Derm-it Trotter! Don't Swear About Skincare.

The internet can make isotretinoin (Accutane) sound like a horror story, but the science and our day-to-day dermatology experience tell a very different story. We sit down with board-certified dermatologist Dr. Josh Grosshandler to unpack why this medication has stayed under the microscope for 40+ years and still stands as one of the most disease-changing tools we have for acne.We start with the basics: what isotretinoin is, how an oral retinoid works, and why the sebaceous (oil) gland sits at the center of acne, inflammation, and scarring. From there, we get practical about who should consider Accutane today, including patients who are not “the worst of the worst” but are developing scars, feeling burned out on long routines, or carrying a heavy mental load from persistent breakouts.Then we take on the myths head-on: Will acne purge before it clears? Does it work for hormonal acne? Can it shrink your nose? Is it truly a last resort or just a band-aid? We also tackle the biggest fear-based claims we hear online, including depression and suicide risk, infertility, permanent liver damage, and inflammatory bowel disease, plus what monitoring actually looks like in real care. You’ll also learn why absorption and taking isotretinoin with dietary fat can matter, and how simple supports like omega-3s may help with dryness.If you’ve been scared off by viral posts, we made this for you. Subscribe, share with a friend who’s stuck in the acne cycle, and leave a review if it helps. What Accutane question do you want us to answer next?DISCLAIMER: The views and opinions expressed in the Derm-it Trotter! podcast are those of the host and guests and do not necessarily reflect the views or positions of the guests’ or host’s institution or employers. The Derm-it Trotter! Podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user’s own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.

TikTok can make a 12-year-old think they need retinol and a 10-step routine, and it can make grown adults feel behind because they still have pores. We sit down with Abby Sipe, a dermatology nurse practitioner and mom raising Gen Z kids, to separate what is actually good for your skin from what is just good content.We break viral skincare into three clear buckets: helpful trends (like smarter skin barrier repair and better sunscreen habits), overhyped add-ons that are usually fine if you enjoy them, and the truly harmful stuff that can leave you inflamed or infected. You will hear practical, evidence-based guidance on choosing a sunscreen you will wear, when to consider mineral vs chemical sunscreen, and how to respond when someone says they stopped SPF because they heard it was “toxic.” We also talk about why “million-step” routines cause irritation, why at-home microneedling is risky, and what UV maxing and UV contouring are really doing to your skin long term.Along the way, we do a fun rapid-fire “trot or not” on buzzy ingredients and hacks like azelaic acid, niacinamide, snail mucin, hypochlorous acid spray, spicules “liquid microneedling,” beef tallow, and even the old toothpaste-for-acne myth. The goal is not to shame anyone, it is to help you build a simple skincare routine that protects your skin barrier, prevents skin cancer, and keeps expectations realistic in a world full of filters.If this helped you rethink your routine, subscribe, share with a friend who lives on skincare TikTok, and leave a review so more people can find science-first skincare advice.DISCLAIMER: The views and opinions expressed in the Derm-it Trotter! podcast are those of the host and guests and do not necessarily reflect the views or positions of the guests’ or host’s institution or employers. The Derm-it Trotter! Podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user’s own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.

If you have ever left a clinic wondering, “Wait, was that a doctor, a nurse, or someone else?” you are not alone, and that confusion can affect trust, follow-through, and even how quickly you get care. We sit down with Andrew Baker, a seasoned Physician Assistant working in dermatology, to make the PA role easy to understand without glossing over the details patients actually care about.We trace the history of the physician assistant profession from the access-to-care shortages that sparked the first PA program in the 1960s to the modern reality of PAs practicing across medical and surgical specialties. Andrew walks through PA education step by step: the prerequisite science track, the master’s level training model, clinical rotations, the PANCE board exam, and what ongoing continuing medical education and recertification look like over an entire career. We also get practical about scope of practice, including why what a PA can do varies by state, and how fellowship-style training programs are changing the onboarding and specialty training landscape in areas like dermatology.Then we tackle the questions patients ask in real exam rooms: how a PA differs from a nurse practitioner, what “physician assistant” versus “physician associate” means, and why name changes can create confusion even when scope is not changing. We close with what makes a PA-physician relationship work: collaboration, trust built over time, and a shared commitment to better patient care and better access.If this helped you, subscribe, share it with a friend who has asked “what is a PA?”, and leave a review so more patients can find it. What is the most confusing part of the healthcare team for you right now?DISCLAIMER: The views and opinions expressed in the Derm-it Trotter! podcast are those of the host and guests and do not necessarily reflect the views or positions of the guests’ or host’s institution or employers. The Derm-it Trotter! Podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user’s own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.

