Clinical outcomes associated with a digital standardized skin care regimen in acne-rosacea comorbidity: A real-world longitudinal study with cross-lagged and mediation analyses.

Abstract

Co-occurring acne and rosacea is challenging. A digital standardized skin care regimen (SSCG) may be associated with better real-world outcomes, but the clinical-barrier temporal sequence remains unclear. To evaluate associations between SSCG participation and outcomes, the clinical-barrier temporal sequence, transepidermal water loss (TEWL) mediation, and communication frequency. Single-center retrospective cohort with verified dual diagnosis. All patients received doxycycline plus azelaic acid; propensity score matching yielded 282 pairs. Primary outcome was IGA 0/1 at week 12. Cross-lagged, mediation, and E-value analyses were used. SSCG participation was associated with higher IGA 0/1 (54.6% vs 34.4%; RR = 1.59, 95%CI:1.31-1.92), lower relapse (18.8% vs 34.0%), and greater DLQI MCID attainment (91.1% vs 71.3%). Week-6 IGA predicted week-12 TEWL reduction; the reverse path was nonsignificant. TEWL mediated 12.4% of the estimated association. Communication frequency showed no dose-response. Retrospective design, bundled intervention, possible self-selection and cost-related bias, chart-based adherence assessment, and unrecorded exposome and contraceptive changes. In this cohort, SSCG participation was associated with higher clearance and lower relapse. Findings are associative and hypothesis-generating.