Acne Risk and Severity in Patients With AD Varies By Age and Sex

itch, atopic dermatitis
The prevalence, incidence, and risk for acne in adolescent and adult patients with atopic dermatitis (AD) is assessed.

The incidence rate of acne is highest in 12- to 18-year-old patients with atopic dermatitis (AD) and is overall slightly higher in women compared with men, according to study findings in the Journal of the European Academy of Dermatology and Venereology.

Researchers evaluated the prevalence, incidence, and risk for acne in adolescents and adults with AD from the Danish National Patient Registry.

All participants had a recorded diagnosis of AD after their 12th birthday from January 1, 2005, to December 31, 2013, from a hospital-employed dermatologist and 5 years’ or more of follow-up data. The primary endpoint was acne defined as a filled prescription for topical acne medication.

A total of 6600 adults and adolescents with AD and 66,000 matched reference individuals were included. The mean age for both groups was 33.0 years and 61.6% were women.

At baseline, the 12-month prevalence of acne was 3.7% in the general population and 3.9% in patients with AD, with the highest estimates occurring in 18- to 29-year-olds, 6.7% and 6.5%, respectively.

The overall incidence rate (95% CI) was 8.3 (7.5-9.0) per 1000 person-years in the AD group and 8.4 (8.2-8.7) in the reference group. The incidence rate was greater in 12- to 18-year-old patients with AD vs older patients with AD—20.0 (17.4-22.9) for 12- to 18-year-old patients, 9.2 (7.9-10.7) for 18- to 30-year-old patients, 4.9 (3.8-6.4) for 30- to 40-year-old patients, and 2.0 (1.4-2.8) for patients aged 40 years or older. Women had a slightly higher incidence of acne compared with men.

The overall acne risk was comparable in patients with AD and those in the general population (hazard ratio [HR] 0.96; 95% CI, 0.88-1.06) but significantly increased in male patients with AD (HR 1.22; 95% CI, 1.03-1.44). The HR of acne increased with age—1.41 (95% CI, 1.07-1.87) for those aged 30 to 39 years and 2.07 (95% CI, 1.42-3.03) for those aged 40 years or older.

The risk for severe acne was significantly lower in patients with AD compared with individuals in the reference group (HR 0.59; 95% CI, 0.47-0.73).

Among several study limitations, the investigators noted that they had no information about emollient use or whether topical corticosteroids were used to treat facial AD, and it is possible that some physicians may have misdiagnosed acne. Also, they could not assess the influence of AD severity on the risk for acne or evaluate acne cases that did not lead to treatment. Furthermore, it is possible that physicians avoided use of isotretinoin in patients with AD to avoid further aggravating dry skin.

“Treatment for acne is overall uncommon in patients with AD, but the risk differed between men and women, and changed with age compared to reference individuals from the general population,” the researchers commented. “The severity of acne seemed to increase with age in AD patients. Since acne is a common adverse event when treating AD with JAK-1 inhibitors, physicians should be cognizant about the background risk.”

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Thyssen JP, Nymand LK, Maul J-T, et al. Incidence, prevalence and risk of acne in adolescent and adult patients with atopic dermatitis: a matched cohort study. J Eur Acad Dermatol Venereol. 2022;36(6):890-896. doi:10.1111/jdv.18027