OBJECTIVES: To examine one-year patterns of topical acne prescription medication use among enrollees of a US national pharmacy benefits management system. METHODS: We conducted a one-year, retrospective, longitudinal cohort study of pharmacy claims (ie, prescription fills) for topical acne prescription medications among continuously enrolled patients with at least one claim for: retinoids (tazarotene, retinoic acid) or antimicrobials (erythromycin, erythromycin with benzoyl peroxide, clindamycin, clindamycin with benzoyl peroxide, azelaic acid, sulfacetamide, benzoyl peroxide). We examined patient characteristics (age, gender), proportion of patients using topical medications as monotherapy or in combination with other targeted medications, and average number of targeted medication claims per patient. RESULTS: Among 76,407 identified patients, 11.4% were under age 14, 35.3% age 14 to 17 years, 19.1% age 18 to 24 years, 9.2% age 25 to 31 years, 8.3% age 32 to 38 years, 6.9% age 39 to 45 years, and 9.8% over 45 years. Sixty-four percent were female. Three quarters (74%) of patients used only one targeted topical acne medication (ie, monotherapy) throughout the index year. Among patients receiving monotherapy, total average number of claims was 2.3 (erythromycin, 1.7 claims; erythromycin with benzoyl peroxide, 2.4; clindamycin 2.8; clindamycin with benzoyl peroxide 2.7; azelaic acid, 2.3; benzoyl peroxide, 2.8; sulfacetamide, 1.9; retinoids, 2.0). Among patients receiving combined therapy, total average number of antimicrobial claims was 2.2 and total number of retinoid claims was also 2.2 Number of claims, types of topical acne prescription medications, and other patterns of use did not significantly differ by age or gender. CONCLUSIONS: Overall, patients had approximately two targeted prescriptions fills over a one-year index period. Rates of prescription fills did not differ by class of medication, patient age, or gender. Assumptions that females or older patients are more compliant with their topical prescription acne regimens were not supported by our findings.