John Barbieri, MD, MBA
@DrJohnBarbieri
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Derm @bwhdermatology (acne, epi, patient-reported outcomes, antibiotic stewardship, high-value care). Assoc Ed @JAMADerm . Views are mine, not medical advice.
Boston, MA
Joined June 2018
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Isotretinoin can be a highly effective treatment for
#acne
and is the only acne treatment that can provide a lasting remission. However, there are many misconceptions about
#isotretinoin
. In this Tweetorial, let's bust some common isotretinoin myths!
#dermtwitter
1/13
32
233
1K
Isotretinoin is a highly effective treatment for acne and the only acne treatment that can provide a lasting remission. However, there are many misconceptions about isotretinoin. In this updated Tweetorial, let's bust some common isotretinoin myths!
#dermtwitter
#JBAcneTips
1/19
16
118
579
Isotretinoin can be highly effective for
#acne
and is the only treatment that can provide a lasting remission. While we often discuss skin dryness, we don’t often consider the eyes. In this Tweetorial, let's explore the effects of
#isotretinoin
on the eye.
#dermtwitter
1/9
12
68
503
Patients often ask about the potential role of
#diet
in
#acne
. Can changing what you eat reduce breakouts? In this Tweetorial, let’s take a deep dive into the potential association between diet and acne.
#dermtwitter
#MedEd
⬇️
1/10
7
42
157
It is not uncommon for women to have acne persisting into their 20s and 30s. For those with moderate-to-severe acne requiring oral treatment, we often think of oral antibiotics and isotretinoin. But what about hormonal treatments like spironolactone? A
#tweetorial
#meded
⬇️
14
28
143
Can someone please explain to me why insurance companies cannot be sued for malpractice? If they want to effectively practice medicine through their formulary design, they should have some accountability for their decision making.
6
12
123
🚨Attention Dermatology Residents🚨
Excited to share the 1st edition of our new comprehensive board review book, which includes >300 kodachromes and >800 practice exam questions designed to reflect the new board format. Also with lots fun memory aids!
5
16
120
Patients are spending ~$550 on average for their
#acne
in the 6 months prior to seeing a
#dermatologist
, with most of this spending on OTC products. Given reduced access in setting of
#COVID19
, let's discuss cost-effective OTC acne management. A thread ⬇️
2
35
114
Weekly
#acne
tip: Don't fall victim to the dogma that only acne on the lower face is "hormonal". It does not reliably predict PCOS and most adult women with acne have a similar distribution to adolescent acne. All acne is related to hormones.
#dermtwitter
0
18
95
Acne Tip of The Week: Looking for an over-the-counter
#acne
treatment? Try adapalene 0.1% gel (Differin, 15g for <$15). Topical retinoids such as adapalene are one of the best initial treatments for acne. Start every other day during the 1st month to reduce irritation and dryness
6
21
94
What is the optimal approach to monitoring patients being treated with
#isotretinoin
for
#acne
? In this Tweetorial, let’s review the evidence for best practices!
#dermtwitter
#MedEd
1/13
4
21
93
Myth
#1
- Isotretinoin and depression: Multiple meta-analyses have found that there is no population level association between isotretinoin use and depression. In fact, isotretinoin may be associated with decreased depressive symptoms. 2/13
5
10
91
This morning have done 3 PAs for generic triamcinolone ($5 on GoodRx), as well as for oral terbinafine ($8), and clindamycin lotion ($20). The abuse of PAs as a blanket barrier to access rather than as a tool to ensure appropriate medication use is distressing.
#PriorAuthReform
8
18
92
Why
@US_FDA
needs to immediately halt the iPLEDGE REMS program to address the rollout failure of the new platform by
@SyneosHealth
, a thread:
#dermtwitter
#isotretinoin
#iPLEGEfailure
1/9
7
23
90
@DGlaucomflecken
Asking to prescribe two creams separately that cost more than the generic combination cream with both of them in the same medication (e.g. adapalene-benzoyl peroxide)🤦♂️
The constant non-medical switching between drugs in the same class (likely based on arbitrary PBM discounts)
1
0
90
Weekly
#acne
tip: Remember, 120-150mg/kg cumulative dose for
#isotretinoin
is a relatively arbitrary recommendation. Aiming for clear skin x2 months may be a more reliable approach to reduce the frequency of relapse.
