BACKGROUND: Topical tretinoin is effective treatment for both acne and 
photoaging. This creates a problem for insurers that cover medication costs, 
because treatment of acne is often covered but treatment of photoaging is not. 
The age distributions of patients with acne or photoaging are likely to be very 
different. Therefore, one approach insurers can use is an age cutoff for 
covering the cost of topical tretinoin therapy.
OBJECTIVE: Our purpose was to determine at what age patients are more likely to 
receive tretinoin for treatment of acne vulgaris versus other conditions to 
provide a rational basis for insurers to set coverage cutoffs.
METHODS: National Ambulatory Medical Care Survey data for the years 1990 to 1994 
were analyzed to ascertain the age distribution of acne vulgaris office visits 
and treatment with topical acne agents including tretinoin. These data were 
compared to office visits and tretinoin treatment of wrinkles, solar elastosis, 
and other conditions.
RESULTS: The mean age (+/- standard deviation) of patients seen for acne 
vulgaris was 24.3 +/-11.5 years old. The age distribution of topical tretinoin 
treatment paralleled the age distribution of acne. Tretinoin treatment of acne 
and of nonacne conditions were equal at an age of 44.
CONCLUSION: The distribution of outpatient visits for acne treatment is skewed 
toward older patients and persists beyond age 40. A rational age cut-off for 
coverage of topical tretinoin treatment is 40 years.