Dermbusters

In this episode of Dermbusters, host Nicholas Brownstone, MD, chats with Cheri Frey, MD, about some common misperceptions they often hear from their patients.Dr Frey shares some suggestions on how to counsel patients on 2 significant topics: retinol use for patients with sensitive skin and moisturizing for patients with acne.Myth 1: Patients with sensitive skin can’t use retinol for acne.Dr Frey addresses a common myth that dermatologists often hear from their patients: that they shouldn’t use retinol to treat acne if they have sensitive skin. She offers a few suggestions for dispelling this misperception when speaking with patients.Tips for counseling your patients:Advise eligible patients to try an over-the-counter retinol that’s not as strong or harsh as prescription-strength retinoidsExplain application strategies such as the sandwich method, which involves applying retinol between 2 layers of moisturizer, and short-contact application, where retinol sits on the skin for a few minutes before being washed offExpress the importance of retinol as a cornerstone of acne treatment and reassure patients there is always a way to incorporate it as a therapyMyth 2: Patients with acne can’t moisturize their skin.Dr Brownstone and Dr Frey next cover another common myth often heard from patients: that moisturizing can exacerbate acne.Dr Frey stresses the importance of moisturization for patients with acne and serves up a few tips to use in patient conversations when addressing this topic.Tips for counseling your patients:Explain the barrier disruption that occurs in patients with acne and how it can cause more irritation and inflammation; advise patients that moisturizing can mitigate this disruption to the top layer of skinEducate patients on the drying nature of retinols and other acne-fighting ingredients; emphasize the importance of keeping skin hydrated so patients can tolerate their acne medications

Join Dr Nick Brownstone in this episode of Dermbusters, where he chats with Dr Elizabeth Swanson to address some common misperceptions surrounding the use of Accutane that they often hear from both colleagues and patients. Are monthly labs for Accutane needed for safety? No. Dr Swanson notes that she has been in practice for over 12 years, and when she was in training, providers did do labs every month for patients taking Accutane, including a liver function test, a lipid panel, and sometimes a CBC. Since she’s been practicing, the guidelines for Accutane have recommended less and less monitoring over time. She references an article published in JAMA Dermatology that recommended testing only for alanine aminotransferase (ALT) and triglycerides at baseline and again at 2 months or after peak dose is reached. Dr Swanson comments that testing only twice for 2 things is great news for patients. Dr Brownstone asks Dr Swanson how she counsels patients when they want additional labs performed to ensure the medication isn’t causing side effects. She remarks that her patients never request that, and she generally finds they are very pleased to only need minimal blood draws for monitoring. Does Accutane increase the risk of suicidal behavior or depression? Dr Swanson notes that this is a very controversial topic. When she addresses this with her patients and their families, she explains that there were some initial concerns about suicidal behavior and depression in patients with Accutane, but because of these concerns, it has been extensively studied in tens of thousands of patients. Those studies found that most patients actually notice an improvement in their mood due to clearer skin and improved self-esteem and confidence. As a pediatric dermatologist, Dr Swanson prescribes Accutane daily; she reassures her patients and their families that in her years of practice, she has had only 6 patients who exhibited signs of depression and had to stop the medication. She concludes by noting that while these side effects do occur rarely, the studies support patients seeing an improvement in their mood.