#dermtwitter
6
11
84
How does choice of contraception influence acne? Do IUDs or hormonal implants (e.g. Nexplanon) cause acne? In this Tweetorial, let’s take a deep dive into the relationship between contraception use and acne.
#dermtwitter
#acne
#MedEd
⬇️
1/9
2
12
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Thank you
#DermatologyFoundation
for the honor of receiving a career development award! Looking forward to exploring the promise of item response theory to develop patient-reported outcomes for the clinic.
@bwhdermatology
7
0
73
🚨Excited for the SAFA trial results to be published! With over 400 participants, this is by far the largest trial of spironolactone for acne to date. In this thread, let's break down the results of the study
1/14
2
12
71
Low-dose (“submicrobial”) antibiotics (e.g. doxycycline 20mg twice daily, doxycycline-MR 40mg-Oracea) have been marketed as a strategy to avoid issues associated with chronic antibiotic use in acne and rosacea. However, is lower dosing really the solution? A
#tweetorial
#meded
⬇️
4
40
71
Acne Tip of the Week: For
#acne
prone skin, consider moisturizers and sunscreens containing
#niacinamide
, which has anti-acne properties. Elta MD UV Clear sunscreen and CeraVe PM moisturizer are some examples (no COI, just some products that my patients and I like).
#dermtwitter
1
9
67
Collagen is a protein. It’s not going to magically go through your skin barrier or gut to get where you need it. It will be broken down into amino acids just like any other protein. If you eat bacon you don’t turn into a pig. Same is true for topical or supplemental collagen.
Why are dermatologists endorsing topical collagen in the media now?
It’s always the same derms too 😑
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12
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3
20
66
Weekly
#acne
tip: Though trials of longer duration are needed, antihistamines may be a useful adjuvant to isotretinoin. In this small RCT, adjuvant desloratadine resulted in faster response, reduced sebum production, and fewer side-effects.
#dermtwitter
7
6
66
Acne Pearl of the Week: For patients on
#isotretinoin
, try 1g/day omega-3 to reduce incidence of mucocutaneous side effects. In an RCT, this approach reduced the incidence of dry mouth (26% vs 14%), nose (11% vs 0%), skin (11% vs 2%), and eyes (4% vs 0%). (
0
8
65
Two tips from one of my sessions at
#AAD2023
about how to reduce the rate of isotretinoin side effects: Consider Omega-3s to prevent dryness and consider antihistamines to prevent purging and improve satisfaction.
#dermtwitter
3
4
64
Despite approximately half of patients with acne having involvement of the chest and back, truncal acne is often overlooked. In this Tweetorial, we’ll dive into the epidemiology, pathophysiology, and management of truncal acne. 1/10
#dermtwitter
#acne
#MedEd
⬇️
1
16
62
As a final thought, spironolactone is likely effective for all acne, not just “hormonal” acne along the jawline. Hormones and the sebaceous gland play a key role in ALL acne (hence why onset is after adrenarche) and thus spironolactone can address this critical driver of acne.
2
5
63
While pregnancy can be associated with worsening of acne, it can be challenging to treat given more limited available options. In this Tweetorial, we'll explore how to approach acne during pregnancy.
#MedEd
#dermtwitter
1/8
1
6
62
My favorite topical retinoid is generic adapalene (tretinoin is close 2nd and sometimes better covered). It's compatible with benzoyl peroxide, less photolabile than tretinoin, and possibly less irritating. OTC Differin also gives a nice back-up option if insurance is an issue.
What is your favorite topical retinoid for acne?
Share why in the comments (particularly if you have a preferred formulation/vehicle)!
5
0
16
7
7
58
This is an important report/FDA petition, but I think it requires some additional context to avoid making the wrong conclusions. Before we consider banning the sale of one of the most beneficial acne treatments, let's review what is actually presented in the report. A thread:
1/8
🚨 BREAKING NEWS: High levels of the cancer-causing chemical benzene were found in various benzoyl peroxide acne products from major brands, including Proactiv, Clinique, Clearasil, and more.
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1
14
57
@MakeupForWOC
Exactly. While diet may play a minor role in acne, it is rare that diet alone is the primary driving factor and it is rare that changing diet alone will treat acne successfully.
Patients often ask about the potential role of
#diet
in
#acne
. Can changing what you eat reduce breakouts? In this Tweetorial, let’s take a deep dive into the potential association between diet and acne.
