Rosacea Support Group » accutane

Accutane Dose 22mg a day compares well to low doses of Doxycycline

David Pascoe — Tue, 20 Apr 2010 10:45:39 +0000

A paper that Rosacea News previewed in November last year: Accutane dose of 22mg a day works best: EADV has now been published in the JDDG: Journal of German Society of Dermatology.

As we learned from the EADV paper, the Spanish pharmaceutical company Almirall is hoping to promote their “branded version of isotretinoin in the treatment of rosacea.” It seems like a bold move; to attempt to market oral isotretinoin as an alternative to oral antibiotics.

For those enrolled in this blind study, 0.3 mg/kg per day was found to be as effective as 50mg a day of doxycycline at treating the papules, pustules and phymatous growth of rosacea.

Getting the dose right is important if you want to try Isotretinoin as a treatment for your troublesome rosacea. How do you know if you are taking too much ? A high dose of accutane can lead to unpleasant side effects and even worsen the flushing associated with rosacea.

If you consider an average weight of 166 pounds (around 75kg) this paper would lead to a recommended dosage of around 22mg a day. Even this amount may be viewed as moderate to high when compared to advice from Dr. Plewig that “doses of isotretinoin typically used in the United States and Europe are far too high. For many patients, as little as 2.5 mg twice a week, which he describes as `a drop of rain on a dusty road’ is adequate.”

For more information see what accutane dose works for rosacea ?

Systemic isotretinoin in the treatment of rosacea – doxycycline- and placebo-controlled, randomized clinical study. J Dtsch Dermatol Ges. 2010 Mar 12.

Authors: Gollnick H, Blume-Peytavi U, Szabó EL, Meyer KG, Hauptmann P, Popp G, Sebastian M, Zwingers T, Willers C, von der Weth R

Summary Background: Systemic isotretinoin has been known for decades to be effective in the treatment of severe forms of rosacea, but it must be used off-label because of the lack of evidence-based data.

Patients and Methods: 573 patients with rosacea subtype II and III received one of three different dosages of isotretinoin (0.1 mg, 0.3 mg, or 0.5 mg per kg body weight), doxycycline (100 mg daily for 14 days, then 50 mg daily) or placebo in a double-blinded, randomized way for 12 weeks in 35 German centers.

Results: Isotretinoin 0.3 mg/kg proved to be the most effective dose with significant superiority versus placebo. Isotretinoin 0.3 mg/kg showed also significant non-inferiority versus doxycycline with reduction of lesions of 90 % compared to 83 % with doxycycline. Investigators diagnosed complete remission in 24 % and marked improvement in further 57 % of patients with isotretinoin treatment, in contrast to remission in 14 % and marked improvement in 55 % of patients treated with doxycycline. Isotretinoin 0.3 mg/kg revealed a similar safety profile as for the treatment of acne. Isotretinoin 0.5 mg/kg showed more dermatitis facialis as compared to 0.3 mg/kg.

Conclusions: Isotretinoin 0.3 mg/kg is an effective and well-tolerated therapy option for the treatment of rosacea subtype II and III and can therefore be used successfully as an alternative to therapy with oral antibiotics.

Accutane dose of 22mg a day works best: EADV

David Pascoe — Wed, 18 Nov 2009 13:02:54 +0000

A summary from a the recent 18th Congress of the European Academy of Dermatology and Venereology has presented some findings relating to the most effect dosage of accutane to treat rosacea.

Accutane (Isotretinoin) has been successfully prescribed in low doses to treat rosacea, and especially the `lumps and bumps’ of rosacea that have not responded to other treatments.

Despite some good published papers that deal with treating rosacea with low doses of accutane, officially isotretinoin needs to be prescribed `off label’ for treating rosacea.

For those enrolled in this blind study, 0.3 mg/kg per day was found to be as effective as 50mg a day of doxycycline at treating the papules, pustules and phymatous growth of rosacea.

Dr. Erdogan et.al. suggested that “In our small group, using a daily dose of 10 mg of isotretinoin, we did not observe such adverse effects. Although we selected patients resistant to treatment with a long history of complaints, our results confirmed the efficacy of isotretinoin use, but whether remissions will continue after the cessation of treatment is not addressed by our study.”

