The mechanism by which low dose accutane (isotretinoin) i.e. around 10mg a day, is effective in treating rosacea is not clearly understood.
Just the name accutane is enough to strike fear into many doctors and patients.
Hopefully the following articles will provide some pointers to useful information when researching whether accutane/roaccutane is a suitable treatment for your rosacea. These papers will also prove useful when discussing with your doctor the best dose for your rosacea symptoms.
1. Efficacy of Low-Dose Isotretinoin in Patients With Treatment-Resistant Rosacea, Archives of Dermatology, Vol. 134 No. 7, July 1998.
Isotretinoin was shown to be effective in patients with treatment-resistant rosacea by Nikolowski and Plewig in 1980 for the first time. Since then, many other studies confirmed its efficacy in a daily dose of 0.5 to 1.0 mg/kg. However, it has also been noted that adverse effects of the drug may limit its use. In this study, we aimed to determine if low doses of isotretinoin were effective in patients with treatment-resistant rosacea.
…
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.
2. Continuous ‘microdose’ isotretinoin in adult recalcitrant rosacea. Clinical & Experimental Dermatology, March 2004, Volume 29 Page 204
Update: I have gotten hold of a copy of this paper and have made some comments in a news item titled `long term extra low dose accutane‘.
3. Treatment of rosacea with isotretinoin., International Journal Dermatology. 1986 Dec;25(10):660-3.
A multicenter trial of isotretinoin in severe papulopustular rosacea in adult patients was undertaken to evaluate the efficacy and safety of this treatment. A 20-week course of therapy was instituted in 92 patients from 11 dermatology departments. At the end of the study period, isotretinoin was found to be highly effective in the clearing of refractory rosacea lesions.
4. Isotretinoin treatment of rosacea. Acta Derm Venereol. 1987;67(1):89-91.
Twenty patients with severe rosacea were treated with isotretinoin for 3-6 months. Six patients initially received 1.0 mg/kg and 14 patients 0.5 mg/kg of isotretinoin. The response was good or excellent in all patients and the papulopustular lesions in particular cleared promptly. Patients receiving 1.0 mg/kg of isotretinoin experienced more side-effects and the dose had to be lowered in five of the six patients. Seventeen of the 20 patients had no relapses during a follow-up of one year showing that isotretinoin has a long-lasting favourable effect in rosacea.
5. Low-Dose, Pulsed Oral Isotretinoin May Clear Resistant Rosacea Skin & Allergy News 30(12):23, 1999.
He (Dr. Odom) suggested using 10 mg of oral isotretinoin two or three times a week or 20 mg twice a week. He gives the agent for up to a year, at which point he likes to cut back the dosage and eventually discontinue the drug.
It would take 3-5 years of therapy at this level of dose and schedule to amount to one regular 15- to 20-week course of isotretinoin for acne. Because the dosage is so low, Dr. Odom does not order special lab tests as long as patients have not had hepatitis and are not taking cholesterol-lowering or triglyceride-lowering medications.
6. Rosacea: A Common, Yet Commonly Overlooked, Condition, American Family Physician, August 1, 2002.
Low-dose treatment with oral isotretinoin (10 mg, three times weekly for two to three months) has also been successful in recalcitrant ocular cases
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Recent research has yielded insight into the role of vascular endothelial growth factors (VEGF) in a variety of disorders, including rosacea. Retinoids appear to modulate the expression of VEGFs in the skin; this may explain the therapeutic benefit of isotretinoin in the treatment of rosacea observed in some studies
7. Low Dose, High Rates of Success: Ultra-low dose isotretinoin is all many acne patients need, Dermatology Times, Jul 1, 2003.
Gerd Plewig, M.D., believes that the 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.
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“When you talk to doctors in this country and other countries of the world, they use 10 mg twice a week or three times a week, which is a low or ultra-low dose. But nobody ever bothered to show and demonstrate that it works,” he said. Thus, he and his team performed two clinical trials to assess its efficacy.
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A great benefit of using lower doses of isotretinoin is that it can be used continuously. There are other important advantages, as well. “In terms of pharmacoeconomics, it is cheaper to use lower doses, it is better tolerated by patients, has fewer side effects, fewer laboratory abnormalities, and of course the patients like it when they have continuous elegant treatment,” Dr. Plewig said.
