John Barbieri, MD: Strategies for Different Types of Moderate to Severe Rosacea, Acne

During this HCPLive interview, John Barbieri, MD, MBA, described some of the treatment strategies he recommends for moderate-to-severe acne and rosacea that he made in his presentation at the Society of Dermatology Physician Assistants (SDPA) 2023 Annual Summer Dermatology Conference.

In his work, Barbieri serves as Director of the Advanced Acne Therapeutics Clinic and as Assistant Professor of Dermatology at Harvard Medical School.

He began this interview segment with a discussion of some of the clinical manifestations of rosacea that can be observed in patients.

“When I think about rosacea, there's really a couple of main manifestations of it,” he explained. “And we want to align our treatments with what the patient's experiencing. So there's redness that can mean broken blood vessels like glandular stages on the skin. That can be flushing, that can be kind of fixed background redness on the face, there's lumps, there's papules, and pustules, just like an acne, and then some people can get what's called rhinophyma changes where their nose starts to get thicker, and the sebaceous tissue becomes too big.”

Barbieri noted that the treatments he recommends are distinct for each of those types of manifestations.

“For the bumps, (the treatments) actually do overlap a bit like with acne,” he stated. “So topical antimicrobial things we often use metronidazole or ivermectin, and now there's a benzoyl peroxide that's more gentle and can be used for rosacea-prone skin and where that benzoyl peroxide is encapsulated. So for bumps there is some overlap.”

In his discussion, he continued to explain some of the other treatments he recommends for dermatologists.

“For redness, we do use some of the same ideas like we talked about for acne associated erythema using alpha-agonists like oxymetazoline,” he stated. “That's one of our go-to’s for rosacea redness, and also, energy-based devices like pulsed-dye laser or KTP laser can be helpful for redness as well.”

Barbieri later discussed moderate-to-severe acne treatments that he highlighted in his presentation.

“From the standpoint of acne, I think trying to create a simple regimen that's affordable is not something that's that hard to do. And I think we often get caught up and lots of (the idea that) the newest medicine must be the best. There's a real lack of evidence for a lot of these products.

He added that there may not also be enough head to head data for some newer treatments.

“So for me, I think about mechanisms,” he said. “And I really try to pick the most affordable one in that category. So you know, topical retinoids and benzoyl peroxide are great for whiteheads and blackheads. I just pick the most affordable one or the one that patient can access the easiest, because there's not a lot of data that other ones are better, with the one caveat being if they do have trouble tolerating a retinoid, and they really need one, some of the lotion formulations like tazarotene lotion do have evidence that they're more tolerable and work just as well.”

In addition, Barbieri also discussed topical antibiotics for patients struggling with more inflammatory acne.

“If they’ve got more inflammatory acne, I usually just use clindamycin. Because it's easy to access. It's affordable. And there's really no evidence that dapsone or minocycline foam or anything like that is any better. So I tend to not use those. I find dapsone gel is helpful for scalp folliculitis. That's kind of a neat case and I'll use it but for run of the mill acne, but I'm not sure it's particularly better on average, there's not really actually data that supports it as better for adult women.”

For more information, view the full interview with Barbieri posted above.

The quotes contained in this description were edited for clarity.