Further, advice from Dr. Hofer suggests doses of around 3mg to 8mg in what he calls his continuous microdose regime are suitable for treating rosacea. In 2000, Palmer et al. showed that continuous microdose isotretinoin (CMI) treatment (0.04-0.11 mg/kg daily) was sufficient to control adult relapsing acne, but they mentioned that this is an unlicensed method administration.

This paper will hopefully give some weight to the argument that under controlled circumstances, in the right doses, and for the indicated rosacea symptoms, low dose accutane can be a viable treatment.

If indeed this research helps lead to accutane being available as an on-label prescription for rosacea sufferers, then that is good news especially for those desperate for relief from the recalcitrant lumps and bumps of rosacea.

Optimal Isotretinoin Dosing for Rosacea Identified

BERLIN (EGMN)–Isotretinoin could be headed for a new indication as a licensed treatment for rosacea.

The workhorse oral retinoid has been used off label to treat challenging cases of rosacea for more than 2 decades. However, Barcelona-based Almirall recently sponsored a successful multicenter randomized trial aimed at earning an indication from regulatory authorities for its branded version of isotretinoin in the treatment of rosacea, Dr. Harald Gollnick said at the annual congress of the European Academy of Dermatology and Venereology.

The double-blind, 12-week study involved 224 patients with the papulopustular or phymatous forms of rosacea. Participants in the five-armed trial were randomized to isotretinoin at 0.1, 0.3, or 0.5 mg/kg per day; doxycycline at 100 mg per day followed by 50 mg per day; or placebo, explained Dr. Gollnick, professor of dermatology at Otto-von-Guericke University, Magdeburg, Germany, and president of the European Board of Dermato-Venereology.

The optimal isotretinoin dose proved to be 0.3 mg/kg per day. Its efficacy was superior to placebo and similar to that of doxycycline, with both regimens achieving a 90% reduction in papules and pustules at 12 weeks, according to Dr. Gollnick, who is also chairman of the Global Alliance to Improve Outcomes in Acne, an international group of acne experts.

“That means in the near future we’ll most probably have an on-label indication for isotretinoin in rosacea,” he said.

Over the years isotretinoin has been used off label to treat rosacea, but the best dose was a matter of guesswork. The Almirall-sponsored trial is particularly welcome because it is the first formal study aimed at defining the optimal dose, added Dr. Gollnick.

The 0.3 mg/kg dose was associated with a low rate of side effects, consisting mainly of mild lipid changes and liver enzyme elevations. The 0.5 mg/kg dose wasn’t any more effective, and it produced more irritation and facial dermatitis. The 0.1 mg/kg dose, while significantly better than placebo, was less effective than 0.3 mg/kg.

Topical therapies for rosacea include 0.5%-2% metronidazole, azelaic acid, 0.025% tretinoin, and 2.5%-5% permethrin. Systemic treatments include metronidazole at 500 mg/day, minocycline at 50 mg/day, tetracyclines at 0.5-1.5 g/day, and a subantimicrobial formulation of doxycycline.

Over to You

What dose of accutane have you found to work best for you ?

accutane and drinking alcohol – no problem, apparently

David Pascoe — Thu, 09 Jul 2009 02:07:18 +0000

This just published abstract is suggesting that it appears to be safe to consume alcohol while taking accutane.

Whilst the Accutane Prescribing Information does not prohibit the consumption of alcohol, it does suggest that alcohol may add to any issues with triglycerides induced by accutane. So it is probably wise to moderate alcohol consumption, despite this study using several patients with `considerable weekly alcohol intake’. Accutane is thought to cause depression in some people, and adding a depressant like alcohol to this combination could be risky.

Interesting that the study found a steep enough drop off in the studied teratogenics after 1 month post treatment to suggest that pregnancy would be safe. The Accutane Prescribing Information also suggests that you should not donate blood for 1 month following ceasing treatment.

