#dermJC Transcript
Healthcare social media transcript of the #dermJC hashtag.
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See #dermJC Influencers/Analytics.
| Profile | Tweet |
|---|---|
 | Dermatology Journal Club @DermatologyJC Hi everyone! Go ahead and introduce yourself and remember to use the #dermjc in your tweets so we can follow along!!! #dermatology #dermtwitter |
 | John Barbieri, MD, MBA @DrJohnBarbieri Hi everyone. John Barbieri from Penn. No COI. Looking forward to the discussion. #dermjc |
 | Roxana Daneshjou MD/PhD @RoxanaDaneshjou Hi this is Roxana from Stanford. I consult for Enspectra health, unrelated to this topic. #dermjc |
| Roxana Daneshjou MD/PhD @RoxanaDaneshjou Want to learn more about acne treatments from @DrJohnBarbieri? Join in and follow along the #dermjc, being tweeted out by @DermatologyJC! |
| Dermatology Journal Club @DermatologyJC RT @RoxanaDaneshjou: Want to learn more about acne treatments from @DrJohnBarbieri? Join in and follow along the #dermjc, being tweeted out by @DermatologyJC! |
| John Barbieri, MD, MBA @DrJohnBarbieri RT @RoxanaDaneshjou: Want to learn more about acne treatments from @DrJohnBarbieri? Join in and follow along the #dermjc, being tweeted out by @DermatologyJC! |
| Dermatology Journal Club @DermatologyJC RT @DrJohnBarbieri: Hi everyone. John Barbieri from Penn. No COI. Looking forward to the discussion. #dermjc |
| Dermatology Journal Club @DermatologyJC We know some people like to lurk; if you’re lurking, we would love to get at least a hello! Also trainees are very welcome to participate! #dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri A common clinical scenario we encounter is how to approach acne when topical treatments are not enough. The main systemic medications for women are oral antibiotics, isotretinoin, oral contraceptives, and spironolactone. In this article we compare AtBx and spironolactone #dermjc |
| Roxana Daneshjou MD/PhD @RoxanaDaneshjou @DrJohnBarbieri, this #dermjc paper and a lot of your work has been about antibiotic stewardship and appropriate use. Do you think there has been any shift in clinical practice? I feel like during residency I have seen a shift away from long term antibiotic use. |
| John Barbieri, MD, MBA @DrJohnBarbieri Since we don't have the benefits of a large RCT (no financial incentive to conduct at this point since spironolactone is generic), we sought to use a cohort study design to help inform clinical decision making when choosing between oral antibiotics and spironolactone #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DrJohnBarbieri: A common clinical scenario we encounter is how to approach acne when topical treatments are not enough. The main systemic medications for women are oral antibiotics, isotretinoin, oral contraceptives, and spironolactone. In this article we compare AtBx and spironolactone #dermjc |
| Dermatology Journal Club @DermatologyJC RT @RoxanaDaneshjou: @DrJohnBarbieri, this #dermjc paper and a lot of your work has been about antibiotic stewardship and appropriate use. Do you think there has been any shift in clinical practice? I feel like during residency I have seen a shift away from long term antibiotic use. |
| Roxana Daneshjou MD/PhD @RoxanaDaneshjou RT @DrJohnBarbieri: A common clinical scenario we encounter is how to approach acne when topical treatments are not enough. The main systemic medications for women are oral antibiotics, isotretinoin, oral contraceptives, and spironolactone. In this article we compare AtBx and spironolactone #dermjc |
| Roxana Daneshjou MD/PhD @RoxanaDaneshjou RT @DrJohnBarbieri: Since we don't have the benefits of a large RCT (no financial incentive to conduct at this point since spironolactone is generic), we sought to use a cohort study design to help inform clinical decision making when choosing between oral antibiotics and spironolactone #dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri Using the Optum claims database, we compared women who were started on AtBx vs spironolactone, controlling for age and other treatments. As a surrogate outcome, we looked at treated switching/escalation as a way to assess treatment failure #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DrJohnBarbieri: Using the Optum claims database, we compared women who were started on AtBx vs spironolactone, controlling for age and other treatments. As a surrogate outcome, we looked at treated switching/escalation as a way to assess treatment failure #dermjc |
