Racial Differences in Dermatologic Treatment for Adolescents With PCOS-Related Acne Vulgaris

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women, with acne frequently appearing during adolescence. Racial and ethnic disparities in PCOS phenotype and adult acne treatment are well documented, yet differences in acne management among adolescents with PCOS remain unclear. This study evaluated racial and ethnic differences in acne treatment patterns among adolescents with PCOS.

A retrospective chart review was conducted of female patients younger than 18 years with PCOS and acne vulgaris evaluated at a single urban academic medical center from 2012 to 2022. Demographic, clinical, and treatment data were extracted from the electronic health record. Group differences were assessed using χ ² or Fisher's exact tests. Multivariable logistic regression models examined associations between race/ethnicity and receipt of acne therapies, adjusting for acne severity, insurance status, and interpreter use.

Among 138 adolescents (35.5% White, 10.9% Black, 7.9% Asian, 36.2% Hispanic, 9.4% Other), most had moderate acne (52.2%). Insurance type and interpreter use differed by race/ethnicity (p < 0.001). Hispanic patients had lower odds of spironolactone (aOR 0.22), combined oral contraceptives (COC) (aOR 0.16), and isotretinoin (aOR 0.08) prescription. Black patients had lower odds of topical antibiotic prescription (aOR 0.10).

Racial and ethnic disparities exist in acne treatment among adolescents with PCOS, particularly reduced prescribing of spironolactone, COC, and isotretinoin for Hispanic patients and topical antibiotics for Black patients. These differences are not fully explained by acne severity, insurance, or interpreter use. Further research should assess how prescribing differences impact outcomes and inform equitable dermatologic care.