Despite the safer side-effect profile with low-dose isotretinoin, Dr. Plewig emphasized that, at any dose, the drug should still be considered teratogenic and be used with great caution in women of childbearing age.
Over to you
Low Dose Accutane is still a controversial treatment. Have you tried it? how did you find the benefits and side effects? How hard was it to get your doctor to agree to prescribe it for you? Please leave a comment below and let us all know.
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83 Comments over 2 pages ↓
Hi David,
I was diagnosed last year (age 40) with papulopustular Rosacea. I never had any issues with erythema – just annoying papules and pustules that took forever to disappear. I tried Oracea along with various standard topicals, but nothing really seemed to keep my Rosacea under control.
Back in August, my Dermatologist started me on a course of Isotretinoin (60mg per day). Every day, I noticed my face getting redder and redder. At day seven, I finally stopped because the erythema was so noticeable that my daughters were commenting on how “sunburned” my face was.
After a two week break, my face did calm down significantly and for the most part, returned back to normal. My Dermatologist (she’s great by the way) allowed me to try a 10mg per day dose. My face definitely tolerated 10mg per day much better than 60mg per day. However, after about four weeks, my erythema slowly became noticeable again.
I was disheartened by the whole experience because the Isotretinoin was definitely keeping my spots at bay. I wasn’t happy, however, replacing one problem with another (the redness bothered me more than the p&p’s). And, I definitely wasn’t excited about the idea of possibly having to deal with both issues in the long term because of the treatment.
Now, I’m taking 20mg per week. I still get some spots occasionally but not to the extent before I started the treatment. My face has a slightly pink tint to it and I definitely flush these days, although very mildly, when I hit certain triggers. I’m not sure if my erythema will go away when/if I completely stop.
The key here is that individual responses to Isotretinoin are HIGHLY variable. Some people experience side effects on 10mg per week and some don’t experience any even at 80mg per day. I think the best course of action is to start low and constantly evaluate the side effects vs. the benefits as you start stair-stepping your way up the dosage ladder. There’s a fine line here that is unique to everyone and you just have to find where yours is.
Good luck!
David, my redness was only when I had any sun exposure, and after drinking hot beverages. I don’t have any redness now and have not done anything different. It took my skin a very short time to adjust.
I had a few broken capillaries before I started accutane and had them removed by laser a year prior to starting accutane. My treatment of Accutane was more for the oiliness rather than the Rosacea but am thrilled with the results for both conditions.
I should state that I am very fair skinned with dark hair and blue eyes. As a child and through my teen years I played in the sun a lot. I can remember several very bad sunburns and even remember having tan lines well into spring from the previous year. I never layed out in the sun, just played at the resevoir and swam a lot. My face peeled all the time. I believe that my younger and more naive years are probably what caused this later in my life. I now wear sunscreen and avoid over exposure to sunlight. I still like to be outside, but do it now with care and moderation. Hats are my skins best friend.
I think taking it slow and keeping track of your reactions is key. I knew all the bad reactions and was prepared well in advance to keep the dryness away. I did do my treatment over the winter so the sun exposure would be even less.
Also, before accutane my redness was worse with my rosacea and has really subsided almost completely after being off accutane for 11 months. Everyone reacts differently but I think you are informed enough to take it slow and see what works for you.
Take care David and keep us posted to your journey.
April
Hi April thank you so much for your prompt response. I was an outdoors kid as well – but being Italian I did have olive skin. As stated I think I gave myself rosacea by using Retin A on my skin & cortisone to help with the side effects – my dermatologist was to blame but I quickly gave her the flick but a little too late.
I just wanted to repeat that I am now going to start on roaccutane for a return of some pimples not the rosacea side of things as my rosacea is under control unless I eat the wrong thing or like you – stay in the sun which is an absolute no no for me. My fear was that from reading some blogs here & there some people blamed roaccutane for their rosacea & I guess I was worried that I would undo all my good work (with the laser treatments) but I feel more confident after reading your comments so I really appreciate everything you have said – I definitely feel more at ease going into the treatment. I will keep everyone posted on my progress. I am due to start at the end of April (Autumn for us Australians).
Take care & best wishes
David.
Hi Hammer – thank you so much for your reply. I’m really sorry that you had trouble with the roaccutane. It is like you say – we all react differently just as the cause of rosacea is different for all of us.
