In episode 55 of Derms and Conditions, our host James Q. Del Rosso, DO, sits down with Guy Webster, MD, PhD, FAAD, a clinical professor of dermatology at Jefferson Medical College. The 2 discuss new developments in the pathophysiology and management of acne as well as key pearls and pitfalls when using topicals, antibiotics, and isotretinoin.

Dr. Del Rosso begins by asking Dr. Webster about any major changes to acne dogma over the last few decades. Dr. Webster points out that while our knowledge is constantly evolving, our understanding of acne hasn’t changed as drastically as it has for diseases such as psoriasis. We know the 4 common pillars for acne pathophysiology, and we know the immune system is involved. The main mistake we have made is placing too much weight on newer data and ignoring older, equally robust data.

Next, they switch focus to antibiotics and Dr. Del Rosso asks about their role in acne management. Dr. Webster finds topical antibiotics such as erythromycin and clindamycin ineffective as monotherapy due to drug resistance. However, benzoyl peroxide has not been shown to create resistance and therefore remains very effective. They also discuss oral antibiotics and some of the newer narrow-spectrum options like sarecycline.

Dr. Del Rosso then asks Dr. Webster about a hypothetical but very common case of a patient with moderate acne and how he would approach treatment. Dr. Webster states that he disagrees with stepwise therapy and believes you should use your clinical experience to start with the right medication, right away. You should also identify what the patient’s goals are and recognize what they are willing to tolerate with regard to treatments. He notes that after about 4-6 weeks of treatment he can tell if a therapy is having a beneficial effect or if he needs to recommend a stronger option. Finally, they discuss isotretinoin and key considerations surrounding its usage. Tune in to this episode to learn more!