#dermtwitter
#MedEd
⬇️
1/10
7
42
157
0
15
57
iPLEDGE call center is still terribly dysfunctional. Have not gotten through a single time in over a week, despite 30+ attempts. This is completely unacceptable and patients are suffering.
@US_FDA
please act with true urgency and halt the iPLEDGE program immediately.
5
8
56
In summary, spironolactone is an effective, safe, and likely underutilized treatment for women with acne. As we continue to develop a stronger evidence base, we may one day see it being recommended as first-line systemic treatment for women with moderate-to-severe acne.
2
2
57
In addition, patients being treated with isotretinoin can expect an average of >50% improvement in quality of life by month 2 and a 4-fold to 5-fold improvement from baseline with a full course of isotretinoin. 3/13
1
5
55
We are starting a new trial (SD-ACNE) comparing spironolactone versus doxycycline for women with acne. Patients can continue topicals. We have sites in Boston, Philadelphia, Miami, San Francisco, Ohio, Arkansas, with more to come.
For those interested:
1
8
56
There is also evidence that Omega-3 supplementation can protect the Meibomian gland from damage and reduce ocular side effects (similar to how it can help reduce other mucocutaneous side effects). I recommend 1g/day for all my patients on isotretinoin 7/9
3
2
54
I don't often get excited about new acne topicals, but this one is impressive. We never see IGA success rates this high for a topical, and it clearly outperforms each dyad. Should be very convenient and efficacious option for our patients once available.
1
6
52
Thoughtfully designed matched cohort study in
@BrJDermatol
finding that
#isotretinoin
use in
#acne
is associated with reduced risk of neuropsychiatric outcomes for those with moderate-to-severe acne.
@seenafazel
#dermtwitter
2
11
54
Myth
#1
- Isotretinoin and depression: Multiple meta-analyses have found that there is no population level association between isotretinoin use and depression. In fact, isotretinoin may be associated with decreased depressive symptoms. 2/19
2
3
50
iPLEDGE day 8 update:
-Website still dysfunctional
-Call center still dysfunctional
-Platform administrators not acting responsibly (who are they?)
-We continue to actively propose workarounds to FDA & pharmacists
🚨We need brave action from
@US_FDA
to immediately halt iPLEDGE🚨
3
12
51
While
#isotretinoin
is not without risks and side-effects, it can be a life changing treatment for many patients with
#acne
. We should use it thoughtfully, but we should not let isotretinoin myths prevent us from prescribing it for the patients who need it. 13/13
3
2
49
Weekly
#Acne
Tip: In a cross-sectional study of acne scarring, less severe scarring was seen in those treated primarily w/
#isotretinoin
vs oral
#antibiotics
(9% vs 38%). Consider early use of isotretinoin in those w/ any evidence of scarring
#dermatology
0
6
49
Maybe we should have legislation that there can’t be prior authorizations for prescriptions costing <$20-50.
@AADmember
1
4
48
How well does
#spironolactone
work for facial and truncal adult female
#acne
? Our 403 patient study out in
@JAADjournals
led by Vaibhav Garg w/ support from Bill James and Julie Choi. 🧵1/9
#dermatology
#dermtwitter
2
8
47
Therefore, while we should not fear isotretinoin causing or worsening depression, given the association between acne itself with depression as well as rare reports of idiosyncratic reactions to isotretinoin, it is prudent to monitor for depression in all acne patients. 5/13
2
4
46
Think of acne treatments such as topical retinoids as PREVENTING your future acne. Thus it is best to treat the whole area (not just the acne spots) and these treatments need to be used consistently to be effective.
#dermtwitter
#JBAcneTip
1
6
46
It's possible to create a good over-the-counter acne regimen for under $24:
-Adapalene (Differin) gel: $14
-Benzoyl peroxide 4-5% wash (Panoxyl, Differin): $10
-Can add a moisturizer if needed (Neutrogena, LaRoche Posay, CeraVe): $10-20
2
8
43
We’ve busted some common
#isotretinoin
myths, but what about actual side effects of isotretinoin in the treatment of
#acne
. In this Tweetorial, we’ll review the most common side effects and how they can be managed.
#dermtwitter
#MedEd
1/16
Isotretinoin can be a highly effective treatment for
#acne
and is the only acne treatment that can provide a lasting remission. However, there are many misconceptions about
#isotretinoin
. In this Tweetorial, let's bust some common isotretinoin myths!