I was thinking why not give high dose vitamin A a try? (I was taking 50,000 IU). It may help the pustules & not give you the redness/flushing that the roaccutane does. Maybe ask your dermatologist next time you see her? It’s worth the question.
I will let everyone know how I go – I’m not starting until after Easter – so it is a while away yet.
Best wishes & best of luck.
Cheers
David.
Hi everyone just reporting back on my Roaccutane treatment. I told my derm that there was a possibility that I may experience redness/rosacea symptoms with the drug as I had read everyone’s posts. I did ask him to check with his other rosacea patients who are taking roaccutane & to let me know. Well he said that none of his patients had worsening rosacea related effects with the drug so I agreed to start on 20mg a day.
Everything was going fine until day 14 – then my rosacea flared up big time. It was like I had never had the 4 laser treatments. I spent all day sucking on ice cubes & sitting in front of a fan. I have stopped the tablets (off 4 days now) & the intense flushing has subsided by about 90%. What to do now? I see my derm in 2 weeks. I was thinking that maybe I should have started on 10mg every 2nd day & worked my way up OR like Hamer I just can’t tolerate it which is weird because I was on it 13 yrs ago at 40mg a day & I had no problems BUT I didn’t have rosacea then either. I noticed this post from Liz Goldman in January 2008:
“But important to note. when I first started the accutane the first three days my skin felt worse and looked more “bumpy” the first month but the burning sensations decreased drastically after two weeks. So if you experience this do not ditch it, I know it is hard, especially if like me you tried other things.”
April it is amazing that you were able to take 80mg – my face was just so dry at 20mg. I moisturised my face 5 times a day & even that wasn’t enough.
MAYBE I should have stuck it out a little longer – maybe my body just had to adjust to the treatment. My question is: Has anyone else had an experience similiar to Liz – i.e bad at first but then the face adjusted? I was also thinking that maybe I could take a beta blocker while on the treatment which might assist but I have never taken any. Can anyone recommend a good one?
Thanks in advance for any comments.
Best wishes David.
David,
You mention taking 20mg per day. I would not consider that to be a particularly low dose. 20 to 40mg per week would be a low dose for an adult male. You might want to consider taking 40mg per week for awhile to see what happens. That is what I’ve been taking for several years now with very good results. Note that my condition is the papulo-pustular variety, however.
My face still flares up occasionally if I get too much sun or ingest enough of my trigger foods but the turmoil subsides when I return to my normal mode of operation.
I expect to be on this regimen for the rest of my life because it is a coping strategy, not a cure. But it is the only treatment that has ever worked for me so I am pleased to have it as an option. I am simply flabbergasted that so few dermatologists are aware of this approach and that so many who know about it consider it to be controversial.
Don
Hi Don – thanks for your email. I have lowered the dose to 20mg for 2 days then 1 day off then 2 days on again. I see my derm next week & we will see what he says. Wouldn’t it be nice to not to have to deal with all this rubbish & have a normal life.
Best wishes
David.
David, sounds like you are on the right track. I did get very red with the accutane but knew the end result would be worth it. I am now 14 month post Accutane and have lived a much more care free lifestyle without the acne and redness. I still get red when I drink alcohol or too many hot beverages. And of course the sun exposure. I am now dealing with hives that are chronic but I would much rather take an antihistamine than go through the acne.
I am so glad to hear that you have not given up and are still willing to figure out what is best for you. Good to hear about your progress too. In thinking back, My face got bumpier too after a week or so, but my derm said it was my body changing how my skin works and pushing all the junk out. Once all the sebum was out of my skin it was smooth and soft.
April
Hi April thank you for your response. It seems that too much roaccutane can cause redness for us rosacea sufferers. My nephew had to take it for his acne but he was white as a sheet. I wanted to take a high dose (30mg a day) for 7 months & then be done with it just like you. But with what is happening as I previously stated I have tapered back. I would be willing to put up with the redness if I knew that once I was off the tablets the redness would be gone & not leave any lasting problems, like the exacerbation of the rosacea symptoms again. I didn’t really want to undo the work of 4 laser treatments.
Did you find that once you were off the tablets it did not damage your skin i.e that it was the same as pre-roaccutane? OR did it cause a little damage to your capillaries?
