John Barbieri, MD: Tools for Acne, Rosacea Management

John Barbieri, MD, MBA, spoke with HCPLive about his presentation at the Society of Dermatology Physician Assistants (SDPA) 2023 Annual Summer Dermatology Conference titled ‘Foundational Tools for Acne and Rosacea Management.’

Barbieri is known for his work as Director of the Advanced Acne Therapeutics Clinic and Assistant Professor of Dermatology at Harvard Medical School.

“My research focuses really on 3 main topics,” he began. “It focuses on non-antibiotic alternatives in the treatment of acne, on the use of patient-reported outcomes both in clinical trials and in clinical practice, and on something we may call health services research.”

Barbieri began discussing acne and some of the reasons for his decision to pursue the topic for his conference presentation.

“About 85% of adolescents, at some point, have acne,” he explained. “And acne often persists into adulthood, too. We usually think of it like a disease of adolescence, but about 50% of women have acne in their 20s, 30% in their 30s, and about 10% do into their 40s. And you see a similar pattern with men.”

In this discussion, Barbieri first noted that rosacea impacts a large number of individuals of all skin types, despite the fact that it is often thought of as something people with lighter skin tones have, it is also seen in patients with skin of color.

“So let's start with mild acne, and mild moderate acne,” he stated. “When we think about it, we really have several treatment classes that we can think about. We have topical retinoids, which are going to help to reduce inflammation and help address hyperkeratinization where the skin is getting clogged up with sebum, the oil and the skin cells’ keratinocytes. We can also use benzoyl peroxide, which is going to be antibacterial…And then we also have antibiotics, both topical and oral, which kill acne bacteria.”

He then discussed a new type of treatment which some dermatologists may recommend for patients struggling with acne, and it can be used in both men and women.

“And then we have a new class of medicine called clascoterone or Winlevi is the brand name of it, which is a topical antiandrogen,” Barbieri said. “So it addresses really the fundamental driver of all acne, which is that when we hit puberty, we have more hormones. As hormones turn onto the skin that makes more oil, which leads to acne having ‘food’ to eat up, and also clogging up the pores.”

Barbier continued to address some of the ways he believes clinicians and patients can address the different forms of acne.

“So for someone who has more whitehead and blackhead kind of acne, that's really where a topical retinoid and benzoyl peroxide are going to be the key treatments, since they are really great at those open and closed comedones,” he noted. “In contrast, for more inflammatory acne, people who are getting more inflammatory papules and pustules, or even sometimes nodules, that's where topical antibiotics and where something like clascoterone might be more helpful, or in someone for whom their acne really seems to flare around their menstrual cycle.”

For more information from Barbieri’s presentation, view the full interview above.

The quotes contained in this description were edited for clarity.