Acne & Rosacea Pearls with Dr. John Barbieri: Diagnosis, Antibiotics, Isotretinoin Dosing, and Pregnancy-Safe Options | The Derm Resident

In this “Meet the Expert” episode of The Derm Resident, Dr. Jonny Hatch talks with acne and rosacea expert Dr. John Barbieri about practical, early-resident approaches to acne and common mimickers, emphasizing comedones as a key differentiator and reviewing clues for periorificial dermatitis, rosacea, and pityrosporum folliculitis. They discuss why “jawline acne” is not a strong predictor of PCOS/PMOS and why signs like irregular menses, hirsutism, and acanthosis nigricans are more informative. Dr. Barbieri outlines systemic treatment decision-making, favoring spironolactone over long-term antibiotics in many patients, and reviews antibiotic choices and resistance concerns. The conversation then covers isotretinoin timing, dosing to clinical endpoints, adjuncts to reduce flaring and side effects (loratadine, omega-3, L-carnitine), counseling on growth and mood risk, pregnancy-safe acne options, benzoyl peroxide/benzene concerns, rosacea redness treatment (oxymetazoline), and common trainee mistakes.

00:00 Welcome and Guest Intro
00:42 Acne Exam Basics
01:08 Acne Mimickers
02:36 History and PCOS Clues
03:30 Jawline and Hormones
05:26 Systemic Treatment Choices
07:01 Low Dose Doxy Debate
08:59 Antibiotics as Bridge
10:59 Which Antibiotic to Pick
13:35 Starting Isotretinoin (Accutane)
15:46 Dosing and Endpoints
17:32 Cumulative Dose Myths
19:17 Higher Daily Dosing
20:12 Antihistamine Add On
21:09 Omega 3 For Dryness
22:25 L Carnitine For Soreness
23:42 Growth Stunting Myth
24:33 Mood And Suicide Risk
27:02 Acne In Pregnancy
28:09 Topical Combo Strategies
29:23 Benzoyl Peroxide and Benzene
30:41 Resident Mistakes And Rosacea
33:18 Rosacea Phenotype Approach
34:52 Advice For New Residents
35:30 Final Thanks And Wrap

Acne Boot Camp: Pathogenesis, Clinical Evaluation, Variants, Mimickers & First-Line Topicals | The Derm Resident

Hosts Dr. Jonny Hatch and Dr. Deven Curtis introduce The Derm Resident and begin an acne “boot camp” covering high-yield basics for clinic and boards. They review acne’s etymology and outline the four pillars of pathogenesis: follicular hyperkeratinization (microcomedone formation), androgen-driven sebum production (DHT via 5-alpha reductase), Cutibacterium acnes colonization with inflammatory free fatty acids, and inflammation. They discuss clinical morphology and distribution, inflammatory vs noninflammatory lesions, PIH versus true scarring (ice pick, boxcar, rolling, and hypertrophic scars), and diet associations (skim milk, whey protein, high glycemic load, vitamin B12/energy drinks). The episode covers variants and special populations including adult female acne, neonatal/infantile/mid-childhood/pre-adolescent acne (with workup triggers), acne fulminans treatment with prednisone then low-dose isotretinoin, follicular occlusion tetrad, acne excoriée, drug-induced acne, acne mechanica/occupational acne/chloracne, and mimickers like rosacea and gram-negative folliculitis, then closes with topical treatment ladders and key agents (retinoids, benzoyl peroxide, clindamycin, azelaic acid, dapsone, clascoterone).