I have never had hives – I feel sorry for you it must be a pain. I have severe dust allergies & I have to take 2 anti-histamines a day. Thank God for Zyrtec!
Thanks in advance for your response.
Best wishes
David.
Hello all………..Im so grateful for this amazing group
..
i just want to share my expierence about accutane for rosacea, first will start briefly saying that my rosacea symptoms have started 7 years ago but i was well diagnosed from 7 months ago only, my trigger was definetly the sun,i used to stay all day long in the very hot sunny weather and also used alot of harsh skin products,i never expierenced any acne i was just using alot of creams that contains fragrence etc to make my skin more glowing ..( stupid me it eventually brought up the rosacea in the way)….
i have cried alot and was soooo desperate ( and still desperate also) to find a good ttt for this disease..
my rosacea sypmtoms is not that severe flushing , my main problem is that my skin is so extremely tight/dry/flaky all over especially on my cheeks/chin and around my mouth with alot of little bumps which r very itching/cause burning and stinging and my majoy trigger is the sun so i nearly stay away from the sun but its very hard i know
to cut it short : my derm last feb prescribed me accutane 40mg/day for 4 months and he told me it was increase the redness and dryness but it will cure the rosacea from inside,,ofc i couldnt tolerate the severe redness and dryness especially coz i dont use any moisturezers or any topicals bec of my super sensitive skin, so i decreased the dose to first 4 months i took 10mg 3 times a week,,then from last april till now im on 10mg EOD, and i tried to increase the dose to 10/day but it was terrible,,so redness and severe dryness that i couldnt open my mouth,,,,now i can tolerate the 10mg EOD with ofc dryness in the skin and in lips but manageable and i will stay on this dose till next october ( so that will be a 8 month course) my doc said that i will be okay after it and my rosacea will be fine,,but i will always have to watch out for any triggers and be ware always that i have sensitive skin
i must say that accutane ofc clogged my pores and made it shrunken which is very good and decreased the redness at all,,,,but dryness increased so i guess i have to wait and c after i stop the drug
and will still keep u update with everything
im sorry for my long post and hope this will help
bye bye all wish u all the luck and im sure someday we will all be cured from this disease hehe
Rama….
Rama,
Have you tried Dr. Dan’s Cortisone Lip Balm for the dry lips. I get here at Walgreens. It was the best and prevented my lips from cracking and bleeding. I also used Aquafor. It was the best moisturizer i used and did not burn my skin.
Good Luck and know it will get better.
April
hello april,,thanks alot for ur reply
which i guess nearly all creams contain at least one of these ingredients )
i typed the message and then it disappeared not sure where it is but i think i wil retype it again
i dont live in USA i do live in egypt,,so i dont know wht walgreen is, apparently its a pharmacy right?hehe
my main problem is not the dry lips bec i dont have sensitive lips so i can use any lipstick and the dryness is manageable,,,my main and tough problem is the severe scaly/flaky/tight skin that was found preaccutane also,,i dont know if those symptoms r associated with rosacea or i do have coexcisting seb dermatitis,,but my derm said that the dryness will subside when the rosacea is cured ??not sure really where is the truth….
my skin is so senstive to the extent that i nearly tried all moisturzers ever with no luck ,,all burned my skin till now, but i think from wht i read and researched,,that any cream that contains oils/petroleum/fragrance/SLS/plant extract..causes dryness and burning
April i would like to ask u: after u stopped the accutane course, do all the side effects disppear?im scared that the dryness will be forever….i mean ur skin and lips returned to normal after u stopped ur ttt?
Any help would be appreaciated and thanks alot for ur time
urs:
Rama xx
Rama,
No dryness has reappeared. I actually took the treatment for the Rosacea and very oily skin. The oil is dried up and my skin is soft and smooth. I did not experience too much dryness, but used Aquafor which is like Vaseline to help elevate any dryness.
Yes Walgreens is a Pharmacy in the US.
All my side effects disappeared. I went into the accutane knowing that it was going to be 5 monthes of discomfort but took precautions and measures to alleviate the side effects. I drank a ton of water everyday and was careful about sun exposure. I can say today that Accutane changed how my skin works. Everyone does react differently to the drugs, but with vigilance and finding what works for you, I hope you get some relief.