This is just one study of course. When you read the list of potential side effects you can’t but think you still need to follow a doctor’s advice carefully. I’d be inclined to read the prescribing information closely and heed my doctor’s advice before taking this study’s findings too far.

One final word of warning, although there is no substantive link between alcohol and rosacea, alcohol can cause strong flushing symptoms. As most rosacea sufferers will tell you, reducing obvious flushing triggers, where possible, is worthwhile pursuing.

The metabolism and pharmacokinetics of isotretinoin in patients with acne and rosacea are not influenced by ethanol, Br J Dermatol. 2009 May 21, Grønhøj Larsen F, Jakobsen P, Grønhøj Larsen C, Heidenheim M, Held E, Nielsen-Kudsk F.

Background: Isotretinoin is effective in the treatment of severe acne and rosacea. Both parent drug and its main metabolite 4-oxo-isotretinoin are potentially teratogenic compounds and contain a carboxylic acid moiety. In the presence of ethanol, naturally occurring as well as synthetic retinoids also containing a carboxylic acid moiety are capable of undergoing an ethyl esterification with the metabolic formation of more lipophilic compounds with a much longer terminal half-life.

Objectives: To determine if isotretinoin (13-cis-RA), its main metabolite 4-oxo-isotretinoin (4-oxo-13-cis-RA), and other possible metabolites in the presence or absence of ethanol are converted to their corresponding ethyl derivatives in patients with severe acne or rosacea after multiple isotretinoin dosing. In addition, pharmacokinetic parameters of the parent drug and its 4-oxo metabolite were determined.

Patients/methods: Eleven patients with severe acne or rosacea were treated with isotretinoin daily for 3 months and investigated pharmacokinetically during 24 h after 1 month of treatment and for up to 28 days after discontinuation of therapy. A possible influence of ethanol was evaluated using a simple self-administered questionnaire and by measuring serum ethanol levels during treatment. The concentrations of isotretinoin, 4-oxo-isotretinoin and possible ethylated and nonethylated metabolites were measured by reverse-phase high-performance liquid chromatography.

Results: Although seven of 11 patients had a considerable weekly alcohol intake, no endogenous synthesis of ethyl derivatives of isotretinoin, the main 4-oxo metabolite or the all-trans compounds was chromatographically detectable in any of the patients’ plasma samples during the treatment period. Multiple dose pharmacokinetic data for the parent drug and its main metabolite were comparable to previous studies.

Conclusions: The metabolism and pharmacokinetics of isotretinoin and its main metabolites are not influenced by ethanol during long-term isotretinoin treatment. After ceasing long-term isotretinoin therapy the recommended period of 1 month for using anticonceptive measures in fertile women seems adequate.

How to cure a red swollen nose

David Pascoe — Thu, 13 Nov 2008 05:33:17 +0000

The red swollen nose of rosacea is a much hated symptom. I know that this was the symptom that I despised most and indeed drove me 10 years ago to start to look for good information about how to treat rosacea. Incidentally, this drive lead to the creation of the internet based Rosacea Support Group in 1998.

I hated that I looked like I had adult acne and a constant sun-burned nose. Especially as I have somewhat fair skin, a red nose stood out a mile away.

There has been quite a lot of interest in a article I wrote titled “how to cure a red face (facial erythema or redness)“. That article gave some tips on how to deal with general facial redness. What about a red and swollen nose ? What can you do to treat a red rosacea nose ? Read on for some suggestions.

A rosacea nose has the extra complication that one might end up suffering from rhinophyma. Although rare, rhinophyma is also a much hated symptom of rosacea. While we don’t know for sure how any particular rosacea sufferer’s symptoms will progress, reducing your inflammation and flushing is a good start to winning the battle.

Here are my top tips for dealing with the red nose of rosacea.

Rosacea-LTD III

Rosacea-LTD was one of my first discoveries after starting to look for treatments on the internet in 1998. They consist of compressed disks of sulfur and various salts. You wet your face and glide them over the skin, leaving a thin film. For me these `disks’ did a great job of reducing the papules and pustules on my nose. I could feel them shrinking all those acne looking lumps and bumps. As much of my redness was associated with my papules and pustules, this treatment was a good step in the right direction. I continued to use rosacea-ltd for several years.

