Introduction

Acne vulgaris adversely affects quality of life in adolescents. Treatment efficacy is usually assessed by lesion reduction, while the Children’s Dermatology Life Quality Index (CDLQI) measures the impact on quality of life. This index has not been extensively studied in relation to treatment escalation, particularly when comparing isotretinoin with benzoyl peroxide.

Objective

To compare the outcomes of the Children’s Dermatology Life Quality Index, CDLQI response, safety profiles, and patient satisfaction between the two treatment protocols.

Material and methods

This prospective, comparative cohort study enrolled 82 adolescents with acne attending our clinic. Patients were assigned to the isotretinoin group (50 patients) or the benzoyl peroxide group (32 patients). Baseline characteristics, clinical acne assessment according to the Global Acne Grading System, and domain-specific changes in the Children’s Dermatology Life Quality Index before and after treatment were recorded. Patients were followed monthly for 4–6 months.

Results

The mean age of the patients was 13.7 ±2.8 years. Treatment duration was significantly longer in the isotretinoin group than in the benzoyl peroxide group (5.2 vs. 3.5 months, respectively; p < 0.001). Skin irritation (56.3% vs. 30%) and redness (37.5% vs. 16%) was significantly higher among patients treated with benzoyl peroxide; p = 0.015, 0.027 respectively. The Children’s Dermatology Life Quality Index scores decreased by 47.0% overall (p < 0.001), with improvement across all assessed domains and a greater effect in the isotretinoin group. The reduction in the Children’s Dermatology Life Quality Index score was greater with isotretinoin than with benzoyl peroxide (–9.1 and –6.8, respectively; p = 0.002). The isotretinoin group showed a more favorable satisfaction distribution on the 4-category ordinal scale (Cochran-Armitage trend test, p = 0.039), although the difference was no longer statistically significant after merging responses into a single satisfied/very satisfied category (90.0% vs. 78.1%; p = 0.140).

Conclusions

Isotretinoin was associated with greater improvement over the treatment period, higher patient satisfaction, and more pronounced improvement in the Children’s Dermatology Life Quality Index, making it an appealing option for adolescent acne. Patient-centered and psychosocial outcomes are crucial in guiding treatment escalation and in developing tailored management protocols, independently of conventional clinical grading.