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.
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.
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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.
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‘.
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.
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.
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.
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
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 ? Please leave a comment below.
30 comments ↓
I am one month into low dose, 10mg four times a week, course of accutane. I will be on it until my skin “smooths out.” My skin was never perfect but I received many compliments. After surgery in February of 2007 my skin went “crazy” apparently exposure to thimerosol ( after patch test I am allergic) triggered my rosacea. Nothing helped me, antibiotics, topicals or laser. My skin become completely intolerant and burned like crazy. After two weeks on accutane my skin calmed down drastically. Now after one month I see a noticable decrease in redness on my chin and cheeks and I do not have any burning sensations.
Great to hear Liz. Some do report good reports after a short period. We wish you all the best for continued good success with your treatments.
Hi i am fourty one years old six months ago i had surgery, and have not yet recoverd, my husband left me ten months ago, i have had a bit of stress with him and the pain, six months ago my face started to burn on and of for one month then started to get red, and now it has been blotchy all over my face and neck and chest. It pains and burns, i have had laser and did not work now i am on isotretinoin ten milligrams per day now for two weeks. I am a little bit worried about the side effects as i have liver and pancreatics problems. I would like to no any body who has tried this treatment and how long it takes to work, as i am seeking help. thankyou tamm winter.
10 mg low dose accutane is working for mee..but yet to confirm full proven results..i have been taking it for i mnth 10 mg twice a week
Hey. I am back to give an update. I started the accutane back at the end of October. Now my skin acutally feels “normal” most of the time. I am still hyper reactive but the accutane has made a huge difference. I am going to get more patch tests to determine if I am allergic to anything else (food additives etc.) I am taking 10mg five times a week. The side effects are mild. Also AVENE intolerance facial lotion (comes in individual vials because has no chemicals) has been a life saver. Before I could not tolerate a thing. It is soothing and light. I use La Roche Posay preservative free gentle cleanser. And Laura Mercier Minerals SPF 15, again very few ingredients and Zinc Oxide. Not only does not irritate my super sensitive skin but helps soothe. I am not perfect and may never be but my skin has drastically improved.
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. Also my derm (after trying five supposedlty top docs) told me that the flora on my face cannot tolerate antibiotics. All the derms insisted I take the low dose doxy and it made me worse and they acted like I was crazy. Until this doc. Again for me accutane has been the answer but I am also allergic to chemicals (which triggered my rosacea) so please go get patch tested by a reputable contact dermitis doc so you can avoid triggers. I drink coffee, wine occasionally and I am fine, topicals and the wrong food, MSG etc… cause me to get a angry red hive on my rosacea patch. Hope this helps someone !
Liz, my face is very very oily. I am hoping that if I get accutane in low dose it will help dry my skin out. Did the low dose dry your skin at all?
I am on the second week of oral isotretinoin… Here is my experience…
My rosacea cleared up spontaneously about a year ago (when I stopped all medicines for rosacea). Last month nodules and redness reappear, then I started oral isotretinoin two weeks ago. I feel no change with oral isotretinoin (20mg - two times /week) at this moment, but I know that pharmacological treatments could take some time to clear the redness and lesions associated with rosacea (I am a physician with a master degree in pharmacology). Very little information exist about isotretinoin for the treatment of rosacea and clinical trials conducted in this disease are poorly designed… For that reason, I think that information about the individual experience of each one is very, very important!!
Please excuse my poor english, I live in Colombia (South America)
I am 47 years and first noticed the papules and pustules associated with Rosacea after surgery in 2004. After a few unsuccessful years on topical preparations and antibiotic therapy my rosacea was definately becoming problematic despite eliminating may dietary factors such as caffeine, hot spicy foods, hot drinks etc. I also modified lifestyle factors such as significant sun exposure, hot showers etc but to no avail. My dermatologist suggested I was a good candidate for Isotretinoin. Initially I was commenced on 10mg daily, then 20 mg with a minimal improvement after 3 - 4 months. I am now taking 40 mg daily and will complete the drug regime in March. I am now virtually pustule and papule free, I occasionally get a flush and the burning sensation usually from an accidental exposure to sun but no pustules. Most of my friends have commented on the good appearance of my skin. I have had a few side effects from the drug treatment, dry eyes which have been greatly relieved by Bion Teardrops and dry peeling lips which I find completely relieved by Lucas’ Pawpaw Ointment. My liver function tests have been normal but my cholesterol did elevate for a month but decreased after a month of Lipitor (atorvastatin). I am unsure how my skin will respond apon the cessation of Roaccutane and I have been unable to find any clinical studies on Rosacea sufferers post-Isotretinoin. Any information on this would be valuable. Basically I have a positive mindset and will continue avoid known triggers. Sydney. 25/01/08
Hey I am back to answer jo’s question. Joe my skin is oily too. since on the accutane it is alot less oily and my poors are smaller. I cannot stress enough though how anyone with rosacea should rule out contact dermitis.
