Beyond Isotretinoin: Long Term Management, Controversies, and What’s Next in Acne

Part two of this Acne Awareness Month series picks up with the questions that can make isotretinoin feel a little complicated. Jamie Restivo, PA-C, and John Barbieri, MD, MBA, move into the issues clinicians counsel on constantly, like psychiatric safety, inflammatory bowel disease, lab monitoring, supportive skin care, maintenance after treatment, and newer as well as trending acne therapies. 

Dr Barbieri brings a measured, evidence-based approach to psychiatric counseling, acknowledging that mood changes can occur while emphasizing the broader context of acne’s psychosocial burden. He also discusses how he talks about inflammatory bowel disease, why acne and IBD may share inflammatory pathways, and the ways prior antibiotic exposure can complicate interpreting risk. 

The episode then turns to lab monitoring, where practice patterns still vary widely. Dr Barbieri walks through his approach to baseline and peak-dose testing, triglycerides, liver enzymes, and less frequent monitoring. The conversation stays practical, with attention to what actually changes management vs what may simply add burden for patients. 

From there, Restivo and Dr Barbieri move into the supportive care patients need to get through treatment: barrier-focused cleansers and moisturizers, lip care, dry eye, nasal dryness, and what to avoid while on isotretinoin. They also discuss the end of a course, including when doing nothing may be appropriate, when topical retinoids may make sense, and recognizing patient anxiety about recurrence in the plan. 

The episode closes by widening the lens to acne care beyond isotretinoin, including LED light devices, hormonal therapy, topical retinoids, clascoterone, and oral antibiotics. It is a jam-packed conversation about prescribing thoughtfully, counseling honestly, and building acne treatment plans that are both evidence-based and real-world.