00:00 Welcome and Focus
00:45 Acne Name Origins
02:15 Acne Pathogenesis Overview
03:24 Hyperkeratinization Explained
04:38 Comedones and Sebum Words
05:59 Androgens and Sebum
07:55 C Acnes and Inflammation
10:00 Diet and Acne Evidence
12:46 Clinical Exam and Severity
14:23 PIH Versus True Scars
17:46 Adult Female Acne
20:06 Acne Fulminans Treatment
23:45 Fulminans Name and Tetrad
25:32 Follicular Occlusion Tetrad
26:54 Pilonidal Cyst Etymology
27:21 Acne Excoriée Explained
28:39 Pediatric Acne Types
32:57 Drug Induced Acne Clues
36:28 Mechanica Occupational Chloracne
39:06 Acne Mimickers Differential
41:27 Hyperandrogenism Lab Workup
44:28 Acne Treatment Ladder
49:56 Topicals Beyond Retinoids
52:33 Systemic Therapy Next Episode
53:03 Wrap Up And Goodbye

Full Body Skin Exam: Sequence, Missed Sites, and High-Yield Lesions for Skin Cancer Screening | The Derm Resident

In episode two of The Derm Resident, hosts Dr. Jonny Hatch and Dr. Deven Curtis walk through a practical approach to the full body skin exam for skin cancer screening, emphasizing the importance of a consistent exam sequence, patient communication, and documenting spots of concern. They review commonly missed sites (scalp, behind ears, interdigital toe spaces, palms/soles, genitals) and note the need for chaperones for sensitive exams. The episode covers high-yield benign lesions (seborrheic keratoses, sebaceous hyperplasia, cherry angiomas, nevi subtypes and dermoscopy patterns, dermatofibromas, lichen planus-like/lichenoid keratosis, skin tags) and premalignant/malignant lesions (actinic keratoses, basal cell carcinoma, squamous cell carcinoma including keratoacanthoma, and melanoma types including subungual melanoma and Hutchinson sign). They close with biopsy pearls, follow-up intervals based on risk, and counseling on warning signs and daily sun protection.

00:00 Welcome and Disclaimer
00:35 Why Skin Exams Matter
00:49 Starting the Encounter
02:37 Building Your Exam Sequence
05:26 Commonly Missed Sites
08:07 Benign vs Malignant Overview
08:29 Seborrheic Keratoses
12:37 Leser Trelat and Boards Pearls
14:14 Sebaceous Hyperplasia
16:27 Cherry Angiomas
18:20 Nevi Types and Aging
23:23 Dermoscopy of Junctional Nevi
25:10 Intradermal Nevi Patterns
25:21 Intradermal Nevus Clues
26:31 Dermatofibroma Exam Pearls
28:41 Lichenoid Keratosis Explained
30:37 Skin Tags Basics
31:38 Actinic Keratosis Recognition
32:55 AK Treatment Options
35:23 Basal Cell Carcinoma Signs
37:46 Squamous Cell and KA Debate
42:27 Melanoma Types and ABCDE
44:55 Subungual Melanoma Hutchinson
47:51 Biopsy Depth and Technique
48:58 Follow Up and Sun Safety
52:01 Final Wrap and Takeaways

Dermatology Morphology Basics: Building Differentials & Primary vs Secondary Lesions | The Derm Resident

Hosts Dr. Jonny Hatch and Dr. Deven Curtis introduce The Derm Resident and outline the podcast’s goal of reviewing dermatologic diseases by pathogenesis, clinical features, workup, and management to help with clinic and boards. They discuss an approach to building differentials using a “tree” framework (neoplastic vs inflammatory, then infectious vs noninfectious) and emphasize that morphology is the core language of dermatology, sometimes outweighing patient history. The episode reviews key primary lesions—macule vs patch, papule vs plaque, nodules, wheals, vesicles vs bullae, and pustules—and explains why precise word choice matters. They then cover secondary changes including scale vs crust, fissures, excoriations, erosions vs ulcerations, atrophy, and lichenification, and end by stressing the importance of palpation in lesion assessment.

00:00 Welcome to the Podcast
00:52 How to Build a Differential
02:38 Disease Buckets and Pathogenesis
05:56 Morphology Is King
08:43 Primary Lesions Basics
11:54 Nodules and Wheals
14:49 Blisters and Pustules
19:52 Secondary Lesions Explained
21:06 Scale vs Crust and Micaceous
24:10 Breaks in the Skin
27:46 Atrophy and Lichenification
30:10 Palpation Pearls
32:17 Wrap Up and Next Episode