increased by+13% as measured by number of prescriptions. GP prescription of tetracyclines decreased – 11%, however, courses had a mean duration of 160 days, which is longer than the recommended 90, and only 26% had a co-occurring topical treatment prescription. GPs initiated 5% of isotretinoin courses in 2012, vs. 10% in 2019, and 19% (N=1,339) of GPs ever initiated isotretinoin during the study period.

Conclusion GPs reduced their prescription of tetracyclines, still our data shows potential for further improvements in prescribing practice. Increased isotretinoin prescription by GPs may lead to reduced antibiotic use and better treatment regimens for moderate-severe acne.