| Roxana Daneshjou MD/PhD @RoxanaDaneshjou RT @DrJohnBarbieri: Using the Optum claims database, we compared women who were started on AtBx vs spironolactone, controlling for age and other treatments. As a surrogate outcome, we looked at treated switching/escalation as a way to assess treatment failure #dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri We found that both treatments had similar rates of switching/escalation (~14%). This result highlights that for many women with acne, spironolactone is effective and works similarly well to oral antibiotics. #dermjc |
| Dermatology Journal Club @DermatologyJC @SmritiSaid #dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri Since the patients may not have the same baseline acne type/severity, we conducted a sensitivity analysis to highlight that our results remained similar under a range of alternative assumptions. #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DrJohnBarbieri: We found that both treatments had similar rates of switching/escalation (~14%). This result highlights that for many women with acne, spironolactone is effective and works similarly well to oral antibiotics. #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DrJohnBarbieri: Since the patients may not have the same baseline acne type/severity, we conducted a sensitivity analysis to highlight that our results remained similar under a range of alternative assumptions. #dermjc |
 | Smriti Prasad, MD MPH @SmritiSaid RT @DrJohnBarbieri: A common clinical scenario we encounter is how to approach acne when topical treatments are not enough. The main systemic medications for women are oral antibiotics, isotretinoin, oral contraceptives, and spironolactone. In this article we compare AtBx and spironolactone #dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri However, while these observational data are encouraging with respect to the effectiveness of spironolactone, there is a need for prospective trials to understand the optimal management strategies for women with acne. #dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri When treating moderate to severe acne in women, do you tend to prescribe: #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DrJohnBarbieri: When treating moderate to severe acne in women, do you tend to prescribe: When treating moderate to severe acne in women, do you tend to prescribe: #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DrJohnBarbieri: However, while these observational data are encouraging with respect to the effectiveness of spironolactone, there is a need for prospective trials to understand the optimal management strategies for women with acne. #dermjc |
| Roxana Daneshjou MD/PhD @RoxanaDaneshjou @DrJohnBarbieri Wondering how the answers to this poll differ by specialty. How often do PCPs give spironolactone vs antibiotics? #dermjc |
| Dermatology Journal Club @DermatologyJC RT @RoxanaDaneshjou: @DrJohnBarbieri Wondering how the answers to this poll differ by specialty. How often do PCPs give spironolactone vs antibiotics? #dermjc |
| Smriti Prasad, MD MPH @SmritiSaid @DrJohnBarbieri Not a prescriber but I’ve recommended using spironolactone > abx to my attendings on multiple F patients I’ve followed in clinic! Patients have tolerated it well with great results in my limited experience. #dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri RT @RoxanaDaneshjou: @DrJohnBarbieri Wondering how the answers to this poll differ by specialty. How often do PCPs give spironolactone vs antibiotics? #dermjc |
| Dermatology Journal Club @DermatologyJC RT @SmritiSaid: @DrJohnBarbieri Not a prescriber but I’ve recommended using spironolactone > abx to my attendings on multiple F patients I’ve followed in clinic! Patients have tolerated it well with great results in my limited experience. #dermjc |
| Roxana Daneshjou MD/PhD @RoxanaDaneshjou I’m particularly wary about longterm antibiotic use in acne. Have seen several cases of teens getting DRESS or SJS from Bactrim for acne! #dermjc |
| Dermatology Journal Club @DermatologyJC RT @RoxanaDaneshjou: I’m particularly wary about longterm antibiotic use in acne. Have seen several cases of teens getting DRESS or SJS from Bactrim for acne! #dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri @RoxanaDaneshjou We’ve looked at this question in Optum and non-derms prescribe spironolactone less frequently than derms. But both prescribing antibiotics ~3-5x more than spironolactone. https://t.co/86p1o2T7dk #dermjc |
