Predictors of lesion clearance rate in adult dermatology patients with acne vulgaris

Li Zhang; H. Wang; H. Zhang

doi:10.5281/zenodo.22814476

Authors

Li Zhang Department of Dermatology, Mackenzie Center for Dermatology Author https://orcid.org/9124-5809-9580-6019
H. Wang Department of Clinical Dermatology, Narmada Institute of Dermatology Author https://orcid.org/5166-3610-0149-817X
H. Zhang Department of Dermatology, Mekong Institute of Dermatology Author https://orcid.org/8527-8614-0710-8283

DOI:

https://doi.org/10.5281/zenodo.22814476

Keywords:

acne vulgaris, lesion clearance, isotretinoin, adult acne, treatment response

Abstract

Graphical abstract

Background: Lesion clearance rate, the percentage reduction in inflammatory and non-inflammatory lesion counts over a defined treatment interval, has become the standard outcome measure in acne vulgaris trials, yet patients started on identical regimens at identical baseline severity often diverge sharply in how quickly they clear.

Objective: This review synthesizes the published evidence on patient-level, disease-level, and treatment-level predictors of lesion clearance rate in adult dermatology patients with acne vulgaris.

Methods: We synthesized epidemiological cohorts, randomized treatment trials, and consensus guideline literature addressing baseline severity, hormonal and sex-related factors, lifestyle and psychosocial contributors, and treatment regimen intensity as determinants of clearance trajectory.

Findings: Higher baseline severity predicts larger absolute lesion reduction but a smaller proportion reaching near-complete clearance; adult women with premenstrual flare or polycystic ovary syndrome show a slower, more relapsing course; dietary glycemic load, dairy intake, and stress each contribute measurable effects; and combination topical therapy, adequate cumulative isotretinoin dosing, and early follow-up are the strongest clinician-modifiable predictors of faster clearance.

Conclusions: Clearance rate can be anticipated, not merely discovered in retrospect, by stratifying patients at first visit using baseline severity, hormonal history, lifestyle factors, and disease duration, allowing earlier regimen intensification for patients on a predictably slower-clearing trajectory.

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