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Acne & Rosacea Pearls with Dr. John Barbieri: Diagnosis, Antibiotics, Isotretinoin Dosing, and Pregnancy-Safe Options | The Derm Resident

In this “Meet the Expert” episode of The Derm Resident, Dr. Jonny Hatch talks with acne and rosacea expert Dr. John Barbieri about practical, early-resident approaches to acne and common mimickers, emphasizing comedones as a key differentiator and reviewing clues for periorificial dermatitis, rosacea, and pityrosporum folliculitis. They discuss why “jawline acne” is not a strong predictor of PCOS/PMOS and why signs like irregular menses, hirsutism, and acanthosis nigricans are more informative. Dr. Barbieri outlines systemic treatment decision-making, favoring spironolactone over long-term antibiotics in many patients, and reviews antibiotic choices and resistance concerns. The conversation then covers isotretinoin timing, dosing to clinical endpoints, adjuncts to reduce flaring and side effects (loratadine, omega-3, L-carnitine), counseling on growth and mood risk, pregnancy-safe acne options, benzoyl peroxide/benzene concerns, rosacea redness treatment (oxymetazoline), and common trainee mistakes.

00:00 Welcome and Guest Intro
00:42 Acne Exam Basics
01:08 Acne Mimickers
02:36 History and PCOS Clues
03:30 Jawline and Hormones
05:26 Systemic Treatment Choices
07:01 Low Dose Doxy Debate
08:59 Antibiotics as Bridge
10:59 Which Antibiotic to Pick
13:35 Starting Isotretinoin (Accutane)
15:46 Dosing and Endpoints
17:32 Cumulative Dose Myths
19:17 Higher Daily Dosing
20:12 Antihistamine Add On
21:09 Omega 3 For Dryness
22:25 L Carnitine For Soreness
23:42 Growth Stunting Myth
24:33 Mood And Suicide Risk
27:02 Acne In Pregnancy
28:09 Topical Combo Strategies
29:23 Benzoyl Peroxide and Benzene
30:41 Resident Mistakes And Rosacea
33:18 Rosacea Phenotype Approach
34:52 Advice For New Residents
35:30 Final Thanks And Wrap