| Roxana Daneshjou MD/PhD @RoxanaDaneshjou RT @DrJohnBarbieri: @RoxanaDaneshjou We’ve looked at this question in Optum and non-derms prescribe spironolactone less frequently than derms. But both prescribing antibiotics ~3-5x more than spironolactone. https://t.co/86p1o2T7dk #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DrJohnBarbieri: @RoxanaDaneshjou We’ve looked at this question in Optum and non-derms prescribe spironolactone less frequently than derms. But both prescribing antibiotics ~3-5x more than spironolactone. https://t.co/86p1o2T7dk #dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri @RoxanaDaneshjou Yes, also is a risk of minocycline that is often not considered. For that reason I prefer doxycyline despite greater photosensitivity issues. #dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri RT @RoxanaDaneshjou: I’m particularly wary about longterm antibiotic use in acne. Have seen several cases of teens getting DRESS or SJS from Bactrim for acne! #dermjc |
| Roxana Daneshjou MD/PhD @RoxanaDaneshjou Retrospective data suggests that spironolactone and antibiotics may have equal efficacy in treating acne. Wondering how other specialties feel about spironolactone? Feel free to weigh in! #dermjc https://t.co/uapbue53VD |
| Roxana Daneshjou MD/PhD @RoxanaDaneshjou RT @DrJohnBarbieri: @RoxanaDaneshjou Yes, also is a risk of minocycline that is often not considered. For that reason I prefer doxycyline despite greater photosensitivity issues. #dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri For those who prescribe mostly antibiotics, based on this study would you consider using spironolactone more? #dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri RT @RoxanaDaneshjou: Retrospective data suggests that spironolactone and antibiotics may have equal efficacy in treating acne. Wondering how other specialties feel about spironolactone? Feel free to weigh in! #dermjc https://t.co/uapbue53VD |
| Dermatology Journal Club @DermatologyJC RT @DrJohnBarbieri: For those who prescribe mostly antibiotics, based on this study would you consider using spironolactone more? #dermjc |
 | David Harker, MD, FAAD @HarkerDavid @DermatologyJC David Harker, PGY-4 derm, UTSW (currently on my last week of inpatient call in residency!). COI: advisory board for @VisualDx. #dermjc |
| Roxana Daneshjou MD/PhD @RoxanaDaneshjou @DrJohnBarbieri Okay to be fair, your tweetorials and several of your papers that I’ve read through twitter have convinced me to reach for spironolactone, even when there isn’t a clear association of the acne with menstrual cycles. It works. #dermjc |
 | Leo Shmuylovich, MD PhD @leoshmu @DrJohnBarbieri @RoxanaDaneshjou We have one attending who alternates dcn in fall winter and mcn in summer spring- has done so for decades. Other attendings won’t touch mino for acne given worries about risk/benefit. I like your push for spiro, but how many long term acne patients just need accutane? #dermjc |
| Dermatology Journal Club @DermatologyJC RT @HarkerDavid: @DermatologyJC David Harker, PGY-4 derm, UTSW (currently on my last week of inpatient call in residency!). COI: @DermatologyJC David Harker, PGY-4 derm, UTSW (currently on my last week of inpatient call in residency!). COI: advisory board for @VisualDx. #dermjc |
| Dermatology Journal Club @DermatologyJC RT @leoshmu: @DrJohnBarbieri @RoxanaDaneshjou We have one attending who alternates dcn in fall winter and mcn in summer spring- has done so for decades. Other attendings won’t touch mino for acne given worries about risk/benefit. I like your push for spiro, but how many long term acne patients just need accutane? #dermjc |
 | Ilana Rosman, MD @ilanarosman @DrJohnBarbieri @RoxanaDaneshjou I very very rarely prescribe mono cyclone for acne. Although risk of DRESS is small, it just doesn’t seem worth it to me given other options. I’ve found it relatively easy in most patients to manage photosensitivity and GI upset with doxy. #dermjc #dermatology |
| David Harker, MD, FAAD @HarkerDavid @DrJohnBarbieri I've seen great results with spironolactone - but Whitney High says he now counsels patients only to start on wknds and not to drive on the same day they start. One patient patient passed out and got in a car wreck when starting spironolactone. Anyone else hear this? #dermjc |
| Dermatology Journal Club @DermatologyJC RT @ilanarosman: @DrJohnBarbieri @RoxanaDaneshjou I very very rarely prescribe mono cyclone for acne. Although risk of DRESS is small, it just doesn’t seem worth it to me given other options. I’ve found it relatively easy in most patients to manage photosensitivity and GI upset with doxy. #dermjc #dermatology |
| John Barbieri, MD, MBA @DrJohnBarbieri @leoshmu @RoxanaDaneshjou I prescribe a lot of isotretinoin. It is unique in that it is truly a “disease modifying” treatment. For those who don’t want to be on a medication long term, are considering pregnancy in near future (after rx), or who have severe or scarring acne, it’s a great option. #dermjc |