I have know complete my last round of patch testing and it turns out iam allergic to another preservative found in food and cosmetics. So for me, my skin would continue to be a problem despite the accutane if I didn’t eliminate these chemicals from my skin care and diet.
I went to several derms before I found the right one. I would suggest you go to a derm who specializes in contact dermitits. For me my rosacea is no longer a mystery. It was caused my chronic exposure to chemicals through my contact lense solution and cosmetic and hair care products.
I’ve taken a course of accutane before when I was younger for cystic acne, I didnt experience any of the side effects people talk about and my acne totally cleared.
I’d like to try low dose accutane for my Rosacea. Does anybody know a decent place to buy accutane from online?
Hey I am now starting my fifth month of low dose accutane. My doctor lowered my dose twice from 50mg a week to 40 mg and now 30mg. I am having minor side effects. My skin is more sensitive, a common side effect, so I have minor skin irritation on my neck and chest. My skin is dryer. But important to note, I tried a makeup that was on my safelist and it irritated my skin. what was odd was that within two days of using it my skin got very oily even on the accutane and once I stopped using it within a few days my skin went back to a dryer state. My derm said that was my bodies reaction to an irritant.
so for some of you people with oily skin it could be from irritation. Anyway no treatment is perfect but no question that accutane helped alot. My derm mentioned staying on it a year but I am not going to stay on past May. My pharmacist mentioned that many of his customers on accutane in the summer get rashes. I also feel like I have plateaued. I am not seeing any further improvement although the change from when i started has been great. Once I am off I will let you all know If i relapse or if I am okay.
I read your comments with interest Liz. Was put on 10mg/day .After two weeks noticed many bumps in certain lights, not a typical outbreak. Part of my skin had a ‘alligator skin” look, but was not dry (took vit e and Fish oil (no vitamin A). Felt I needed to stop this for a week because it looked terrible and not the typical break out one sees with accutane. Can you comment on this?
Have been following your comments above, especially Liz Goldman’s and Jan Donahue’s; had an IPL treatment 6 days following a “macrodermabrasion”; they also used a very strong BLT topical anesthetic, and following treatment, an ultra strong corticosteroid clobetasol propionate; the anesthetic was to last 1 hr, but lasted over 5 1/2; the next day, when I went to apply my regular “cosmetics” which I had used for 26 yrs (and some for 4 yrs), my face became red, and swelled a horrific amount from my cheeks down to the jawline and up to my lower eyelids, where it stopped. It took 2 1/2 months for that to dissipate, and it never did entirely-during that time, I could use no products w/o burning/stinging; I was able to exercise; marks appeared w/in a day that were sebaceous hyperplasia and my skin was deep down dry to the bone-this was the day and week after the procedure; towards the end of April, due to the extreme dryness, I was told to use my B5 gel to try to get moisture to my face; it again swelled appreciably. Here is when it started to sound like Jan’s-it got creases like elephant skin, the “cobblestone” effect or look of a leather wallet increased (skin of the orange or peau de la orange); because the swelling again took over 2 1/2 mths to start to really dissipate, I began showing “rosacea-like” symptoms for the first time first week of July. Fibrosis had started to set in on my cheeks and nose; and as of today, I can still no longer do anything that I used to do (I played tennis 1 1/2 hr/day-in the heat, swam a mile a day/5 days per week, and never, ever had a problem w/heat-lived in Saudi Arabia just prior to this where heat was 113 deg.) Never had a problem w/my skin-it was “happy” and smooth. It is continually lumpy, bumpy w/swelling never truly going away, and increasing now at “insults” and becomes more sensitive depending on the accumulated insults that week. It has been a year now since I have done anything at all re exercise, and I have put no product on my face since May; every time I try-all the recommended sunscreens, moisturizers, etc. cause reactions. I never flushed/blushed for 5 months while the initial swelling was present; it was only over time that this happened. I have tried accutane for 3 months now-the first 2 were with food, but not fatty food; I started w/fatty foods only a month ago, but during this time, my face started to become more sensitive (flushing increasing appreciably, as well as more fibrosis, burning). I am thinking of reducing the 10mg/day down to every other day because I’m wondering that since I took it w/o fatty foods for the first two months, maybe I was only absorbing 1/2 the dosage (???); Anyway, “wrinkles or the elephant skin, sebaceous hyperplasia and lumpy bumpy + swelling came on pretty much “immediately ” following the procedure last Feb. Any comments from anyone? My thought is there might have initially been a problem w/the lymphatic system being overwhelmed and unable to throw off so much fluid at once and/or damage to that system that I have not been able to, and maybe never will be able to, repair that is underlying what seems to be progressing rosacea…