#dermtwitter
1/13
32
233
1K
2
12
44
@StefanieParty
@RoxanaDaneshjou
@DrOniBee
It also has niacinamide, which can be helpful for
#acne
prone skin. I often suggest it to help manage dryness associated with topical retinoid use.
1
0
44
Excited to share news about upcoming changes to the iPLEDGE classification system, which will now be “patients who can become pregnant” or “patients who cannot become pregnant.” We'll continue working to reform iPLEDGE to provide patient-centered care
@DrKlintPeebles
#dermatology
3
5
43
Interested in more acne & rosacea content? We just launched a
@YouTube
channel! Our first video on the pathogenesis of acne is available now 😎
Special thanks to
@Sophia_Ly_MD2b
for her help in getting things up and running! 🙏
0
8
41
Weekly
#acne
tip:
#Clascoterone
is now commercially available and is the first FDA approved topical antiandrogen for acne. It's an exciting new option for our patients with acne and has a novel mechanism of action compared to other topicals.
#dermtwitter
5
7
42
Acne Tip of the Week: For healthy patients on
#isotretinoin
, check lipids + LFTs at baseline and peak dose (~2 months). If normal, no further testing may be needed. There is no value to routine CBC monitoring, yet it is checked monthly for 40% of patients.
2
11
42
Myth
#4
- isotretinoin "hard on the liver": LFT abnormalities are just as common at baseline as on therapy, suggesting many may not be related to isotretinoin. In addition, elevations are typically mild and unlikely to be clinically meaningful. 11/13
1
1
41
Could it help if we had a cap on research that you can include on ERAS (e.g. up to 3 projects)? This would disincentivize having lots of low quality publications and make it less critical to be at a program with loads of research opportunities.
@ilanarosman
@MishaRosenbach
Research Fever—An Ever More Prominent Trend in the Residency Match Residency applicant research items have ballooned over time, but has this made students better off? Does this translate into better residents? Or does this just fuel more box checking.
2
8
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0
40
Acne Tip of the Week: A combined oral contraceptive can be an excellent option to help reduce
#acne
, and may even offer similar effectiveness to oral antibiotics. Those with
#drospirenone
(similar to 25mg
#spironolactone
) likely have even greater efficacy.
0
7
40
Weekly
#acne
tip: While not a performance enhancing drug, it is important to remember
#spironolactone
(and its metabolite canrenone) are on many banned substance lists because can be used as a masking agent. As a result, be cautious when using in high-level athletes.
#dermtwitter
0
4
40
Myth
#3
- isotretinoin requires frequent lab monitoring: Several studies have called into question the need for frequent lab monitoring on isotretinoin. Abnormalities are very rare and of unclear clinical significance. 8/13
2
4
39
Honored to have received this award from
@AADmember
and feeling fortunate to have such great mentorship from David Margolis,
@DrJoelGelfand
, and
@AMostaghimi
, among others!
Looking forward to continuing our work to improve the care of patients with skin disease.
Congratulations to
@DrJohnBarbieri
and Sherrie Divito, MD, PhD, for receiving the 2022 AAD Young Investigator Awards!
Basic/Translation Research Award - Sherrie Divito, MD, PhD
Clinical Research Award - John Barbieri, MD, MBA
@AADmember
#Brighamderm
7
3
46
2
2
40
🚨 The updated
@AADskin
Guidelines for the Management of Acne have just been released 🚨
Let's go through some of the key recommendations in this tweetorial!
1/19
1
11
39
In fact, oral antibiotics are associated with inflammatory bowel disease and it may be that prior oral antibiotic exposure was an ignored confounder in many early studies of isotretinoin and inflammatory bowel disease. 7/13
3
2
38
Don't fall victim to the dogma that only acne on the lower face is "hormonal". It does not reliably predict PCOS and most adult women with acne have a similar distribution to adolescent acne. All acne is related to hormones.
#dermtwitter
#JBAcneTip
3
5
39
Topical retinoids are a mainstay of acne treatment, yet often are not prescribed. Using every other day dosing, moisturizers, lower strength, or new formulations (e.g. tazarotene lotion) can help reduce dryness and irritation.
#dermtwitter
#JBAcneTip
4
7
37
#Acne
is more than skin deep:
-57% answered that they had been verbally abused by a friend or family member due to their acne
-44% had been regularly bullied
-30% felt they had been dismissed by a medical professional
#dermtwitter
2
12
38
Want to hear the latest on acne at
#AAD2023
? Join me:
-Fri 9-11a, Theater A: Controversies in acne and rosacea
-Fri 1-4p, Room 268: High-value acne care
-Sun 1p, Room 388: Do we need labs for isotretinoin?