| Dermatology Journal Club @DermatologyJC RT @HarkerDavid: @DrJohnBarbieri I've seen great results with spironolactone - but Whitney High says he now counsels patients only to start on wknds and not to drive on the same day they start. One patient patient passed out and got in a car wreck when starting spironolactone. Anyone else hear this? #dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri @ilanarosman @RoxanaDaneshjou Completely agree! #dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri RT @ilanarosman: @DrJohnBarbieri @RoxanaDaneshjou I very very rarely prescribe mono cyclone for acne. Although risk of DRESS is small, it just doesn’t seem worth it to me given other options. I’ve found it relatively easy in most patients to manage photosensitivity and GI upset with doxy. #dermjc #dermatology |
| Ilana Rosman, MD @ilanarosman @DrJohnBarbieri I love spironolactone and I have definitely seen great results in female patients. But, I also have a fairly low threshold for starting isotretinoin. #dermjc #dermatology |
| Dermatology Journal Club @DermatologyJC RT @ilanarosman: @DrJohnBarbieri I love spironolactone and I have definitely seen great results in female patients. But, I also have a fairly low threshold for starting isotretinoin. #dermjc #dermatology |
| Dermatology Journal Club @DermatologyJC RT @DrJohnBarbieri: @leoshmu @RoxanaDaneshjou I prescribe a lot of isotretinoin. It is unique in that it is truly a “disease modifying” treatment. For those who don’t want to be on a medication long term, are considering pregnancy in near future (after rx), or who have severe or scarring acne, it’s a great option. #dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri @HarkerDavid What is the typical starting dose that he uses? Have not had much issue with orthostasis/hypotension at 100mg/day or less. I tell patients to take in the evening for that reason though. #dermjc |
 | Goran Micevic MD/PhD @gmicevic @RoxanaDaneshjou Reservations I sometimes hear about spironolactone: 1) patients that are sexually active/can potentially become pregnant, 2)potential for hyperkalemia. However, most of the antibiotics are class C anyway, and hyperkalemia incidence is = baseline (Plovanich et al. 2015) #dermjc |
| Ilana Rosman, MD @ilanarosman @DrJohnBarbieri @leoshmu @RoxanaDaneshjou Exactly. Although, I definitely have a fair amount of female patients (particularly in 30s-40s) who are just not interested in isotretinoin. Could be that they don’t want to have to come in every month. Or they don’t want to go back on OCPs. #dermjc |
| Dermatology Journal Club @DermatologyJC RT @gmicevic: @RoxanaDaneshjou Reservations I sometimes hear about spironolactone: @RoxanaDaneshjou Reservations I sometimes hear about spironolactone: 1) patients that are sexually active/can potentially become pregnant, 2)potential for hyperkalemia. However, most of the antibiotics are class C anyway, and hyperkalemia incidence is = baseline (Plovanich et al. 2015) #dermjc |
| Dermatology Journal Club @DermatologyJC RT @ilanarosman: @DrJohnBarbieri @leoshmu @RoxanaDaneshjou Exactly. Although, I definitely have a fair amount of female patients (particularly in 30s-40s) who are just not interested in isotretinoin. Could be that they don’t want to have to come in every month. Or they don’t want to go back on OCPs. #dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri @ilanarosman @leoshmu @RoxanaDaneshjou And some feel relapse rate for isotretinoin is higher for persistent acne in adult women compared to traditional published rates treating teenagers/young adults. #dermjc (although not much data here to guide practice) |
| Ilana Rosman, MD @ilanarosman @DrJohnBarbieri @HarkerDavid Do you start at a lower dose if the patient has a history of low blood pressure/orthostasis? What about if the patient is already on other blood pressure meds? #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DrJohnBarbieri: @ilanarosman @leoshmu @RoxanaDaneshjou And some feel relapse rate for isotretinoin is higher for persistent acne in adult women compared to traditional published rates treating teenagers/young adults. #dermjc (although not much data here to guide practice) |
| Dermatology Journal Club @DermatologyJC RT @ilanarosman: @DrJohnBarbieri @HarkerDavid Do you start at a lower dose if the patient has a history of low blood pressure/orthostasis? What about if the patient is already on other blood pressure meds? #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DrJohnBarbieri: @HarkerDavid What is the typical starting dose that he uses? Have not had much issue with orthostasis/hypotension at 100mg/day or less. I tell patients to take in the evening for that reason though. #dermjc |
| David Harker, MD, FAAD @HarkerDavid @DrJohnBarbieri Not sure what his starting dose is, but I think he was citing a lawsuit so there’s precedent out there just to be aware of #dermjc |