I have had my Rosacea for 18 years and this is the first time I feel good about my face.
My daughter’s Pediatrician is always saying how great my skin looks, so for me the side effects were gone about 1 month after I stopped treatment.
Keep in touch, and wish you the best.
April
Hi Everyone,
I just wanted to provide an update. My last post was 11 Feb. I’m currently taking 10 mg isotretinoin every four days. I can honestly say that this ultra-low dose isotretinoin treatment has been a life-saver for me. I’ve been completely p&p free for four months now. Other than my face having a slight pinkish hue to it (which I’ll take any day over the p&p’s I was battling before my treatment started), I haven’t had any side effects whatsoever. I hope this information helps.
Thanks!
Hi everyone – like Hammer I just wanted to give everyone an update. It’s been 5 months for me now & things are going ok. I take 20mg a day for 4 days & then off for 1 day & then on again for four days & so on. The next goal is 5 days on & then 1 day off etc. Just a reminder that I am taking it for a resurgence of mild acne which I squashed with roaccutane 15 years ago at 40mg a day for 5 months. I would love to have been able to do that again & have it over & done with, but at the above mentioned dose my derm said I might need to stay on it for about 14 months to rid the acne problem again. I think my four PDL treatments have saved me from having a red face & flushing at this dose. I do have one trick up my sleeve – Hammer, this might interest you. Why not take an anti histamine everyday? It works a charm, even if you don’t have allergies & may stop your face becoming pink. As I mentioned earlier I do have bad allergies all year round but worse in spring so I usually have to take something stronger like sudafed double action or claratyne -D (both have pseudoephedrine in it). I spoke to my allergy doc & he said Pseudoephredrine closes the capillaries – I can testify to that! I had to go to a funeral the other day & I knew it was going to be really tough & I knew I would cry like a baby & probably flush BUT I took a claratyne D 2 hours before the funeral & I did not get red AT ALL.
Anyway, hope everyone who is currently using roaccutane is coping well. Like April said earlier, the trick is finding the right dosage – this drug really does work.
Best wishes
David C
David, you are so right about the anti-histamine and the flushing. I had a very bad allergic reaction to some cold medicine in March. After 2 office visits and 2 ER visits I must take an anti-histamine daily or I get hives everywhere but the upside is no flushing!! Pepcid AC is a histamine 2 blocker and might also provide some help. I am still thrilled with how my skin has changed and feel much better about my appearance.
I am thrilled to hear that your treatment is going well and I would not have realized that the anti-histamine was the cure for the redness until you mentioned it. I will have to mention this to my dermatologist, she may already know but has never mentioned it to me.
Take care and glad to hear your updates!!
April
Hi April I thought the anti-histamine thing was general knowledge – I am fairly certain that I read it somewhere on one of the rosacea forums. I might mention it to my derm as well.
There is definitely something in zyrtec that really helps to cool the face and prevent a flush. Maybe this could be a silver bullet, who knows? It would be great if a company would investigate the possibilities of this harmless little drug.
Take care & best wishes
David.
Hi everyone, I was glad to find this site as I have just started on Roaccutane after exhausting all the other traditional methods since it’s onset 12 months ago. My derm has been fantastic(I live in Perth, Western Australia) and at this point had no problems prescribing it. I am on ultra low dose of 5mg daily. I had to find a chemist that could order it it from the supplier as it was not a doseage that is in stock. My derm thinks might be better for a daily low dose to keep even rather than on off (but who knows). I am at day 15 and apart from really dry lips that come and go it’ been okay. I dont have p&p’s my main symptons were redness and flushing/severe burning daily – especially at work when concentrating or busy. The redness seemed to reduce quite a bit in the first week and the biggest improvement has been the burning. My face used to feel on fire at work but now I’ve had days where I suddenly think…wow I have not noticed my face (that’s pretty amazing). Some days I still get a mild warm feeling. I did have a big flush late yesterday which was disappointing, both cheeks went really red. It died down after a couple of hours. I am trying not too get too downhearted about it as I’m only a couple of weeks in so perhaps it will take time for this part to get better. What I really miss is being able to exercise hard such as running etc and have out on weight. I hope that one day I can put a really good workout back in to my day!
Hi Sam – just be patient with the roaccutane – your body & skin just needs to adjust – which takes about a month so hang in there.
