Epidemiology and Healthcare of Juvenile and Late-Onset Acne: Claims Data Analysis

Acne is the most frequent chronic inflammatory skin condition in adolescence but occurs also in later age. Our study aimed to characterise the epidemiology, geographical distribution, comorbidity and healthcare of acne juvenilis (AJ) and acne tarda (AT). Statutory health insurance (SHI) data from 2016 to 2020 were analysed. Prevalence rates, including geographical distribution, comorbidities and drug use by specialists group, were measured. In 2020, the prevalence of acne among adults was 1.50% (AT > 25 years) and among adolescents was 3.88% (AT ≤ 25 years). The highest prevalence (13.02%) was observed at the age of 17 years. Sex differences were higher in AT (73.80% in women) than in AJ (64.55% in women). Compared with non-affected persons, individuals with acne – in particular with AT – showed significantly higher rates of skin-related comorbidities, including folliculitis (rate ratio (RR) 8.89), pyoderma (RR 7.27) and rosacea (RR 5.53), and non-skin-related comorbidities, such as ovarian dysfunction (RR 2.36), rhinitis allergica (RR 1.84) and Crohn's disease (RR 1.79). Preferred systemic therapeutics prescribed were anti-infectives in AT (46.86%) and retinoids in AJ (52.35%). In the majority of cases, dermatologists were involved in the treatment of acne (AT 65.77%; AJ 76.27%). The most commonly prescribed topical agents were adapalene with benzoyl peroxide (AT 87.72%; AJ 85.75%), while systemic isotretinoin (AT 81.20%; AJ 90.06%) was also a frequently used drug. General practitioners were more likely to prescribe anti-infectives, especially topical antibiotics such as chlortetracycline (AT 52.38%; AJ 44.44%) and systemic antibiotics, especially tetracycline (AT 58.33%; AJ 67.50%). Acne affects a relevant proportion of the German population not only in adolescence, and management of this inflammatory skin disease does not naturally follow medical guidelines or specialist recommendations. These findings emphasise the importance of specialised care and comprehensive therapeutic management that should also consider the exploration of comorbidities. We performed an analysis on the frequencies of illness and concomitant diseases of acne in Germany based on health insurance data. Furthermore, the treatment of acne in regard to drug choices and prescribers was characterised. In 2020, about 2 million people in Germany had acne. The mean age was 31 years, and women were more often affected (68.58%). The highest proportion of acne was observed at the age of 17 years (13.02%). Overall, adolescent acne (younger than 25 years) was more frequent than adult acne (older than 25 years). People with acne, especially with adult acne, had higher rates of concomitant diseases (compared with non-affected persons, both related to the skin and beyond). About a third of people with acne were not treated by a dermatologist, and the majority of these patients were not treated according to guidelines. In conclusion, acne and related concomitant diseases affect a relevant proportion of adolescents and adults in Germany. The high prevalence of adult acne suggests a special focus also on this age group, including exploration of hormonal and psychological disorders. Early and effective treatment, adapted to the severity of the acne, can prevent complications such as scarring.