-Sun 1-4p, Room 245: Acne Symposium
-Mon 1-3p, Room 266: Spironolactone
2
5
37
Weekly
#acne
tip: Don't be afraid to use
#isotretinoin
in patients with
#depression
. While it is important to monitor for idiosyncratic mood changes, isotretinoin treatment is associated with reduced depression overall.
#dermtwitter
1
10
38
Insurer step therapy: Please prescribe this teratogenic drug.
Me: Gentle reminder, the patient is pregnant. Could we please have access to a first-line option that is safe in pregnancy?
Insurer: Please prescribe this teratogenic drug.
How is this ok?
#dermtwitter
#PAReform
1
4
37
Excited to share our study in
@BrJDermatol
highlighting greater risk of idiopathic intracranial hypertension with minocycline than doxycycline/sarecycline (likely related to minocycline's penetration of blood brain barrier). More reasons to be cautious about minocycline for acne.
Excited to announce my 1st publication in the British Journal of Dermatology
@BrJDermatol
@OUPAcademic
w/
@dagaratehealth
under
@DrJohnBarbieri
We investigated tetracycline use in acne patients and idiopathic intracranial hypertension risk.
Read Here:
1
2
25
4
8
36
Given the limited clinical utility of lab monitoring, checking lipids and potentially liver function tests at peak dose and possibly at baseline is likely all that is needed (and even this may be low value). Minimizing labs reduces unnecessary pain, fear, and cost. 10/13
1
0
36
Remember, 120-150mg/kg cumulative dose for
#isotretinoin
is a relatively arbitrary recommendation. Aiming for clear skin x2 months may be a more reliable approach to reduce the frequency of relapse.
#dermtwitter
#JBAcneTip
1
4
36
Isotretinoin use for acne is associated with:
-Reduced tear production (Shirmer test)
-Reduced tear quality (tear break-up time)
-Increased conjunctival fluorescein staining
-Decreased corneal thickness
-Worse patient report of ocular surface disease
3/9
3
0
36
Weekly
#acne
tip: Compared to doxycycline, minocycline has no evidence of better efficacy and has important safety risks (e.g. DRESS, hyperpigmentation). As a result, I typically use doxycycline first.
#dermatology
Cochrane review:
0
5
36
iPLEDGE update day 9:
A brief thread on the history of the current iPLEDGE debacle, including how we got here, why this problem has been so hard to fix, and what are the next steps to restore access to isotretinoin for our patients.
1/13
1
6
36
Acne Tip of The Week: Using a combined oral contraceptive with
#spironolactone
for
#acne
can decrease the incidence of menstrual side effects by ~40%. In addition, the risk of menstrual SEs is 4x higher with doses of 200mg/day compared to lower doses.
0
6
36
Acne Tip of the Week: Spironolactone is a great alternative to oral antibiotics (and even isotretinoin) for women with acne. Check out this
#tweetorial
for more details.
It is not uncommon for women to have acne persisting into their 20s and 30s. For those with moderate-to-severe acne requiring oral treatment, we often think of oral antibiotics and isotretinoin. But what about hormonal treatments like spironolactone? A
#tweetorial
#meded
⬇️
14
28
143
1
3
33
More data highlighting that
#isotretinoin
use for
#acne
is associated with decreases in
#depression
as treatment progresses. While we should watch for idiosyncratic depressive symptoms, we should not fear prescribing isotretinoin to those with depression
2
5
35
50% of women experience
#acne
in their 20s and 35% in their 30s. Acne should not be viewed as only a cosmetic problem given these significant life impacts.
#dermtwitter
In this qualitative study of 50 adult women with acne, participants described diverse impacts on their lived experience, including concerns about appearance, mental and emotional health consequences, and disruption to their personal and professional lives.
1
4
18
1
4
35
In summary, we shouldn’t neglect the potential ocular effects of isotretinoin. While dry eye symptoms are uncommon and improve after completing the isotretinoin course, avoiding excessive cumulative dose and Omega-3 supplementation can be considered to reduce toxicity. 9/9
3
3
34
Weekly
#acne
tip: Don't have a comedo extractor available? Consider using a disposable syringe! Interesting technique from Jun Young Kim in
@JAADjournals
. I wonder if it could also be useful for small milia cysts.