If you do go back to running make sure it’s after the sun has set as you should be staying out of the sun while on roaccutane – which I am sure your derm has told you.
Perth gets quite hot (I live in Sydney) so try & stay indoors as much as possible over sumer.
Cheers
David C.
Hi there everyone – what a great forum.
I too, like many of the contibutors here have been through all the various medications without any improvement at all and am now into my first week of Roaccutane (20mg) perday.
I have Erythematotelangiectatic rosacea so the skin on my face is red and flushes constantly. Since staring the treatment, I have noticed that the general redness of my face has increased to an even greater level and I am worried at just how red this will become over the course of the treatment.
The dermatologist I have been referred to is pretty terrible in that he had no time for any of my questions and sent me on my way with a prescription and a leaflet on the side effects as quickly as he could. Since, I have not been given a follow up appointment to see him again for another 2 months, I am worried that my skin will go from bad to worse and wonder if any others here have been treated for this type of rosacea and what sort of experiences they had?
I can understand that all of us are individuals and may react in different ways. I will continue at my current dosage for a couple of weeks but am feeling really apprehensive about how bad my skin will become. Luckily, my GP is extremely suportive and I may end up going to her with the hope that she may suggest 20mg every other day.
Thanks, Richard
Hi Richard I’m no Dr but perhaps see your GP who you trust – maybe 20mg every other day would be better to start with. It does take the body a little time to adjust as I mentioned previously.
Do see your GP regarding your concerns – they should know if the dose is too much for you.
Good luck
David C.
Hi Sam, I am from Canberra. I was not aware that roaccutane is available in 5mg dose in Australia. If you see this, could you please explain what did the chemist you contacted exactly do? Did he contact a supplier in the United States, Europe or where? What is the supplier’s name? How long did you have to wait to get it? How large is your supply and how long will be your course? I have been twice on Roaccutane and was very happy with the results, but I’m very worried about some of the side effects that I’ve suffered. The 5 mg/day dose sounds like a good idea, as I’m sure it would work for me equally well as the higher doses I had to put up with. If I had known about it, maybe I wouldn’t have experienced serious side effects. The dermatologists I’ve seen so far normally have 5 minutes for me, if I’m lucky. Maybe less, if they have too many patients that day. No chance to discuss issues more thoroughly with any of them, let alone latest research and advancements in the treatment of the condition. Coming from Europe, I can say Australia has one of the worst health systems in the world. The first dermatologist that recommended Roaccutane to me insisted 20 mg/day was the lowest dose available, and I stayed on the medication for a whole year. I’ve been through a lot as a consequence. Bunch of ******.
Hi Aleks, sorry to hear about your experience with your dermatologist. I was very lucky to find mine. Although he has no miracle cures or anything new to offer he is very open to the information I have found on this site and the experiences of others and has supported my choices throughout the last year. It was a different derm who actually put me on to Oratane 5mg. She warned me I would have to find a chemist who was prepared to ring the distributor as she had only just been made aware of it from a seminar she had been to over east. This particluar dosage didnt come up on their computers and one chemist said there was nothing more they could do. I found a Terry White Chemist near me who tracked it down. It came in within a week – a rep delivered to the store. The cost is $60 for a box of 60 which I didnt think was too bad. I have 3 repeats so I guess that is 8 months worth. I have heard everyone has different experiences even on low dosage. I have just developed a satff infection (very minor) on my shoulders just looks dry and scaly. The pharmacist said the roaccutane could cause it but hard to say. Just using a wash to kill the bacteria so should clear up soon. If you still cant find anyone to help you with sourcing the 5mg I will ask my chemist next time I am in who they get it through.
