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Study Finds Isotretinoin Effective for Acne in Transgender Patients on Hormone Rx
TOPLINE:
, but more information is needed on dosing and barriers to treatment.
METHODOLOGY:
- Acne can be a side effect of masculinizing hormone therapy for transmasculine individuals. While isotretinoin is an effective treatment option for acne, its effectiveness and safety in transgender and gender-diverse individuals are not well understood.
- This retrospective case series included 55 patients (mean age, 25.4 years) undergoing masculinizing hormone therapy at four medical centers, who were prescribed isotretinoin for acne associated with treatment.
- Isotretinoin treatment was started a median of 22.1 months after hormone therapy was initiated and continued for a median of 6 months with a median cumulative dose of 132.7 mg/kg.
- Researchers assessed acne improvement, clearance, recurrence, adverse effects, and reasons for treatment discontinuation.
TAKEAWAY:
- Overall, 48 patients (87.3%) experienced improvement, and 26 (47.3%) achieved clearance during treatment. A higher proportion of patients experienced improvement (97% vs 72.7%) and achieved clearance (63.6% vs 22.7%) with cumulative doses of ≥ 120 mg/kg than those who received cumulative doses < 120 mg/kg.
- The risk for recurrence was 20% (in four patients) among 20 patients who achieved clearance and had any subsequent health care encounters, with a mean follow-up time of 734.3 days.
- Common adverse effects included dryness (80%), joint pain (14.5%), and headaches (10.9%). Other adverse effects included nose bleeds (9.1%) and depression (5.5%).
- Of the 22 patients with a cumulative dose < 120 mg/kg, 14 (63.6%) were lost to follow-up; among those not lost to follow-up, 2 patients discontinued treatment because of transfer of care, 1 because of adverse effects, and 1 because of gender-affirming surgery, with concerns about wound healing.
IN PRACTICE:
“Although isotretinoin appears to be an effective treatment option for acne among individuals undergoing masculinizing hormone therapy, further efforts are needed to understand optimal dosing and treatment barriers to improve outcomes in transgender and gender-diverse individuals receiving testosterone,” the authors concluded.
SOURCE:
The study, led by James Choe, BS, Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, was published online in JAMA Dermatology.
LIMITATIONS:
The study population was limited to four centers, and variability in clinician- and patient-reported acne outcomes and missing information could affect the reliability of data. Because of the small sample size, the association of masculinizing hormone therapy regimens with outcomes could not be evaluated.
DISCLOSURES:
One author is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Three authors reported receiving grants or personal fees from various sources. The other authors declared no conflicts of interest.
A version of this article first appeared on Medscape.com.
TOPLINE:
, but more information is needed on dosing and barriers to treatment.
METHODOLOGY:
- Acne can be a side effect of masculinizing hormone therapy for transmasculine individuals. While isotretinoin is an effective treatment option for acne, its effectiveness and safety in transgender and gender-diverse individuals are not well understood.
- This retrospective case series included 55 patients (mean age, 25.4 years) undergoing masculinizing hormone therapy at four medical centers, who were prescribed isotretinoin for acne associated with treatment.
- Isotretinoin treatment was started a median of 22.1 months after hormone therapy was initiated and continued for a median of 6 months with a median cumulative dose of 132.7 mg/kg.
- Researchers assessed acne improvement, clearance, recurrence, adverse effects, and reasons for treatment discontinuation.
TAKEAWAY:
- Overall, 48 patients (87.3%) experienced improvement, and 26 (47.3%) achieved clearance during treatment. A higher proportion of patients experienced improvement (97% vs 72.7%) and achieved clearance (63.6% vs 22.7%) with cumulative doses of ≥ 120 mg/kg than those who received cumulative doses < 120 mg/kg.
- The risk for recurrence was 20% (in four patients) among 20 patients who achieved clearance and had any subsequent health care encounters, with a mean follow-up time of 734.3 days.
- Common adverse effects included dryness (80%), joint pain (14.5%), and headaches (10.9%). Other adverse effects included nose bleeds (9.1%) and depression (5.5%).
- Of the 22 patients with a cumulative dose < 120 mg/kg, 14 (63.6%) were lost to follow-up; among those not lost to follow-up, 2 patients discontinued treatment because of transfer of care, 1 because of adverse effects, and 1 because of gender-affirming surgery, with concerns about wound healing.