That “sandpaper” patch you keep rubbing might be more than dry skin. We sit down with board-certified dermatologist Dr. David Cleaver to talk about sun damage, actinic keratoses, and why outdoor life in rural communities can quietly build a lifetime of precancerous change. If you have a history of tanning, years of farm work, construction, or just a lot of time outside, this conversation will help you connect the dots between chronic UV exposure and the day-to-day reality of prevention. We dig into photodynamic therapy (PDT), a light treatment that targets a whole field of sun-damaged skin, not just the spots you can see. We compare PDT with liquid nitrogen freezing and topical field therapy creams like 5-fluorouracil and imiquimod, including why “less homework” can matter for real patients with real schedules. We also break down red light versus blue light PDT, how depth of penetration plays into the choice, and why many practices treat more often in fall and winter when sun avoidance is easier. You will hear the honest version of the patient experience too: incubation time, what the light can feel like, how cooling devices and protocol tweaks can improve comfort, and what recovery looks like over the following one to two weeks. We also talk about newer directions, including FDA-approved red light use for superficial basal cell carcinoma in select cases, plus other emerging and off-label areas dermatologists are watching. If you want practical skin cancer prevention that goes beyond “watch and wait,” press play. Subscribe, share this with someone who lives outdoors, and leave a review to help more people find it. What would you want to know before trying PDT?DISCLAIMER: The views and opinions expressed in the Derm-it Trotter! podcast are those of the host and guests and do not necessarily reflect the views or positions of the guests’ or host’s institution or employers. The Derm-it Trotter! Podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user’s own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.

Most skincare and dermatology treatments don’t fail because the medicine is weak. They fail because real life is messy, routines are hard, and “use this twice a day” turns into “I’ll start tomorrow.” We sit down with returning guest Dr. Steve Feldman, a board-certified dermatologist and dermatopathologist who researches medication adherence, to unpack what actually happens between the prescription and the bathroom counter. We talk candidly about why topical treatments for psoriasis and eczema are uniquely challenging, how objective tracking (like smart bottle caps) changed what we thought we knew, and why the mindset shift matters: don’t blame the patient, redesign the system. Dr. Feldman shares behavior-based tactics you can use immediately, including environmental cues, written instructions, simpler dosing, and why frequent follow-up works like piano lessons. If you’ve ever felt guilty about not using a cream exactly as directed, this conversation replaces shame with strategy. A highlight is the “three-day sprint” approach for scalp psoriasis using clobetasol, built around short timelines, realistic coaching, and accountability that mirrors why people floss right before the dentist. We also explore the future of patient engagement with AI in healthcare, including automated check-ins that may feel surprisingly supportive, plus persuasion tools like anchoring and the outsized power of a single story. If you care about better outcomes in dermatology, skincare routines, and patient-centered care, hit play, then subscribe, share this with a friend who’s struggling with a regimen, and leave a review with your biggest adherence challenge.DISCLAIMER: The views and opinions expressed in the Derm-it Trotter! podcast are those of the host and guests and do not necessarily reflect the views or positions of the guests’ or host’s institution or employers. The Derm-it Trotter! Podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user’s own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.

A painful lump in your armpit is bad enough. Now imagine it keeps coming back, forming tunnels under the skin, draining on your schedule instead of yours, and forcing you to plan your day around bandages and friction. That’s the reality for many people living with hidradenitis suppurativa (HS), and it’s why we wanted a clear, practical conversation about procedures that can actually help.We’re joined by Dr. Nader Aboul-Fettouh, a board-certified dermatologist and Mohs surgeon, to break down what HS is at the follicle level and why chronic inflammation leads to nodules, abscesses, scarring, and sinus tracts. Then we get specific about HS procedures and where they fit alongside modern medical therapy like biologics. We talk through intralesional Kenalog injections for fast flare relief, why standard incision and drainage tends to recur, and why deroofing can be such a high-satisfaction option when the same spot keeps flaring.From there, we zoom out to the bigger toolbox: excision for long-standing scar “balls” that no medication can penetrate, plus niche and emerging options like cryoinsufflation, laser hair removal, CO2 laser ablation, photodynamic therapy, IPL, and even Botox for sweat and friction. We also cover real-world constraints that patients and clinicians face, including healing expectations, skin type considerations, and insurance coverage.If you’re trying to build a smarter HS treatment plan or you care for patients with HS and want procedural options you can confidently discuss, listen now. Subscribe, share this with someone who needs it, and leave a review with your biggest HS question.DISCLAIMER: The views and opinions expressed in the Derm-it Trotter! podcast are those of the host and guests and do not necessarily reflect the views or positions of the guests’ or host’s institution or employers. The Derm-it Trotter! Podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user’s own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.

