Investigating the Relationship Between Acne and Vasodilatory Medications in a Hospital-Wide Adult Population

June 2024 | Volume 23 | Issue 6 | 446 | Copyright © June 2024


Published online May 29, 2024

doi:10.36849/JDD.8362

Paras Patel BAa,b, Jennifer Wang BAa,c, David Bitterman BAa,d, Kayla Zafar BAa,c, Margaret Kabakova BSa,c, Marc Cohen MDa,c, Evan Austin MD PhDa,c, Jared Jagdeo MD MSa,c

aDermatology Service, Veterans Affairs New York Harbor Healthcare System - Brooklyn Campus, Brooklyn, NY 
bRowan University School of Osteopathic Medicine, Stratford, NJ
cDepartment of Dermatology, State University of New York, Downstate Health Sciences University, Brooklyn, NY
dNew York Medical College, Valhalla, NY
eSt. George's University School of Medicine, Grenada, West Indies

Abstract
Acne vulgaris is a common chronic dermatological condition characterized by obstruction and inflammation of pilosebaceous units. Recent research on a different dermatologic condition has demonstrated that the use of vasodilatory medications is associated with a decreased relative risk of rosacea. This finding is significant due to the overlapping inflammatory pathways involved in rosacea and acne. Herein, a retrospective cohort study was designed to determine the correlation between vasodilator usage and the risk of developing acne within 5 years, contrasting it with thiazide diuretics, chosen as a control due to its non-vasodilatory antihypertensive mechanism and availability of data. Angiotensin-converting enzyme (ACE) inhibitors (RR, 0.775; 95% CI, 0.727-0.826; P<0.05), angiotensin receptor blockers (ARBs) (RR, 0.739; 95% CI, 0.685-0.797; P<0.05), beta-blockers (BB) (RR, 0.829; 95% CI, 0.777-0.885; P<0.05), and calcium channel blockers (CCB) usage (RR, 0.821, 95% CI, 0.773-0.873; P<0.05) were associated with a significantly lower risk of developing acne within 5 years of initiating therapy compared to thiazide diuretics. It is unclear if thiazide diuretics are more likely to cause acne within the adult population or if vasodilators are protective against the development of acne. Finding mechanisms and therapeutics that lower the risk of developing acne is of significant public health interest, and this study provides a step toward this endeavor. Further research is required to uncover the underlying mechanisms for this reduction in the development of acne. 

J Drugs Dermatol. 2024;23(6):446-449.     doi:10.36849/JDD.8362

INTRODUCTION

Acne vulgaris is a prevalent chronic dermatological condition characterized by obstruction and inflammation of pilosebaceous units.1,2 Acne presents clinically as inflammatory papules, pustules, nodules, and/or cysts.3 The pathogenesis involves a combination of factors, including excess androgen production, Cutibacterium acnes involvement, and genetics.1,2 Acne, affecting approximately 9.4% of individuals globally, is the eighth most common disease worldwide.4 The prevalence of acne is as high as 90% in adolescents, and in many instances can persist into adulthood.2 Up to 22% of women suffer from acne in their adult life.5 The impact of acne extends beyond physical symptoms, profoundly affecting psychosocial functioning and quality of life.6 Acne is associated with increased rates of anxiety, depression, and reduced self-esteem, even in mild cases.6,7

Recent research has demonstrated that the use of vasodilatory medications is associated with a decreased relative risk of rosacea.8 This finding is significant due to the overlapping inflammatory pathways in rosacea and acne. Both disease processes involve an increase in the type 1 helper (Th1) and Th17 inflammatory pathways.9 Interferon-gamma, tumor necrosis factor-alpha, interleukin (IL)-17a, and IL-6 levels are also elevated in acne and rosacea.9  While the underlying pathophysiology of acne and rosacea is not completely understood, they share several underlying mechanisms. Thus, we hypothesize that vasodilator medications may reduce the relative risk of acne as well.10 This study aims to uncover the relationship between acne and the use of vasodilatory medications, which may reveal possible underlying mechanisms of acne and uncover potential management options.

METHODS

The data used in this study was collected on March 11th, 2024 from the State University of New York Downstate TriNetX Research Network, which provided access to electronic medical records from approximately 124 million patients from 86 healthcare organizations. TriNetX is a health research network that compiles data from electronic medical records and follows patients in a longitudinal manner.
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