| Ilana Rosman, MD @ilanarosman @DrJohnBarbieri @leoshmu @RoxanaDaneshjou I also have several patients who flare predictably around menstrual cycle so they prefer to take doxy for a week or so just when flaring. Works for them, and I like that they’re not on continuous antibiotics but wondering if there are downsides to this approach...#dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri @ilanarosman @HarkerDavid Out of an abundance of caution, I would probably start at 25-50mg in that patient and uptitrate as tolerated/needed. If already on blood pressure meds, usually I don't worry (since their BP tends to be high at baseline). #dermjc |
| David Harker, MD, FAAD @HarkerDavid @ilanarosman @DrJohnBarbieri Also - what do you do if pt is on another drug with hyperkalemia risk? #dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri @ilanarosman @HarkerDavid Spironolactone is a pretty awful blood pressure medication, so I find it doesn't tend to have a big effect. We have some unpublished data that systolic BP is ~1 point lower on average when treating with spironolactone. #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DrJohnBarbieri: @ilanarosman @HarkerDavid Out of an abundance of caution, I would probably start at 25-50mg in that patient and uptitrate as tolerated/needed. If already on blood pressure meds, usually I don't worry (since their BP tends to be high at baseline). #dermjc |
| Dermatology Journal Club @DermatologyJC RT @ilanarosman: @DrJohnBarbieri @leoshmu @RoxanaDaneshjou I also have several patients who flare predictably around menstrual cycle so they prefer to take doxy for a week or so just when flaring. Works for them, and I like that they’re not on continuous antibiotics but wondering if there are downsides to this approach...#dermjc |
| Dermatology Journal Club @DermatologyJC RT @HarkerDavid: @DrJohnBarbieri Not sure what his starting dose is, but I think he was citing a lawsuit so there’s precedent out there just to be aware of #dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri @HarkerDavid @ilanarosman Then I would recommend checking potassium at least once (usually during first week after starting the medication). Hyperkalemia certainly can happen, just doesn't appear to be major issue in those without risk factors. #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DrJohnBarbieri: @HarkerDavid @ilanarosman Then I would recommend checking potassium at least once (usually during first week after starting the medication). Hyperkalemia certainly can happen, just doesn't appear to be major issue in those without risk factors. #dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri RT @HarkerDavid: @DrJohnBarbieri Not sure what his starting dose is, but I think he was citing a lawsuit so there’s precedent out there just to be aware of #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DrJohnBarbieri: @ilanarosman @HarkerDavid Spironolactone is a pretty awful blood pressure medication, so I find it doesn't tend to have a big effect. We have some unpublished data that systolic BP is ~1 point lower on average when treating with spironolactone. #dermjc |
| Roxana Daneshjou MD/PhD @RoxanaDaneshjou @ilanarosman @DrJohnBarbieri @leoshmu I’m going to keep this approach in mind. #dermjc |
| Ilana Rosman, MD @ilanarosman @DrJohnBarbieri @HarkerDavid Yep, I remember attendings checking BMP and BP about a week after starting patients on spironolactone when I was in training...everyone has stopped doing that, and I don’t either unless there is another reason to. #dermjc |
| David Harker, MD, FAAD @HarkerDavid RT @DrJohnBarbieri: @ilanarosman @HarkerDavid Spironolactone is a pretty awful blood pressure medication, so I find it doesn't tend to have a big effect. We have some unpublished data that systolic BP is ~1 point lower on average when treating with spironolactone. #dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri @HarkerDavid @ilanarosman The tricky medication is drospirenone containing COCs (e.g. Yaz). It looks like it's not an issue in the available data, so I don't tend to worry, but it's something to consider when co-prescribing. https://t.co/Ca3SSgrvYP #dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri RT @ilanarosman: @DrJohnBarbieri @HarkerDavid Yep, I remember attendings checking BMP and BP about a week after starting patients on spironolactone when I was in training...everyone has stopped doing that, and I don’t either unless there is another reason to. #dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri @ilanarosman @leoshmu @RoxanaDaneshjou We really need a lot better data on the effects of antibiotics on the #microbiome. It is likely that even short term exposure has an effect, but whether it is meaningful is something that we haven't sorted out. #dermjc |