Disclaimer: rosacea-ltd is a site sponsor of rosacea-support.org

Oral Antibiotics

If the nasal swelling is associated with the papules and pustules normally seen in rosacea, then systemic antibiotics along with topical metrogel or finacea may also be of benefit. Once the papules and pustules are under control, the associated swelling may be reduced enough to see an overall benefit in appearance. One of the newer antibiotics on the market is a low dose form of doxycycline called Oracea, which may be useful in helping to maintain a long term benefit from antibiotic usage.

Accutane

Accutane or roaccutane has been used for many years to treat cystic acne. There is a good body of evidence to say that you can successfully treat rosacea with accutane. Additionally there are some published papers that deal specifically with treating rhinophyma with accutane.

Isotretinoin has also been demonstrated to decrease nasal volume in rhinophyma. The most significant regression has been noted in younger patients with less advanced disease.

…

Isotretinoin has also been demonstrated to decrease nasal volume in rhinophyma. The most significant regression has been noted in younger patients with less advanced disease.

Biopsy specimens from phymatous skin prior to isotretinoin therapy showed numerous large sebaceous glands. During isotretinoin therapy, the glands diminished in size and number. Other studies have confirmed the usefulness of isotretinoin for phymatous change.

[See treating rhinophyma with accutane]

Accutane is not a drug to be taken lightly. If you would like to try this as an option, the above references might help you find a doctor that can support you using this as a treatment option. You may also want to discuss the option of low-dose accutane with your doctor.

Covering Up

As you start to reduce the inflammation, you will probably also benefit from covering over some of the redness. Some options include the easily available Clinique Redness Solutions, or Eucerin Redness Relief which may be able to offer some relief from the redness. Additionally the green tinted version of the Tone Perfecting Cream may cover some redness.

Perhaps you can find some foundation or tinted moisturizer that you can also include in your daily regime. It might not be easily obtainable worldwide, but The Cancer Council in Australia has a range of tinted moisturiser SPF 25 that looks interesting. Don’t discount a liquid foundation as a possibility, even if you are a guy.

IPL and Lasers

We now know that IPL is excellent for treating a red face and broken blood vessels. Will any of the benefits of IPL also help a red swollen nose ? In general IPL and pulsed dye lasers are useful in reducing the redness flushing, burning, itching, dryness and swelling of rosacea.

The AAD suggests that for thickening of the skin on the nose and cheeks as seen in rhinophyma, the CO2 laser and erbium:YAG laser can be used.

Surgical Options

When the growth of the nose tissue becomes impossible to manage with topicals or isotretinion, surgical intervention can be an option. Surgery can naturally have its own risks. With the removal of extra tissue also comes the risk of scarring.

CO2 Laser

A 2004 paper; The Gold Standard for Decortication of Rhinophyma: Combined Erbium-YAG/CO2 Laser, details how the authors suggest that the combined YAG/CO2 laser is superior to other lasers, scalpel, radiotherapy and skin grafts in dealing with rhinophyma.

Also some related comments from the AAD page Is laser treatment right for your rosacea? ;

Some patients with longstanding rosacea develop thickening skin on the nose and cheeks, which is called rhinophyma. The CO₂ laser and erbium:YAG laser can be used to remove this thickening skin and improve the contour of the nose. Other surgical procedures used to treat this condition include dermabrasion and excision with a scalpel. Treatment options may be combined to obtain best results.

Dermatologists recommend early treatment of rhinophyma to help prevent the condition from progressing and becoming more difficult to treat. In the advanced stages, rhinophyma can cause difficulty breathing through the nose. It also is possible for the nostrils to collapse.

Other Surgical Methods

A 2003 paper; New surgical adjuncts in the treatment of rhinophyma: the microdebrider and FloSeal details a novel technique using a standard microdebrider followed by a haemostatic sealant to eliminate bleeding.

