Investigation And Analysis Of The Current Situation Of Chinese Dermatologists Treating Acne

Objective: To investigate the current situation of Chinese dermatologists in the treatment of acne vulgaris,and assess their adherence to the Chinese Guidelines for Acne Treatment(2014),then provide scientific basis for further standardize the prescribing behavior of Chinese dermatologists for the treatment of acne and improve the efficacy of acne.Methods: During the "Acne Week" in China from September to November,2018,the dermatology hospital of the First Affiliated Hospital of Kunming Medical University organized a stratified random sampling method was adopted to select 112 hospitals with dermatology outpatients in China and investigate the treatment of 16,156 acne patients by 928 dermatologists in these hospitals in the form of self-made questionnaire.The contents of the survey include: 1)General information of patients: the patient’s sex,age,acne course,acne grade,complications and the most desired treatment for this visit;2)General information of dermatologists: Gender,age,education background,professional title and hospital level of dermatologists;3)Dermatologists’ prescription habits for acne patients,investigated the treatment methods recommended by the2014 Chinese guidelines,including topical medications(retinoids,antibiotics,BPO,others);systemic medications(isotretinoin,antibiotics,antiandrogen drugs,corticosteroids,Chinese traditional medicine);physical modalities(chemical peels,laser,red and blue light,photodynamic therapy);and whether to choose functional cosmetics.Data statistics and analysis: after the recovered questionnaires,Epidata 3.1was used to input the questionnaires,and SPSS 26.0 statistical software was used for statistical analysis.Measurement data is expressed by mean + standard deviation,and counting data is expressed by frequency and percentage.A descriptive analysis of acne patients,dermatologists basic information and the detailed treatment methods of dermatologists for each grade of acne.Chi-square test were used to screen out the related factors of dermatologist used treatments recommended against by the 2014Chinese guidelines.The potential risk factors of dermatologists not adhere to the guidelines were further identified by multivariate binary Logistic regression model.Results:1.Information of patients: 16156 acne patients: male to female ratio was 0.57:1,average age was 22.9+5.6 years,average course of acne was 4.8+4.2 years.12.4% of patients with grade I,44.0% of patients with grade Ⅱ,26.0% of patients with grade Ⅲand 17.6% of patients with grade Ⅳ acne.There were 856(5.3%)acne patients with other comorbidities,and acne as the only diagnosis had 15,300 patients.2.Information of dermatologists:928 dermatologists: male to female ratio was 0.53 to1,mean age 42.4+8.7 years;67.6% were postgraduate or above,30.9% were undergraduate and 1.5% were junior college.Senior title accounted for 49.9%,intermediate title 32.5%,primary title 17.5%;78.6% were from grade III level A hospitals and 21.4% were from non-grade III level A hospitals.3.Treatment of acne at each grade: For 15,300 patients with acne as the sole diagnosis,93.5% of dermatologists chose two or more treatments,6.0% chose single treatment,and 0.5% chose no treatment.The acne treatments presented in our survey were multiple choice.For each grade of acne patients,whether single or combined treatment,dermatologists used them as "yes" and did not use them as "no".The percentages below are the statistics of "Yes/no" for treatment choices.For Grade I acne patients,dermatologists chose to use topical drugs(74.0%),physical and chemical therapy(60.9%),oral drugs(42.5%),among which topical retinoids(37.4%),chemical peels(38.1%),traditional Chinese medicine(20.4%)were the most commonly used.For Grade II acne patients,topical drugs(88.3%),oral drugs(68.0%),physical and chemical therapy(60.0%)were used,among which topical antibiotics(53.5%),oral antibiotics(37.6%)and chemical peels(32.2%)were used most.For grade III acne patients,topical drugs(91.3%),oral drugs(84.3%),physical and chemical therapy(59.7%)were used,among which topical antibiotics(60.4%),oral antibiotics(57.7%),red and blue light irradiation therapy(36.1%)were used the most.For grade IV acne patients,topical drugs(89.5%),oral drugs(89.5%),physical and chemical therapy(64.2%),among which the most used were topical antibiotics(57.2%),oral antibiotics(57.3%),red and blue light irradiation therapy(34.5%).For Grade I-IV acne,71.5%,74.1%,74.2%,and 71.4% respectively used functional cosmetics.4.Treatment not recommended by the guidelines: For acne patients with grade I,according to the guidelines,oral or topical antibiotics are not recommended,and 41.4%of dermatologists used them.For grade II acne,single oral or topical antibiotics are not recommended by the guidelines,and 3.3% of dermatologists chose to use them.For grade III acne,single system therapy or local single therapy is not recommended by the guidelines,and 8.6% of dermatologists used them.For grade IV acne,topical monotherapy and oral antibiotic monotherapy are not recommended,and 5.7% of dermatologists used.6.Risk factors for Chinese dermatologists not following the guidelines: Multiple responses combined with cross-tabular Chi-square test were used to screen out seven factors related to dermatologists’ treatment behavior: patient age,acne course,acne grade,dermatologist’s professional title,educational background,hospital level,patient willingness and dermatologist’s prescription matching degree.Further analysis by multivariate binary logistic regression model obtained the following results: 1)the age of patients(compared with age>25 years old,8-12 years old OR = 3.701,CI:2.410～5.683,P<0.001;13-18 years old OR = 1.479,CI:1.241～1.764,P<0.001);2)degree of dermatologist(compared with graduate degree or above,undergraduate degree OR=1.232;CI: 1.088～1.396,P=0.001);3)professional title of dermatologist(compared with senior professional title,primary professional title OR=1.338;CI:1.124～1.591,P=0.001);4)hospital level(compared with grade III level A,Non-grade III level A OR=1.384;CI: 1.207～1.587,P<0.001);5)the degree of matching between patients’ wishes and the treatment given by dermatologists(compared with matching,unmatched OR=1.556;CI: 1.382～1.752,P<0.001);These five factors were risk factors for dermatologists not following guidelines.Conclusion:1.Clarified the current situation of acne treatment by Chinese dermatologists Most Chinese dermatologists choose combination therapy in multiple ways to acne patients,which followed the 2014 Chinese Guideline.For Grade I,Chinese dermatologists mainly used topical retinoids and chemical peels adherence to the Guideline,but used oral or topical antibiotics were not recommended by the Guideline;For grade II,mainly used topical retinoids and antibiotics were recommended by the Guideline,while the use of BPO was least.For grade III,mainly used oral and topical antibiotics,consistent with the Guideline,however,the treatment of combined retinoids and BPO was relatively rare,and there were irregular use of antibiotics.For grade IV,oral and topical antibiotics are still the most used treatment for dermatologists,which meet the recommendations of the Guideline,while the proportion of isotretinoin selection were low,and the use of photodynamic therapy were less,which needed to be further promoted.2.clarified the influencing factors of prescription behavior of Chinese dermatologistsFive factors included the patient’s age less than 18 years old,the patient’s treatment intention does not match the doctor’s prescription,dermatologist’s undergraduate degree,the junior professional title,and the non-grade III level A were the risk factors for dermatologists not following the guidelines.In summary,in future updated guideline,it is necessary to emphasize the treatment principles of antibiotics,such as oral and topical antibiotics are not recommended to be used alone or in combination monotherapy,and standardize the behavior of dermatologists in the use of antibiotics.At the same time,there is a need to strengthen health education about acne for patients and their parents,and strengthen the training of dermatologists in grassroots hospitals and improve the overall level of acne treatment by Chinese dermatologists.