| Dermatology Journal Club @DermatologyJC RT @ilanarosman: @DrJohnBarbieri @HarkerDavid Yep, I remember attendings checking BMP and BP about a week after starting patients on spironolactone when I was in training...everyone has stopped doing that, and I don’t either unless there is another reason to. #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DrJohnBarbieri: @HarkerDavid @ilanarosman The tricky medication is drospirenone containing COCs (e.g. Yaz). It looks like it's not an issue in the available data, so I don't tend to worry, but it's something to consider when co-prescribing. https://t.co/Ca3SSgrvYP #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DrJohnBarbieri: @ilanarosman @leoshmu @RoxanaDaneshjou We really need a lot better data on the effects of antibiotics on the #microbiome. It is likely that even short term exposure has an effect, but whether it is meaningful is something that we haven't sorted out. #dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri @ilanarosman @leoshmu @RoxanaDaneshjou It's important to keep in mind that the 3 month 'limit' in the guidelines is largely arbitrary. We don't know if 3 months is any different than 3 days or 3 years. I personally try to limit the number of pts exposed, rather than the duration of exposure in those pts. #dermjc |
 | Jules Lipoff, MD @juleslipoff @RoxanaDaneshjou @DrJohnBarbieri In general my rule now is: 1. Women: OCP and/or spironolactone, failing that isotretinoin (doxycycline only used as alternative) 2. Men: doxycycline, then isotretinoin #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DrJohnBarbieri: @ilanarosman @leoshmu @RoxanaDaneshjou It's important to keep in mind that the 3 month 'limit' in the guidelines is largely arbitrary. We don't know if 3 months is any different than 3 days or 3 years. I personally try to limit the number of pts exposed, rather than the duration of exposure in those pts. #dermjc |
| Dermatology Journal Club @DermatologyJC RT @juleslipoff: @RoxanaDaneshjou @DrJohnBarbieri In general my rule now is: 1. Women: OCP and/or spironolactone, failing that isotretinoin (doxycycline only used as alternative) 2. Men: doxycycline, then isotretinoin #dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri For patients who can't clear with topicals or with mod-severe acne, I tend to use: -Women: COC and/or spironolactone, then isotretinoin or doxycycline (depending on preferences). -Men: Straight to isotretinoin unless logistical or side-effect concerns (then doxycycline). #dermjc |
| David Harker, MD, FAAD @HarkerDavid RT @DrJohnBarbieri: For patients who can't clear with topicals or with mod-severe acne, I tend to use: -Women: COC and/or spironolactone, then isotretinoin or doxycycline (depending on preferences). -Men: Straight to isotretinoin unless logistical or side-effect concerns (then doxycycline). #dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri Excited to see some PCPs joining the discussion. Please remember to use the #dermjc hastag so everyone can see your great comments! |
| Dermatology Journal Club @DermatologyJC RT @DrJohnBarbieri: Excited to see some PCPs joining the discussion. Please remember to use the #dermjc hastag so everyone can see your great comments! |
| Roxana Daneshjou MD/PhD @RoxanaDaneshjou @ilanarosman @DrJohnBarbieri @leoshmu @washuderm #dermjc |
| Roxana Daneshjou MD/PhD @RoxanaDaneshjou @leoshmu @DrJohnBarbieri @ilanarosman #dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri @Collaterly @HarkerDavid @ilanarosman What side-effects tend to be the most problematic? #dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri @Collaterly @HarkerDavid @ilanarosman Yes, I too find diuresis is much more commonly an issue than what is reported in the literature. Sometimes I've found splitting the dose helps. There are also plenty of patients who clear on low doses 25-50mg/day, which is another option to help with side-effects. #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DrJohnBarbieri: @Collaterly @HarkerDavid @ilanarosman Yes, I too find diuresis is much more commonly an issue than what is reported in the literature. Sometimes I've found splitting the dose helps. There are also plenty of patients who clear on low doses 25-50mg/day, which is another option to help with side-effects. #dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri @Collaterly @HarkerDavid @ilanarosman Side-effects tend to get much worse at >150mg/day without as much gain in efficacy. I try to stay below 150-200mg/day and if am getting that high start to consider combination therapy or isotretinoin #dermjc |