Now Over to You

What have you found to be useful in your battles with a red nose ? Please help your fellow rosacea sufferers by leaving a comment below.

how to decrease your visible pore size

David Pascoe — Tue, 28 Oct 2008 02:57:14 +0000

A question we hear from time to time from rosacea sufferers is `how do I go about reducing the size of my skin pores ?’ This is quite a difficult question to properly answer. The enlarged pores that you sometimes see with rosacea or acne can feel like they will never go away.

You are here on this page because you feel sure that there must be a way to reduce the inflammation that leads to swollen pores on your face.

Here are some insightful thoughts from Dr. Linda Sy;

Pores can appear enlarged if filled with sebum & keratinized cells. When the epithelial cells are exfoliated or the sebum production is inhibited (example: by topical tretinoin or accutane prescription), the pores appear smaller. Therefore, any prescription that will reduce accumulation of sebum & keratin in the pores, will most likely help reduce the size.

I doubt that many doctors would recommend that you undertake a treatment regime of accutane just to reduce visible facial pores. If you also have the lump and bumps of acne, or severe pustules and redness of rosacea, you may find accutane is helpful in reducing the pore size also.

The NRS Ask the Doctors Blog also has a post asking Rosacea has made the pores on my face large. When I get my rosacea under control, will my pores return to their normal size?

The Rosacea Experts also come to a similar conclusion as Dr. Sy;

Topical and oral antibiotic therapy may be prescribed for mild cases, but more severe cases may sometimes be treated with isotretinoin, which is an oral medication typically used for severe acne. Clinical studies have shown that patients’ large sebaceous glands were diminished in size and number during isotretinoin therapy. There is also evidence that retinoids, topical medications with many of the same properties of isotretinoin, may decrease skin thickening and sebaceous gland enlargement. Spironolactone, a mild diuretic with anti-androgen properties, can also be used to decrease pore size.

Good to see some more suggested treatments for enlarged pores as I know this is something that worries many rosacea sufferers.

Over To You

Please leave a comment below with any hints or tips you have found that have helped you answer the question “how do I reduce the size of my pores ?”

rosacea not on your face, it is possible

David Pascoe — Tue, 08 Jan 2008 06:46:12 +0000

One often asked question by newly diagnosed sufferers is `can you get rosacea on areas other than your face’. The usual answer is no; you normally only see rosacea symptoms on the flushing zone areas in the central areas of your face. This paper slightly dispels this idea with a case report about one patient who had rosacea lesions on his arm, and upper chest area.

Rosacea with extensive extrafacial lesions, Int J Dermatol. 2008 Jan;47(1):52-5, Pereira TM, Vieira AP, Basto AS
Rosacea is a very common skin disorder in the clinical practice that primarily affects the convex areas of the face. Extrafacial rosacea lesions have occasionally been described, but extensive involvement is exceptional. In the absence of its typical clinical or histological features, the diagnosis of extrafacial rosacea may be problematic. We describe an unusual case of rosacea with very exuberant extrafacial lesions, when compared with the limited involvement of the face.

The patient had papules, red nodules, pustules and large granulomatous lesions involving the face, neck and upper chest, and extending from the left shoulder along the whole left arm. It was mostly missing from the central facial region. Demodex was not seen as a possibility.

The treatment regime was deflazacort (an oral steroid) 30mg for 3 weeks, azithromycin at 500mg, 3 days a week for 4 weeks and isotretinoin (accutane) 10mg a day for 1 year. The accutane was reduced in the later months. The patient was advised to avoid the sun and use a physical sunscreen (i.e. zinc oxide or titanium dioxide based).

After 1 year, the chest, left shoulder and arm were clear, with some facial redness remaining.

In order to diagnose these symptoms as being rosacea-like, the doctors had to rule out several other possibilities like infectious folliculitis and demodicosis.

Therefore, in this case, the presence clinically of inflammatory papules, pustules, and nodules on a congestive background, with spread from the typical midfacial involvement to other areas of the body, and the presence of poorly organized epithelial granulomas and follicular pustules in the biopsy allow the diagnosis of extrafacial rosacea.

A review of 53 cases of granulomatous rosacea found extrafacial lesions in 15% of the patients.

