Nicholas Manuelpillai, Emma Veysey
Aims: Isotretinoin is indicated for moderate-to-severe acne vulgaris. It is associated with adverse effects such as teratogenicity and hepatitis. Guidelines for isotretinoin for the treatment of acne do not exist in Australia but are utilised in comparable health systems in the United Kingdom (UK), Europe and the United States of America (USA). The Australasian College of Dermatologists (ACD) developed a position statement on isotretinoin in 2018. The primary objective of this audit was to compare Australian dermatologist isotretinoin practice against best available evidence and guidelines from the UK, Europe and USA. The secondary objective was to identify areas of practice uncertainty.
Methods: We conducted an anonymous, online, survey using SurveyMonkey™ of Australian dermatologists. An invitation to complete the survey was distributed through the ACD national weekly update email and through state faculty emailing lists with 5 reminders sent 1–2 weeks apart. Audit points included daily dosing, initiation and monitoring investigations and mental health surveillance.
Results: A total of 118 out of 654 (18%) dermatologists completed the survey. An initiation dose of isotretinoin of 10 or 20 mg daily was prescribed by 61.2% of dermatologists. Pregnancy was excluded prior to commencement with serum beta-hCG by 91.4%. Serum lipids and liver function tests (LFT) were checked prior to commencement by 78% and 90.5% of dermatologists respectfully. Serum lipids and LFT were monitored by 68.2% and 77.3% of dermatologists during treatment. Baseline mental health status was assessed prior to treatment by 79.3% and 85.6% of dermatologists directly inquired about mental health during the treatment.
Conclusion: Divergence from audit points was evident in daily dosing, treatment endpoint and monitoring investigations. Areas of practice uncertainty and future research identified included treatment duration, dose escalation and weaning of isotretinoin.