Psoriasis can look like “just plaques,” but the biology underneath is a lot bigger and a lot more hopeful than most people realize. We sit down with Dr. Naiem Issa, a board-certified dermatologist and dermatologic surgeon involved in dermatology research and drug development, to unpack what psoriasis really is: a genetically primed inflammatory disease that shows up on the skin, but also signals from within. We talk practical triggers patients actually recognize, from emotional or surgical stress to infection and skin trauma, and why the Koebner phenomenon can make injured skin a new target.We build a clear map of the immune pathway clinicians rely on when picking modern psoriasis treatments. We walk through the immune “funnel” from TNF to IL-23 and TYK2 signaling, and finally to IL-17, the key effector cytokine that helps drive rapid skin turnover, scaling, and inflammation. If you’ve ever wondered why your care team keeps mentioning cytokines, interleukins, or “biologics,” this is the plain-English framework that connects those terms to what you see in the mirror and how you feel day to day.We also get specific about IL-17 inhibitors and why “same class” doesn’t mean “same drug.” Blocking IL-17A alone, blocking IL-17A plus IL-17F, or blocking the IL-17 receptor can lead to meaningful differences in speed of clearance, durability, and what happens if you pause treatment. We discuss pharmacokinetics, withdrawal-arm trial data, time to flare, and the reassuring concept of recapturing response after restarting. We close with how we think through safety first, comorbidities like inflammatory bowel disease, joint involvement and psoriatic arthritis, injection preferences, and shared decision making.If you found this helpful, subscribe, share it with someone navigating psoriasis treatment options, and leave a review with the question you want us to tackle next.DISCLAIMER: The views and opinions expressed in the Derm-it Trotter! podcast are those of the host and guests and do not necessarily reflect the views or positions of the guests’ or host’s institution or employers. The Derm-it Trotter! Podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user’s own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.

Skincare rules feel totally different when pregnancy enters the chat, and the internet does not make it easier. We sit down with Dr. Kelly Tyler, a rare double board-certified expert in OB-GYN and dermatology, to give you a clear, evidence-based guide to pregnancy safe skincare that you can actually use at the bathroom sink. One of the biggest mindset shifts is simple: if you are trying to get pregnant, we recommend you start following pregnancy skincare guidelines now, because you can be several weeks pregnant before a home test turns positive. We break down what matters most for safety: topical vs oral exposure, how much skin you apply a product to, and why product “vehicles” like ointments can absorb more than gels or liquids. Then we get specific about acne treatment during pregnancy, including why topical retinoids like adapalene and tretinoin are best avoided, while ingredients such as azelaic acid, benzoyl peroxide, and salicylic acid are often reasonable options when used appropriately. For tougher cases, we talk through which oral antibiotics are commonly used in pregnancy and which medications to avoid, including tetracyclines and doxycycline. We also tackle melasma in pregnancy, the hydroquinone warning, and why sunscreen is still the best daily anti-aging and hyperpigmentation prevention tool. From bakuchiol and “natural” skincare claims to newer trends like peptides and exosomes, we share a practical rule: if the data is thin, it is okay to pause. Finally, we cover eczema and pregnancy, including how to use topical steroids conservatively and what we know about short courses of oral steroids for severe flares. If this helped you feel calmer and more confident about pregnancy safe skincare, subscribe, share this with a friend who is trying to conceive, and leave us a review so more people can find science-first guidance. What product are you most unsure about right now?DISCLAIMER: The views and opinions expressed in the Derm-it Trotter! podcast are those of the host and guests and do not necessarily reflect the views or positions of the guests’ or host’s institution or employers. The Derm-it Trotter! Podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user’s own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.

Medicare rules can feel distant until they change what happens in the exam room. Today we sit down with board-certified dermatologist and leading advocate Dr. Sandy Marchese Johnson to explain why a new CMS proposal has physicians calling it a “three-part bomb” and why patients should care right now.We start with the uncomfortable math: Medicare physician reimbursement has effectively gone down over decades, even as inflation and practice expenses rise. Then we translate policy into real life. The proposed modifier 25 change could cut payment when we evaluate a problem and do a procedure on the same day, the exact kind of efficient, patient-friendly visit many people depend on. That can push clinics toward split appointments, more travel, more time off work, and delays for things like biopsies or treatment of multiple concerns in one visit.We also dig into the overhead most patients never see: staffing ratios, supplies, rent, insurance, and the technology required to run a modern dermatology practice. Proposed changes to indirect expense calculations could hit in-office specialties especially hard and accelerate consolidation, shrinking access to independent private practices. Finally, we talk about who gets a voice in how medical services are valued, why clinician input matters, and what the CMS timeline looks like from public comment to potential January 1 implementation.If you’ve ever wondered why call-backs take longer, why waitlists grow, or why clinics ask you to come back for something that used to happen the same day, this conversation connects the dots. Subscribe, share this with someone who relies on Medicare, and leave a review with your biggest question about how these rules should be written.DISCLAIMER: The views and opinions expressed in the Derm-it Trotter! podcast are those of the host and guests and do not necessarily reflect the views or positions of the guests’ or host’s institution or employers. The Derm-it Trotter! Podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user’s own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.