Interestingly the patient was treated with low-dose accutane and pulse dosing with azithromycin. A 3 week dose of oral steroids was also included.

The paper ends with the following conclusion.

Reports of extrafacial rosacea are rather scarce. However, it may be
more common than it is thought, because it is generally not considered and/or not researched. We presented an unusual setting of extrafacial rosacea that is remarkable for the exuberant and extensive involvement, when comparing with facial involvement, the initial diagnostic difficulty and the good therapeutic results obtained

What about you, have you ever suspected that you have `extrafacial rosacea’ ? How did you treat it ? Leave a comment below.

rambazole dose and side effects being studied

David Pascoe — Tue, 20 Feb 2007 07:03:00 +0000

This AAD Poster Session shows that the study of Rambazole is continuing, this time dosage and side effects are being investigated.

Tolerability, safety, and pharmacokinetics of single and multiple oral
dosages of R115866 in healthy volunteers, Marina Cools, PhD, Barrier Therapeutics, Geel, Belgium; Geert Cauwenbergh,PhD, Barrier Therapeutics, Geel, Belgium; Fre´de´ric Vanhoutte, MD, JanssenResearch Foundation, Beerse, Belgium; Lieve Vandeplassche, PhD, Barrier Therapeutics, Geel, Belgium

Introduction: R115866 is a novel benzothiazole derivative which potently and selectively inhibits cytochrome P450-dependent all-trans retinoic acid (RA) catabolism. R115866 enhances endogenous RA levels primarily in tissues where RA is metabolized. Currently, an oral clinical development program for psoriasis and acne has been started.

Objectives: Assess safety, tolerability, and pharmacokinetics of single and multiple oral dosages of R115866. Design: In a first trial, male volunteers were dosed with a single dose of 0.6, 1.25, 2.5, 5, 10, or 20 mg R115866 or placebo. In the 2nd trial, male volunteers were treated b.i.d. for 8 days with dosages of 0.5, 2, and 4 mg R115866 or placebo.

Safety and Tolerability: No clinically relevant changes in laboratory and cardiovascular parameters were seen in either trials. No AEs were observed with 0.6 mg, 3 of 6, and 2 of 6 subjects receiving 1.25 and 2.5 mg reported AEs; all subjects receiving 5mg or higher experienced AEs, the most frequent were erythema and skin peeling. After multiple dosing, the AEs reported were those known to be associated with increased levels of RA in tissues. Most frequent AEs were dry mouth and dry skin. Additionally, a dose-dependent incidence of headache was shown. No SAEs or withdrawal due to AEs were reported. Pharmacokinetics and pharmacodynamics (multidosing trial) PK data are summarized below. Steady-state plasma levels of R115866 were reached after one day dosing. All treatments with R115866 resulted in increases in endogenous RA plasma levels; the total placebo-corrected increase at day 1 averaged 1.8, 2.8, and 2.6 ng/mL and 0.7, 1.4, and 1.9 ng/mL at day 8 for the different dosages of R115866.

Discussion: Four mg R115866 b.i.d. was considered medically safe, but moderately tolerated due to cutaneous RA-related effects. Treatment with 0.5 and 2mg R115866 b.i.d. was well tolerated. These doses are recommended to continue clinical development.

Supported by Barrier Therapeutics.

Poster Abstract P2782, American Academy of Dermatology, 65th Annual Meeting February 2-6, 2007, Washington, DC. Published in Journal of the American Academy of Dermatology Volume 56, Number 2.

Further Reading ;

long term accutane experience from Rick

David Pascoe — Tue, 21 Nov 2006 02:55:00 +0000

Thanks to Rick for continuing to share his experiences in taking accutane long term at low dosage. We really appreciate you continuing to keep us up to date with how accutane is helping you treat your rosacea. It is only through these sort of detailed reports that we can all learn how best to use the available treatments.

As Rick mentions in his most recent message, he first posted some encouraging comments 5 years ago – `Rosacea: dramatic results with low dose accutane‘. Now he has posted a new message to the group – `An update – 5+ years on low-dose accutane‘.

