That would be a great topic for a future video. There is very little high-quality evidence on the topic, which makes it challenging to cover other than describing how the treatments work (i.e. we don't really know which is best, etc).

A lot of reactions to benzoyl peroxide are irritant in nature and this product should help in those settings. However, for those with true allergy to benzoyl peroxide, encapsulation will not solve the issue.

Glad it was helpful!

Glad it was helpful!

Sometimes low dose or intermittent dosing regimens (e.g. MWF) are used to maintain long-term clearance in those who are prone to recurrence.

​Thanks for the reply.....can you please confirm if it a safe option ?​@@DrJohnBarbieri

I can't speak to your specific situation, and no one has specifically looked at olive oil, but 2-4T of olive oil is about 25-50g of fat, which one would expect is likely sufficient.

​@@DrJohnBarbieri Thank you so much for the response!

This is a challenging question. There is a lack of epidemiologic data to support an association between isotretinoin and diabetes. In addition, a meta-analysis exploring the effects of isotretinoin on insulin resistance suggests, if anything, a slightly beneficial effect (pubmed.ncbi.nlm.nih.gov/38921259/). That being said, as you point out there are a few case reports describing diabetes arising in the setting of isotretinoin treatment. The difficulty with interpreting these is that millions of people are treated with isotretinoin each year, so you would expect some to develop diabetes simply by chance (this same challenge applies to studying isotretinoin and inflammatory bowel disease). Ideally, we need studies with a comparator group to see if there are any differences in the rate of incident diabetes between those treated with isotretinoin and other treatments (e.g. oral antibiotics).

Thanks for sharing! Which specific products did you find most helpful?

@@DrJohnBarbieri I’ve grown my beard out now. But when I was shaving it was the Moore unique razor rash relief. There was a shave gel and a toner as well that helped with scarring.

No. In general, higher cumulative doses are associated with greater likelihood of long-term clearance, but some people need higher doses and some need lower doses. Achieving clear skin x2-3 months before stopping is a good predictor of long-term clearance.

@@DrJohnBarbieri and what type of blood test is done while on Accutane i mean what elements are essential in the report

Glad you find them helpful!

Isotretinoin does not appear to be associated with diabetes. The best evidence that we have seems to suggest, if anything, that it has a positive effect on glucose metabolism (pubmed.ncbi.nlm.nih.gov/38921259/). There is not much high-quality data with respect to the question of whether there is or is not an association between isotretinoin use and the risk of autoimmune disease such as thyroid disease and vitiligo.

@@DrJohnBarbieri are you sure it doesn’t cause diabetes? I saw few articles on pubmed which clearly states that Isotretinoin causes insulin resistance and can also trigger type 1 diabetes.

I cannot speak to your specific situation, but low dose regimens can be highly effective (with caveat being they will take longer to reach similar cumulative dose).

No one has done that study, but I would expect that they might be helpful in that setting as well.

I cannot speak to your specific situation or provide you with medical advice, and would recommend you discuss with your doctor. This article can be a helpful summary of what to expect in terms of average improvement by month: www.ncbi.nlm.nih.gov/pmc/articles/PMC7344833/

Glad you found it helpful!

I think it's possible to achieve long-term remission without severe purging. The best predictors of long-term remission are higher cumulative dose and having clear skin for a few months before stopping.

I cannot speak to your situation and you should discuss with your doctor. This video provides some general education around isotretinoin and side effects: kzbin.info/www/bejne/gYaWf6agmaZoZtE

@@DrJohnBarbieri OK, thank you :)

I have seborrheic dermatitis

Absolutely! In the AAD Acne Guidelines we recommend combining treatments with different mechanisms of action.

So winlevi, tretinoin and then moisturizer?

In general, the evidence suggests that isotretinoin is not associated with meaningful changes to bone density (pubmed.ncbi.nlm.nih.gov/8537167/; pubmed.ncbi.nlm.nih.gov/8678568/; pubmed.ncbi.nlm.nih.gov/16922957/; pubmed.ncbi.nlm.nih.gov/15523348/). An observational study by Leachman et al. found increased bone mineral density in the spine, but decrease bone mineral density at Ward’s triangle; no differences in calcium metabolism were noted (pubmed.ncbi.nlm.nih.gov/10456346/). A follow-up from this study evaluating those with decreased bone mineral density found that this improved after 5-9 years (pubmed.ncbi.nlm.nih.gov/12437467/). Notably, a well designed case-control study using the Danish registers did not identify any increased risk of fracture among topical or systemic retinoid users (jamanetwork.com/journals/jamadermatology/fullarticle/421410). Notably, several studies have identified that those with acne tend to have lower vitamin D levels and that this is associated with acne severity. Vitamin D supplementation has also been found to be helpful as an acne treatment for inflammatory lesions (pubmed.ncbi.nlm.nih.gov/33690970/). Interestingly, the Leachman et al. study also found that those with acne had lower bone mineral density compared to the controls at baseline. One important consideration is that those with severe acne might be at risk of lower bone mineral density due some shared causal pathway that also increases the risk of acne (i.e. pleiotropy). With respect to height, stay tuned. We have a few studies on this issue that I hope will be available soon (also generally reassuring).