| Roxana Daneshjou MD/PhD @RoxanaDaneshjou @leoshmu @DrJohnBarbieri @ilanarosman @WUSTLmed #dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri @laceywh @Collaterly @HarkerDavid @ilanarosman I will have to try it! #dermjc |
| Ilana Rosman, MD @ilanarosman @DrJohnBarbieri @Collaterly @HarkerDavid Interesting...I haven’t heard that from patients but I also haven’t asked! Will start asking about diuresis and see how they respond. #dermjc |
| Smriti Prasad, MD MPH @SmritiSaid @DermatologyJC I had an attending once tell me that though Spironolactone is effective, it can take longer (~6 months) to work than Doxy (~3 months), which sometimes alters his decision to use it. Wonder what others thought about this? #Dermjc |
| Roxana Daneshjou MD/PhD @RoxanaDaneshjou @leoshmu @DrJohnBarbieri @ilanarosman @WUSTLmed Sorry, I tag these with #dermjc so I can find the tweets from the main account to retweet. |
| Dermatology Journal Club @DermatologyJC RT @SmritiSaid: @DermatologyJC I had an attending once tell me that though Spironolactone is effective, it can take longer (~6 months) to work than Doxy (~3 months), which sometimes alters his decision to use it. Wonder what others thought about this? #Dermjc |
| Dermatology Journal Club @DermatologyJC RT @ilanarosman: @DrJohnBarbieri @Collaterly @HarkerDavid Interesting...I haven’t heard that from patients but I also haven’t asked! Will start asking about diuresis and see how they respond. #dermjc |
| Ilana Rosman, MD @ilanarosman @SmritiSaid @DermatologyJC I haven’t had that experience. I usually tell patients it can take 3 months to see results with both doxy and spironolactone. I have them come back around 3 months. Almost all if my patients on spironolactone are already better and very happy. #dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri @ilanarosman @SmritiSaid @DermatologyJC Yes, I too find that spironolactone does tend to start working within 8-12 weeks. It is an area where we need more data though with respect to the onset of effectiveness and time to peak effectiveness (e.g. how long to wait before uptitrating dose/switching). #dermjc |
| Ilana Rosman, MD @ilanarosman @DrJohnBarbieri @laceywh @Collaterly @HarkerDavid A pickle a day keeps the diuresis away? #dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri @ilanarosman @laceywh @Collaterly @HarkerDavid But what is the correct strength and dosing regimen for the pickles? #dermjc |
| Ilana Rosman, MD @ilanarosman @DrJohnBarbieri @SmritiSaid @DermatologyJC Yes, that’s what I would love to have a handle on - when to uptitrate. Also, how long do you leave patients on once clear? Do you taper off? Or just leave them on somewhat indefinitely...until menopause?!?! #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DrJohnBarbieri: @ilanarosman @SmritiSaid @DermatologyJC Yes, I too find that spironolactone does tend to start working within 8-12 weeks. It is an area where we need more data though with respect to the onset of effectiveness and time to peak effectiveness (e.g. how long to wait before uptitrating dose/switching). #dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri @ilanarosman @SmritiSaid @DermatologyJC I gradually try to taper off. If they are clear, usually once every 3-6 months I suggest to them the option to decrease the dose 25mg and try to gradually taper off. However, many patients end up on spironolactone for months-years. #dermjc |
| Ilana Rosman, MD @ilanarosman @DrJohnBarbieri @laceywh @Collaterly @HarkerDavid Good point. I have very strong opinions about pickles. I don’t like Vlasic...although I have to admit Vlasix is a pretty good drug name...#dermjc https://t.co/UZVDc1YLLV |
| John Barbieri, MD, MBA @DrJohnBarbieri @ilanarosman @SmritiSaid @DermatologyJC In terms of uptitrating, I typically start at higher doses (i.e. 100mg/day) to avoid need to uptitrate and rather focus on downtitrating. However, if the patient is getting clear, but not quite clear at 3-6 months, will go up on the dose usually if tolerating well. #dermjc |
| John Barbieri, MD, MBA @DrJohnBarbieri RT @ilanarosman: @DrJohnBarbieri @laceywh @Collaterly @HarkerDavid Good point. I have very strong opinions about pickles. I don’t like Vlasic...although I have to admit Vlasix is a pretty good drug name...#dermjc https://t.co/UZVDc1YLLV |
| John Barbieri, MD, MBA @DrJohnBarbieri RT @ilanarosman: @DrJohnBarbieri @SmritiSaid @DermatologyJC Yes, that’s what I would love to have a handle on - when to uptitrate. Also, how long do you leave patients on once clear? Do you taper off? Or just leave them on somewhat indefinitely...until menopause?!?! #dermjc |
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