IN PRACTICE:
“Although isotretinoin appears to be an effective treatment option for acne among individuals undergoing masculinizing hormone therapy, further efforts are needed to understand optimal dosing and treatment barriers to improve outcomes in transgender and gender-diverse individuals receiving testosterone,” the authors concluded.
SOURCE:
The study, led by James Choe, BS, Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, was published online in JAMA Dermatology.
LIMITATIONS:
The study population was limited to four centers, and variability in clinician- and patient-reported acne outcomes and missing information could affect the reliability of data. Because of the small sample size, the association of masculinizing hormone therapy regimens with outcomes could not be evaluated.
DISCLOSURES:
One author is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Three authors reported receiving grants or personal fees from various sources. The other authors declared no conflicts of interest.
A version of this article first appeared on Medscape.com.
TOPLINE:
, but more information is needed on dosing and barriers to treatment.
METHODOLOGY:
- Acne can be a side effect of masculinizing hormone therapy for transmasculine individuals. While isotretinoin is an effective treatment option for acne, its effectiveness and safety in transgender and gender-diverse individuals are not well understood.
- This retrospective case series included 55 patients (mean age, 25.4 years) undergoing masculinizing hormone therapy at four medical centers, who were prescribed isotretinoin for acne associated with treatment.
- Isotretinoin treatment was started a median of 22.1 months after hormone therapy was initiated and continued for a median of 6 months with a median cumulative dose of 132.7 mg/kg.
- Researchers assessed acne improvement, clearance, recurrence, adverse effects, and reasons for treatment discontinuation.
TAKEAWAY:
- Overall, 48 patients (87.3%) experienced improvement, and 26 (47.3%) achieved clearance during treatment. A higher proportion of patients experienced improvement (97% vs 72.7%) and achieved clearance (63.6% vs 22.7%) with cumulative doses of ≥ 120 mg/kg than those who received cumulative doses < 120 mg/kg.
- The risk for recurrence was 20% (in four patients) among 20 patients who achieved clearance and had any subsequent health care encounters, with a mean follow-up time of 734.3 days.
- Common adverse effects included dryness (80%), joint pain (14.5%), and headaches (10.9%). Other adverse effects included nose bleeds (9.1%) and depression (5.5%).
- Of the 22 patients with a cumulative dose < 120 mg/kg, 14 (63.6%) were lost to follow-up; among those not lost to follow-up, 2 patients discontinued treatment because of transfer of care, 1 because of adverse effects, and 1 because of gender-affirming surgery, with concerns about wound healing.
IN PRACTICE:
“Although isotretinoin appears to be an effective treatment option for acne among individuals undergoing masculinizing hormone therapy, further efforts are needed to understand optimal dosing and treatment barriers to improve outcomes in transgender and gender-diverse individuals receiving testosterone,” the authors concluded.
SOURCE:
The study, led by James Choe, BS, Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, was published online in JAMA Dermatology.
LIMITATIONS:
The study population was limited to four centers, and variability in clinician- and patient-reported acne outcomes and missing information could affect the reliability of data. Because of the small sample size, the association of masculinizing hormone therapy regimens with outcomes could not be evaluated.
DISCLOSURES:
One author is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Three authors reported receiving grants or personal fees from various sources. The other authors declared no conflicts of interest.
A version of this article first appeared on Medscape.com.
SCD: Delaying Transition to Adult Care Poses Risks
TOPLINE:
METHODOLOGY:
- Guidelines have recommended that young adults with SCD transfer from pediatric care within 6 months, but many transfers take longer — sometimes up to a year.
- Researchers evaluated the impact of prolonged transition gaps on health outcomes in 183 young adults who completed pediatric care between 2012 and 2018 and were transitioned to an adult care program. Patients were followed for 2-8 years from their first adult care visit.
TAKEAWAY:
- Approximately 88% of patients transferred to adult health care within 6 months, with a median transfer gap of 1.4 months. At 2 years of adult care, patients with a transition gap of 6 months or longer were 89% (relative risk, 1.89) more likely to have an inpatient visit and 75% (RR, 1.75) more likely to have ED visits.
- Those with transfer gaps of 6 months or longer had twice the rate of inpatient visits (rate ratio, 2.01) at 8 years of follow-up, compared with those who transitioned within 2 months.
- However, fewer adult care outpatient visits were seen (5.1 vs 6.7 visits per year) for young adults transferred in 6 or more months versus those within 6 months.
