A new study reveals gaps in acne management for teens with PCOS; Hispanic patients are less likely to receive spironolactone, COCs, or isotretinoin treatment.
Polycystic ovary syndrome (PCOS) affects up to 15% of reproductive-aged women and is frequently associated with dermatologic manifestations.1 Acne in particular often emerges during adolescence in patients with PCOS and may present with greater prevalence and severity compared with adolescents without the condition. Although racial and ethnic disparities in PCOS characteristics and acne treatment in adults have been described, differences in dermatologic management among adolescents with PCOS-related acne remain poorly understood. To address this, a recent study evaluated racial and ethnic differences in acne treatment patterns in adolescents with PCOS.2
A retrospective chart review was conducted of female patients younger than 18 years who were diagnosed with both PCOS and acne vulgaris between 2012 and 2022 at an urban academic medical center. Demographic, clinical, and treatment data were extracted from electronic health records. The primary outcomes were prescription patterns for common acne therapies, including topical retinoids, topical antibiotics, oral antibiotics, spironolactone, combined oral contraceptives (COCs), and isotretinoin. Differences across racial and ethnic groups were analyzed using chi-square or Fisher’s exact tests, and multivariable logistic regression models were used to evaluate associations between race/ethnicity and treatment receipt while adjusting for acne severity, insurance type, and interpreter use.
A total of 138 adolescent patients met the inclusion criteria. The cohort was racially and ethnically diverse;
Most patients presented with moderate acne (52.2%), followed by mild (22.5%) and severe disease (17.4%), and acne severity did not significantly differ across racial or ethnic groups. However, structural factors varied substantially. White patients were more likely to have private insurance, whereas Hispanic patients more frequently had public insurance and were more likely to require interpreter services. Across the cohort, topical retinoids (80.0%), COCs (86.2%), and topical antibiotics (63.0%) were the most commonly prescribed treatments. According to initial unadjusted analyses, spironolactone was prescribed more frequently to White and Asian patients than to Hispanic patients, while isotretinoin use also varied across groups.
After adjustment for acne severity, insurance status, and interpreter use, several disparities remained. Hispanic adolescents had significantly lower odds of receiving spironolactone (adjusted odds ratio [aOR] 0.22), COCs (aOR 0.16), and isotretinoin (aOR 0.08) compared with White patients. In contrast, Black adolescents had significantly lower odds of receiving topical antibiotics (aOR 0.10) than White patients. These findings suggest that treatment differences are not fully explained by clinical severity or measured indicators of health care access.
Acne severity itself was strongly associated with treatment selection. Patients with severe acne were significantly more likely to receive systemic therapies, including oral antibiotics, spironolactone, and isotretinoin, consistent with standard acne management practices. Insurance status also influenced prescribing patterns, as patients with private insurance were more likely to receive spironolactone and oral antibiotics.
The sidebar to the right details several reasons for a lack of proper treatment in certain populations. Because hormonal dysregulation plays a central role in PCOS pathophysiology, the underutilization of therapies such as spironolactone and COCs may have important implications for disease control and long-term outcomes in affected populations. The underutilization of spironolactone and COCs was “particularly concerning” in Hispanic patients, according to the authors, due to “their central role in treating hyperandrogenism, a key pathophysiologic mechanism in PCOS and acne.”
The trial does have several limitations, as its retrospective design and modest sample size limit statistical power and generalizability. Acne severity classification relied on provider documentation and may be subject to variability. Additionally, because COCs are commonly prescribed for both PCOS and acne, the study could not reliably determine the primary indication for their use. Reliance on electronic health record documentation also limited the ability to capture clinical discussions, counseling, or patient preferences.
Despite these limitations, the study highlights important disparities in dermatologic care among adolescents with PCOS-related acne. Addressing these differences is particularly important during adolescence, a critical period for preventing acne scarring and mitigating psychosocial effects. As the investigators noted, future research should examine whether these prescribing disparities translate into differences in clinical outcomes and explore strategies to promote equitable dermatologic care for all patients with PCOS-associated acne.
References
1. Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab. 2004;89(6):2745-2749. doi:10.1210/jc.2003-032046
2. Garcia S, Kenner-Bell B. Racial Differences in Dermatologic Treatment for Adolescents With PCOS-Related Acne Vulgaris. Pediatr Dermatol. Published online February 16, 2026. doi:10.1111/pde.70153
