Q&A: Aaron Farberg, MD, on Isoclear and a 3-Phase Approach to Acne Management

Acne treatment often extends beyond clearing active lesions, with clinicians also managing post-inflammatory hyperpigmentation, residual skin changes, and long-term maintenance. Isoclear, a compounded topical acne treatment developed around topical isotretinoin, uses a 3-phase regimen designed to address these changing treatment goals over time.

In an interview with Dermatology Times, Aaron Farberg, MD, a board-certified dermatologist practicing in Dallas, Texas, discussed the expected treatment timeline with Isoclear, how the regimen changes as patients progress from active acne to maintenance, and considerations surrounding antibiotic stewardship and compounded medications.

Dermatology Times: How soon can patients expect to see results with Isoclear, and what does that treatment timeline look like?

Farberg: Many patients will notice reduced oil production and calmer skin overall within the first several weeks, but the full therapeutic effect is generally seen between 6 and 8 weeks.

We also have a 3-phase regimen mapped out to help patients transition smoothly from treating active acne to addressing their longer-term skin health. It gets back to this idea of longer-term cycling. At the beginning, you have the Clear phase, where the goal is to address the active breakout. From there, we transition into treating the changes acne may leave behind and, eventually, maintaining overall skin quality.

Dermatology Times: Can you walk us through the Clear phase and what you are targeting early in treatment?

Farberg: In the Clear phase, we want to get rid of the active breakout. That's what we're targeting first.

The formulation includes topical isotretinoin to regulate cell turnover. In the short term, we also use topical clindamycin to address bacteria and acute inflammation. The idea is to aggressively target active acne early before moving into the later phases of treatment.

Dermatology Times: How does the regimen change once active acne begins to improve?

Farberg: Around months 4 to 6, we move into what we call the Fade phase. At that point, patients may be dealing with post-inflammatory hyperpigmentation and other marks left behind by their acne, so the treatment goals begin to shift.

We continue topical isotretinoin for skin renewal, but it's paired with tranexamic acid and niacinamide to help even skin tone and support the skin barrier.

Dermatology Times: What does long-term maintenance look like after patients progress through those initial phases?

Farberg: At around 6 months and beyond, we move into the Renew phase. This is really about the long-term maintenance of skin quality.

The formulation again includes topical isotretinoin, but we've also integrated GHK copper peptide, which is intended to support tissue repair, firmness, and texture. The overall goal is to move beyond simply clearing the initial breakout and think about what we're doing for the patient's skin longer term.

Dermatology Times: For clinicians who may be unfamiliar with Isoclear, what message would you share with them?

Farberg: My message to my peers would be that this is another topical, prescription-grade option that clinicians can utilize for patients with acne.

I hope clinicians try it, and I look forward to their feedback so that we can hopefully continue making this approach even better for our patients in the future.

Dermatology Times: You mentioned clindamycin is included during the initial phase. How did antibiotic stewardship factor into the design of the regimen?

Farberg: We included clindamycin in the initial Clear phase, but it was intentionally designed for short-term use. We want to aggressively knock down active inflammation and bacteria without contributing to the broader issue of prolonged topical antibiotic use.

Antibiotic stewardship was an important consideration in designing that phase of the regimen, and we followed the American Academy of Dermatology guidelines.

Dermatology Times: What should clinicians know about Isoclear being a compounded treatment?

Farberg: Isoclear is a compounded treatment prepared under Section 503A of the Federal Food, Drug, and Cosmetic Act.

We've partnered with a licensed US compounding pharmacy and utilize active ingredients sourced from FDA-registered and inspected facilities. Compounding gives us the ability to adapt these formulations for patients' individual needs.

Millions of compounded prescriptions are used in the US every year, and I think it's important for clinicians to understand where this treatment fits and how it is being prepared.

[Transcript has been edited for clarity and length.]