IN PRACTICE:
According to the authors, “longer delays in establishing adult health care following pediatric care were associated with greater acute health care resource utilization and fewer health care maintenance (ie, outpatient) SCD visits. These findings emphasize the importance of swift transfer from pediatric to adult care among young adults with SCD.”
SOURCE:
The study was led by Kristen E. Howell, of the Department of Epidemiology and Biostatistics, Texas A&M School of Public Health, College Station, Texas, and was published online in Blood Advances.
LIMITATIONS:
Data was available only for patients within a specific health care system, limiting the generalizability of the findings. Involving only one pediatric and two adult programs could impact findings. Insurance loss or changes due to low income were not accounted for.
DISCLOSURES:
The study was funded by U1EMC19331 and the American Lebanese Syrian Associated Charities. The authors declared no relevant conflicts of interest.
TOPLINE:
METHODOLOGY:
- Guidelines have recommended that young adults with SCD transfer from pediatric care within 6 months, but many transfers take longer — sometimes up to a year.
- Researchers evaluated the impact of prolonged transition gaps on health outcomes in 183 young adults who completed pediatric care between 2012 and 2018 and were transitioned to an adult care program. Patients were followed for 2-8 years from their first adult care visit.
TAKEAWAY:
- Approximately 88% of patients transferred to adult health care within 6 months, with a median transfer gap of 1.4 months. At 2 years of adult care, patients with a transition gap of 6 months or longer were 89% (relative risk, 1.89) more likely to have an inpatient visit and 75% (RR, 1.75) more likely to have ED visits.
- Those with transfer gaps of 6 months or longer had twice the rate of inpatient visits (rate ratio, 2.01) at 8 years of follow-up, compared with those who transitioned within 2 months.
- However, fewer adult care outpatient visits were seen (5.1 vs 6.7 visits per year) for young adults transferred in 6 or more months versus those within 6 months.
IN PRACTICE:
According to the authors, “longer delays in establishing adult health care following pediatric care were associated with greater acute health care resource utilization and fewer health care maintenance (ie, outpatient) SCD visits. These findings emphasize the importance of swift transfer from pediatric to adult care among young adults with SCD.”
SOURCE:
The study was led by Kristen E. Howell, of the Department of Epidemiology and Biostatistics, Texas A&M School of Public Health, College Station, Texas, and was published online in Blood Advances.
LIMITATIONS:
Data was available only for patients within a specific health care system, limiting the generalizability of the findings. Involving only one pediatric and two adult programs could impact findings. Insurance loss or changes due to low income were not accounted for.
DISCLOSURES:
The study was funded by U1EMC19331 and the American Lebanese Syrian Associated Charities. The authors declared no relevant conflicts of interest.
TOPLINE:
METHODOLOGY:
- Guidelines have recommended that young adults with SCD transfer from pediatric care within 6 months, but many transfers take longer — sometimes up to a year.
- Researchers evaluated the impact of prolonged transition gaps on health outcomes in 183 young adults who completed pediatric care between 2012 and 2018 and were transitioned to an adult care program. Patients were followed for 2-8 years from their first adult care visit.
TAKEAWAY:
- Approximately 88% of patients transferred to adult health care within 6 months, with a median transfer gap of 1.4 months. At 2 years of adult care, patients with a transition gap of 6 months or longer were 89% (relative risk, 1.89) more likely to have an inpatient visit and 75% (RR, 1.75) more likely to have ED visits.
- Those with transfer gaps of 6 months or longer had twice the rate of inpatient visits (rate ratio, 2.01) at 8 years of follow-up, compared with those who transitioned within 2 months.
- However, fewer adult care outpatient visits were seen (5.1 vs 6.7 visits per year) for young adults transferred in 6 or more months versus those within 6 months.
IN PRACTICE:
According to the authors, “longer delays in establishing adult health care following pediatric care were associated with greater acute health care resource utilization and fewer health care maintenance (ie, outpatient) SCD visits. These findings emphasize the importance of swift transfer from pediatric to adult care among young adults with SCD.”
SOURCE:
The study was led by Kristen E. Howell, of the Department of Epidemiology and Biostatistics, Texas A&M School of Public Health, College Station, Texas, and was published online in Blood Advances.
LIMITATIONS:
Data was available only for patients within a specific health care system, limiting the generalizability of the findings. Involving only one pediatric and two adult programs could impact findings. Insurance loss or changes due to low income were not accounted for.
DISCLOSURES:
The study was funded by U1EMC19331 and the American Lebanese Syrian Associated Charities. The authors declared no relevant conflicts of interest.