Rick decided to experiment and stop taking accutane this year. His ongoing dose was two 20mg tablets per week. His rosacea symptoms returned after 4 months. After again returning to taking accutane, the same dramatic effect he felt 5 years ago returned.

Some extracts ;

From: rdl000@_.com
Date: Fri, 17 Nov 2006 01:14:00 -0000
Subject: [rosacea] An update – 5+ years on low-dose accutane

On July 1 this year, I decided to stop accutane completely, just to see if there was any persistent effect. I also started taking a multi-vitamin daily, with standard Vitamin A dosage (which is orders of magnitude lower in retinol than isotretinoin).

For a couple of months, everything was going quite well, and I was about to post here that *possibly* Vitamin A, in conventional doses, could act as a surrogate for accutane in terms of its anti-inflammatory effect.

However, after 4 months of being off accutane, the redness and even some p&p (for first time) came with vengeance. So, on November 1, resumed accutane, taking 4 20 mg tabs over first 7 days. The improvement was (once again) dramatic, and with very high confidence, I believe this could not be observed in any random 1 week period. In other words, it is significant. It is quite reminiscent of what I reported 5 years ago.

…

In my view, this cannot be due to the recognized reduction in seb gland activity. There is some inexplicable anti-inflammatory effect that kicks in almost immediately. I suspect I will lose a little bit of the impact again over time, but I am now convinced that (a) it works and (b) if I stop it, I lose the impact. I may need to take it forever.

treating rhinophyma with accutane (roaccutane, isotretinoin)

David Pascoe — Tue, 26 Sep 2006 02:28:00 +0000

If you are suffering from early stage rhinophyma you may like to consider accutane. There are some good, recently published articles that focus on rosacea and low-dose accutane. It is more difficult to find studies that specificially address treating rhinophyma with accutane.

Unfortunately doctors are finding it harder and harder to prescribe accutane. The wikipedia page on iPledge (the mandatory distribution program in the United States for isotretinoin) has the following quote on how hard it is becoming to get accutane.

In the RxDerm dermatology user group, a physician said, “It will be easier to get a firearm, an abortion or Thalidomide, than to obtain this safe and important medication.”

See Also: Dermatologists Frustrated With Problematic iPledge Program, AAD 64th Annual Meeting, Focus session, March 6, 2006

Hopefully good, peer-reviewed medical data may help you explore accutane as a rhinophyma treatment option.

CONTINUING MEDICAL EDUCATION: Rosacea: II. Therapy (Full Article PDF) J Am Acad Dermatol 2004;51:499-512, Michelle T. Pelle, MD, Glen H. Crawford, MD, and William D. James, MD, Boston, Massachusetts, and Philadelphia, Pennsylvania

Page 7:

Isotretinoin has also been demonstrated to decrease nasal volume in rhinophyma [70][75]. The most significant regression has been noted in younger patients with less advanced disease [75].

Biopsy specimens from phymatous skin prior to isotretinoin therapy showed numerous large sebaceous glands. During isotretinoin therapy, the glands diminished in size and number. Other studies have confirmed the usefulness of isotretinoin for phymatous change [76][77].

Page 11:

Phymatous subtype

Isotretinoin monotherapy is beneficial for early to moderate phymatous rosacea. Advanced phyma should be treated with surgical therapy or the combination of surgery followed by isotretinoin therapy. Surgical approaches to the reshaping of rhinophyma have included the use of a heated scalpel, electrocautery, dermabrasion, laserablation, tangential excision combined with scissor sculpturing, and radio frequency electrosurgery. Often a combination of these approaches is used to obtain the best aesthetic result [76][117][118].

