BACKGROUND: Studies have found demographic differences in prescribing patterns for certain inflammatory conditions, including acne. OBJECTIVE: To investigate acne prescription patterns among patients seen in the private system (PS) and safety-net health care system (SNS) of the University of Southern California (USC). METHODS: This was a multisite, retrospective study of patients obtaining acne care at PS and SNS outpatient dermatology facilities in Los Angeles over a one-year period. RESULTS: Despite similar acne severity, SNS patients were less often prescribed azelaic acid, benzoyl peroxide/clindamycin, benzoyl peroxide/adapalene, sulfacetamide, topical dapsone, and salicylic acid than PS patients (p <
0.001). SNS patients received fewer prescriptions for oral medications including spironolactone, antibiotics, and isotretinoin (p <
0.001). Despite similar acne severity, non-White patients were less frequently prescribed topical retinoids (p = 0.003), benzoyl peroxide/clindamycin (p = 0.003), isotretinoin (p <
0.001) and spironolactone (p <
0.001) than White patients. Despite higher acne severity among Hispanics/Latinos, they were less often prescribed spironolactone and oral antibiotics than their non-Hispanic/Latino counterparts (p = 0.023). CONCLUSIONS: Findings from this study highlight differences in acne prescribing patterns by race/ethnicity and hospital system, which can impact the ability of patients to have successful treatment of their acne and its sequelae.