I cannot speak to a specific situation, but isotretinoin can be helpful for sebaceous hyperplasia.

Glad it was helpful!

Vitamin A can affect neurons in the brain. Acne itself definitely can cause depressive symptoms, and this is likely why we see that on a population level isotretinoin use is associated with IMPROVED mood (since it's such a good acne treatment).

@@DrJohnBarbieri Ahhh ok. Thanks for your answer.

1. Other than isotretinoin, most acne treatments work best at managing acne, rather than putting it into long-term remission/clearance. Thus, continued use is often important to maintain results. Trials are only 12 weeks long because it is more expensive to do them for longer and one can demonstrate something works typically after 8-12 weeks. 2. Check out: kzbin.info/www/bejne/hnTKoIRmbdJqnZo and kzbin.info/www/bejne/eZfcnmqYrZZri8k

This channel is not for personal medical advice (please discuss with your doctor). In general, I do not think it matters when they are taken relative to each other.

I cannot comment on what is best for you (you should discuss with your doctor). In general, a treatment course of isotretinoin is at least 5-8 months.

I'm not sure. I don't have any relationship with the company that makes it. Agree access can often be a challenge with newer products (though eventually often becomes much better with time).

It varies by manufacturer. I do think these findings have implications for transport and suggest that cold-chain transportation might be optimal. Fortunately at baseline after they picked up from the store, most products did not have meaningful benzene levels (though Valisure has not been transparent about these data), suggesting transportation might not be a major issue with current practices.

It would be interesting if this product/technology eventually became over-the-counter (similar to adapalene). This likely would be a good product for acne as well.

Glad it was helpful!

I do not think it has as strong evidence to support effectiveness (particularly with respect to long-term improvement) for acne.

@@DrJohnBarbieri I appreciate the reply- thank you!

Will do!

Thanks for sharing your experience. Some patients do benefit from additional sessions after the 3rd.

It is debatable whether any dose of isotretinoin can cause meaningful, clinical liver damage (rather than just mildly elevated liver function tests): pubmed.ncbi.nlm.nih.gov/35986616/

@@DrJohnBarbieri My triglycerides level is very high. Should I take this medicine

Hydrocortisone (a topical steroid) often can make perioral dermatitis worse in the long run.

@@DrJohnBarbieri pls tell how many days can we use Hydrocortisone?

@@DrJohnBarbieri And can we use talimus sterile for periocular dermatitis for long run

Pat*^ dry

I cannot speak to your situation or provide personalized medical advice, but about 3% of participants in the clinical trials had to discontinue Cabtreo due to side effects. Both retinoids (adapalene) and benzoyl peroxide can be irritating and some have difficulty tolerating them or cannot tolerate them. In some of the other videos we go into strategies to avoid irritation from retinoids, but using topical retinoids every other day (works 80% as well) and applying moisturizer first can help some people.

Thanks for watching!

I hope your acne gets better soon!

Do you think 1 month is enough to cure the acne ?

Glad that you found this video helpful. This channel is not for medical advice, so I cannot comment on your specific situation. More broadly, in network meta-analyses, clindamycin-adapalene-benzoyl peroxide is much more effective than tretinoin on its own. In general, getting rid of acne often requires combining multiple treatments that work in different ways.

Yes, isotretinoin can work for acne in those with PCOS, though I think rates of recurrence might be slightly higher.

Glad that you found it helpful! Make sure to check out the other content on the channel!

Glad you enjoy the content! Sorry, I don't have enough support/funds to be able to hire someone.

Sorry to hear about your struggles with acne. While, I cannot speak to your situation, in general about 60-80% of those treated with isotretinoin have long-term clearance of acne.

@@DrJohnBarbieri Hoping to be in the 60-80% cases. Thanks for you response.

This product can be used at night, though the benzoyl peroxide component could potentially bleach fabrics (i.e. pillowcases, sheets). However, if the concern is sun sensitivity, it will occur regardless of when one applies the topical retinoid. So sun protection will still be important.

No, while a very good acne treatment, it is much less effective than oral isotretinoin (Accutane).

@@DrJohnBarbieri my acne is very mild. My doctor gave me 10mg 3 days a week for 2-3 months. But idk if its the pill but i have been feeling more down and “depressed” these past months and i noticed my body hurts much more after working out

Thanks for watching!

There are some studies about Omega-3 supplementation for primary prevention of cardiovascular disease that have suggested a potential increased risk of atrial fibrillation. However, those studies do not necessarily generalize to this scenario, which is typically a younger population and a much shorter duration of treatment (several months vs indefinite).

Thanks for sharing! Make sure to check out my other videos on perioral dermatitis.