These 2 short extracts refer to the following papers:

[70] Schmidt JB, Gebhart W, Raff M, Spona J. 13-cis-Retinoic acid in rosacea. Clinical and laboratory findings. Acta Derm
Venereol 1984;64:15-21.
[75] Irvine C, Kumar P, Marks R. Isotretinoin in the treatment of
rosacea and rhinophyma. In: Marks R, Plewig G, editors. Acne
and related disorders: proceedings of an international sym-
posium. London: Martin Dunitz; 1988. p. 301-5.
[76] Lloyd KM. Surgical correction of rhinophyma. Arch Dermatol
1990;126:721-3.
[77] Jansen T, Plewig G. Clinical and histological variants of rhinophyma, including nonsurgical treatment modalities.
Facial Plast Surg 1998;14:241-53.
[117] Kotrajaras R, Kligman AM. The effect of topical tretinoin on photodamaged facial skin: the Thai experience. Br J Dermatol
1993;129:302-9.
[118] Kligman AM, Leyden JJ. Treatment of photoaged skin with topical tretinoin. Skin Pharmacol 1993;6:78-82.

The full article: Rosacea: II. Therapy is available via a PDF download.

Related Articles:

oral rambazole and psoriasis: phase IIA study from AAD Poster

David Pascoe — Thu, 23 Mar 2006 22:28:00 +0000

Oral R115866 in patients with moderate to severe plaque-type psoriasis: Safety evaluation from a phase IIA trial

Peter van de Kerkhof, MD, PhD, University Hospital Nijmegen, Princeton, NJ,
United States; Joahan Mertens, Barrier Therapeutics, Geel, Belgium; Peter
Steijlen, MD, PhD, University Hospital Maastricht, Maastricht, Netherlands

R115866 is a second-generation retinoic acid metabolism-blocking Agent (RAMBA), which has been shown to generate retinoid–mimetic biologic effects in various retinoid-sensitive animal models of keratinization by increasing endogenous retinoic acid (RA) levels.

Objective: The objective of this trial was to assess the efficacy and safety of a oncedaily oral dose of 1 mg R115866 for 8 weeks in patients with moderate to severe plaque-type psoriasis.

Patients and Methods: Open-label, single-arm, multicenter trial with 17 patients diagnosed with moderate to severe plaque-type psoriasis. Patients were treated orally once daily with 1mg of R115866 for 8 weeks. Safety parameters were assessed through clinical monitoring (hematology, biochemistry, endocrinology, and urinalysis), cardiovascular safety monitoring, assessment of hypervitaminosis A tolerance, and plasma RA measurements at baseline visit, at the end of the 1-, 2-, 4- and 8-week treatment phase and after a 2-week follow-up period.

Results: At the end of the 8-week treatment phase, the median PASI score relative to baseline was 49%. No deaths or serious adverse events (AEs) occurred. Most AEs were mild to moderate (33.7% and 52.3%); the most frequent AEs were skin and appendages disorders (52.8%, n = 16) and gastrointestinal disorders (20.8%, n = 13). Severe AEs observed in more than 1 subject were pruritus (n = 5) and xerosis (n = 2). Laboratory values normal at baseline and out-of-range in at least 2 subjects at 2 visits throughout treatment/follow-up were for hemoglobin, ALAT, ASAT (n = 2), chloride (n = 3), and triglycerides (n = 6). Hypervitaminosis A–related symptoms were mild to moderate, xerosis and pruritus being the most frequent. The greatest shift from baseline was observed for cheilitis. Predose plasma levels of endogenous RA remained constant during the treatment phase. Postdose plasma concentrations of endogenous RA were increased versus predose at all time points.

Conclusion: This phase IIa trial indicates that oral treatment with R115866 reduces PASI scores in the tested population, supporting further evaluation through a full development program. The safety of 1 mg of R115866, given once daily for 8 weeks, is supported by the finding that plasma levels of endogenous RA rapidly return to baseline after treatment, thereby limiting the accumulation of RA in body tissues and the AEs associated with systemic retinoid treatment.

Author disclosure: Nothing disclosed at press time. 100% sponsored by Barrier Therapeutics.

Poster Discussion Session P2828, American Academy of Dermatology, 64th Annual Meeting, March 3-7 2006, San Francisco.

Supplement to Journal of The American Academy of Dermatology, March 2006, Volume 54, Number 3.

JAAD Poster Abstracts Online (29Mb)

Press Release: Barrier Therapeutics to Present Data on Vusion and Sebazole at the American Academy of Dermatology 64th Annual Meeting

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