#dermtwitter
1
5
33
While only 14 of the top 100 videos on
#YouTube
for
#acne
were by dermatologists, these were most likely to make recommendations in accordance with guidelines. We need more derms on social media!
@RoxanaDaneshjou
@HarkerDavid
@SugaiDaniel
#dermtwitter
3
10
34
Nice to see discussion of antibiotic
#resistance
in dermatology, but why are all the 'alternatives' just different antibiotics? Don't forget
#spironolactone
for women with
#acne
! Sad to see it nearly completely left out from this article😢
#dermtwitter
2
3
34
If I don't prescribe a patient the correct medicine and they are harmed, I am at fault. But if it is the insurance company that is preventing the medication from being prescribed, they have no liability. How does this make sense?
0
0
33
This week, I'm taking a bit of a different approach, sharing a more lecture style video discussing some interesting controversies in acne and rosacea (based on my talk at the recent American Academy of Dermatology meeting). Check it out!
1
5
31
We have so many excellent treatment options for acne. Don’t be fooled by effective marketing campaigns that aren’t based on any actual science or evidence.
@LabMuffin
thank you for raising awareness in this issue.
#dermtwitter
I have just uncovered the horror that is doctors on TikTok recommending succinic acid as a "proven acne ingredient".
In case you've forgotten, there is one single peer-reviewed in vivo study on succinic acid.
It was done on mouse ears.
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279
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33
It is exciting to see that clindamycin 1.2%/adapalene 0.15%/benzoyl peroxide 3.1% is now available! This triple combination topical has the highest rates of IGA success that I have ever seen in acne clinical trials (~50%; ~25-30% greater than vehicle)
3
5
31
Check out the new
#iPLEDGE
guidelines for
#isotretinoin
for
#acne
in setting of
#COVID19
.
1. Telemedicine more explicitly permitted
2. Can use at-home pregnancy test
These are great changes that will help protect our patients from unnecessary visits.
1
9
31
#Acne
Tip of the Week: Chemical peels (e.g. glycolic acid peels and salicylic acid peels) can be a useful adjunctive treatment approach in the management of acne. Glycolic acid peels in particular can also help with post-inflammatory hyperpigmentation.
#dermatology
#dermtwitter
1
5
32
Weekly
#acne
tip: Think of acne treatments such as topical retinoids as PREVENTING your future acne. Thus it is best to treat the whole area (not just the acne spots) and these treatments need to be used consistently to be effective.
#dermtwitter
1
5
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Just out in
@JAADjournals
(w/
@AMostaghimi
,
@DrMeganNoe
, David Margolis, and
@DrJoelGelfand
), we explore how often dermatologists are the main contact within the health care system for patients with chronic skin conditions. A quick thread 🧵⬇️ 1/8
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8
29
How are we approaching potassium monitoring in young women treated for
#acne
with
#spironolactone
and how has monitoring changed over time? Our cohort study out in
@JAMADerm
with David Margolis and
@AMostaghimi
. A thread 🧵
1/10
#dermatology
#dermtwitter
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4
31
Our letter to the editor is now out in which we discuss why androgen testing is not required in all adult women with acne and why spironolactone can be a valuable potential treatment option for all female patients with acne.
#dermtwitter
2
5
31
I've always found steroid acne interesting since we also use steroids acutely to treat acne (i.e. acne fulminans). Although very preliminary data, this study explores the hypothesis that fungal organisms may be the cause of steroid
#acne
.
#dermtwitter
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4
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Always check study funders: In this expert panel algorithm (funded by Galderma) the only topical retinoid mentioned by name is trifarotene (owned by Galderma). There is no evidence trifarotene is any more efficacious than other retinoids for truncal acne.
2
5
30
Weekly
#acne
tip: For many with acne, dark spots left behind can be at least as bothersome, if not more so, as the acne lesions themselves. Check out this nice discussion of management of acne-associated macular hyperpigmentation.
#dermtwitter
1
1
30
Acne excoriee (picking at pimples) can increase the risk of scarring. Check out this
@YouTube
short about how N-acetylcysteine (typically 600mg 2-3 times per day) may be able to help reduce acne skin picking.
1
10
30
@doctorORbust
And why are insurers not held accountable when they are “practicing medicine” through
#priorauthoriaztion
and
#steptherapy
? If a doctor fails to prescribe critical treatment that is malpractice. If an insurer fails to cover a critical treatment that is a prior authorization
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