Aleks some further info to try and help you track this dosage down. My local Terry White Chemist in Warwick (Perth) wouldn’t give me the information when I asked but they did say there is a Terry White in ACT – Belconnen Level 1 (means nothing to me sorry) and a phone number 6251 5125. They should be able to get it for you and if they have problems they can call Warwick and get the distributor details from them. Hope this helps
Sam, thank you so much. You have helped me a lot, should I decide to go on a third course in near future (which is very likely). Belconnen is in my neighborhood by the way, which is very convenient. I had wonderful results with 20 mg/day, although I’m convinced less is more when it comes to isotretinoin and rosacea for most people, although not for everyone. The results for me lasted only a couple of years, before things started going wrong again. This was accompanied by serious gastrointestinal problems that persist even today. I have no evidence of the direct link between my health problems and roaccutane, but I am otherwise very fit and healthy, and the evidence about the link between roaccutane and bowel-inflammatory diseases out there is quite overwhelming and disconcerting. In any case, I would go on a third course if needed, despite everything. That’s the extent to which rosacea affects my self-confidence and quality of life – I’m willing to take huge risks. I’d rather enjoy life and take risks than be safe and depressed. I wish I had a more competent dermatologist though who could have first recommended a much lower dose to begin with (since I respond very quickly and very effectively to the therapy) and second would have advised me about maintenance doses once I finished the second course, which, based on the anecdotal evidence, work very well for so many people, helping them stay clear and redness-free for many years, if not continuously. Seeing a dermatologist (or other specialist) in Canberra is more difficult than seeing the prime minister. I had to wait long 6 months for my last appointment, only to be given 5 minutes of time by her when she finally saw me. Disappointing. Good luck and please keep posting on your progress.
Aleks, sorry to hear you are having some issues with getting the drug and some side effects. I am in the middle of the USA and here the drugs are very expensive and government controlled. I was lucky enough to go through the 5 month regime of 20mg 1st month daily and then 40mg daily for 4 more month’s. I had some drying side effects and my skin became redder as the treatment proceeded, but within a6 weeks of stopping the drug my skin looked and felt amazing.
As far as the cost here, 40mg daily for a month without insurance runs about $1,200 dollars. With Insurance I was able to pay $580. I had met my deductible on the insurance and they picked up the rest, so I only paid for 1 month. But the insurance here is expensive too. Here, very few pharmacists are chemists and they are not allowed to make the drug. The government has a I Promise program, we have to do testing every month, women have pregnancy tests and liver enzyme tests. an Dermatologist appt. Doc, goes on-line and reports test results and appt. then I go on-line and answer a bunch of questions about drug side effects and birth control. Then my pharmacist goes on-line and checks to see if all that happened before they can dispense the drug. This happens every time you get a prescription refilled.
I hope you get relief soon. It was the best course for me and I firmly believe that the anti-histamine Zyrtec really helps with the flushing.
Take Care.
April
I was treated with Roaccutane about 20 years ago for acne. I stopped my treatment early because the medication exacerbated my rosacea. I was left with flushing and some acne and it was only in the last five years that the flushing subsided. Unfortunately my acne and to a lesser extent my rosacea has returned. I would like to try low dose Accutane as antibiotics are no longer effective. I am prepared to take a low dose long term. I have weighed up all other options and this seems the most attractive option and I would like some quality of life back. My dermatologist is talking about starting me low and working up which I know will cause the flushing to and sensitive skin to return long-term. My question is how do I convince him of the long term low dose option? I desperately want a better outcome than the one 20 years ago. I would appreciate views and any ideas
Before you do it try Finacea – it worked for me -it takes about 4 weeks to kick in. Much better bet than Accutane.
Thanks John. I have been reading up on the use of low dose Accutane. There are dermatologists that openly recommend low doses for acne as well as rosacea. When Roche was developing a new formulation back in 2000 one of the papers detailing the rationale for the formulation made a number of assertions that the current (then and now) dosage recommendations for Accutane were too high.
I am still not sure my doctor will open to a long term low dose solution.
If anyone knows of a dermatologist in Australia that would be open to a long term, low dose solution I would love to hear from you. A supportive doctor would be a great Christmas gift!
I am in the UK so can’t help with a dermatologist. All I know is I tried the lot – the dermatologist photographed the contents of my brief case – he couldn’t believe it. Loook at the responses above everyone tolerates the Roaccutane differently – I was ok
although I didn’t like the dried lips but I came off it and back came the Rosacea – it was then he put me on to Finacea and it’s been great. Twice a day in the area where it used to flare up and nothing now – nice clean healthy skin. Cleanse;Finacea;sunscreen/moisturise. Easy.
I urge you to try it before going down the Accutane route.
Hey Sam, what are the contact details of your Perth derm, please? Cheers!
Hi Amanda I saw Dr Hsu at Lumina Cosmetics in Balcatta 9240 8955
Thanks for letting me know, Sam. Much appreciated