To Anyone, and a follow-up to my message above…I do not seem to have the “acne form” of rosacea. As I said above, I took accutane (10mg/day) for two months without any negative effects except dry lips. I took this with meals, but not “fatty” meals. For the third month, I started taking it with food that had fat content, and after a week or so, started to show more sensitivity to flushing/blushing-this continued, w/some swelling which usually does get worse for me after flushing, to the point that after three weeks, I’ve decided that maybe I’m taking too much and should cut down to every other day??? Is this a normal reaction to accutane after you’ve been on it, or did I, in effect, just start since I just began with the fatty foods, or is this a sign that I’m taking “too much”… anyone have any knowledge of this? “Directions” just say to take it with a meal…
Hey guys sorry i have been busy. I have no good news to report. I started to taper my accutane at month 5 from 50 to 40 to 30 mg a week. Pretty quickly the end of February the beginning of this month my skin become intolerant again adn my chin became red, irrirated and swollen worse than before. My derm said I needed to go back to 40mg and be on it longer because it takes time on such a low dose.
I am dissapointed to say the least and scared that I may end up worse than before. I had two good months and now I am back to intolerance of eveything other than my cleanser (La Roche Posay Dermo Cleanser) and the Avene Intolerance cream. All of which is super expensive. I cut out makeup again. I will report back with what my doc says and how I do at 40 mg. I just upped it so it is too soon to tell.
I feel like I am a hamster on a wheel going nowhere! Maybe things will end up okay. I think this damn disease is tricky and one persons cure is another persons dissapointment. I am not losing hope. My derm is good, I am not blaming him and I think that I may need ot give this a shot for a year to know. My redness had gone down globally on my face but my “rebound” from lowering the dose was worse as far as my chin was concerned.
Okay so here it the deal. I started to develop a side effect at 4 months. Hives. And bad ones. Apparently my derm has seen a few other patients on Accutane with the same symptoms so he thinks it is from it and it is listed as a side effect.
So I cut my accutane does and have begun to taper it and the hives have decreased. Over all I have seen a big improvement except for my forhead and chin. THey are more sensitive which I hope will go away once the accutane is out of my system. I will update you.
Just a quick update. My chin and cheeks are still sensitive not as bad as they had been. I have tapered my accutane to 15mg a week. I am going to go off of it the endof the month. It did some good but after two months the negatives began to outweigh the postives. Some aspects of my rosacea are worse and some are better. Accutane does cause increased sensitivity so it is hard to determine where the disease the the drug end. I am going to my derm on 4/30. I am going to discuss stopping completely especiallky because it is getting warm out and I cannot tolerate any sunscreens.
I will update you guys if I found out anything new.
accutane is a great product even if taken in low doses, the unfortunate thing is that the acne keeps coming back approx. 8-10 weeks after discontinuing treatment. 7 years ago I went on my first course of treatment, suffering from moderate, sometimes painful acne. the treatment was 80mg/day for 3 months and another course of 50mg/d for 2 months. acne cleared completely but returned after 2 years. again moderate but sometimes painful. I went on a low dose treatment taking 10mg/day for 6months. but acne returned after only 10 weeks. tried villantae for 4 months, limited success. now back on accutane 20mg/day for 9 weeks. see how that goes.
what helps me most is sunlight -moderately, max1 hour per day, I do naturally have darker skin. what also helps on the low dose is loads of sleep and water. also you should consider changing diet completely, loads of fruit and veg no alcohol or chocolate or salty fatty food. but take your accutane with food and a glass of milk.
like i said the downside of accutane is not its side effects but that the acne will come back. its a struggle.
best of luck to all of you out there, you will need it.
d.
Liz,
I think I also have an intolerance to chemcials etc. What makeup do you recommend? My dermatologist told me that the mineral makeup contains nickel and that is a big irritant for alot of people. Any of recommendations?
I have both acne ( lots of small pimples, oily forehead & chin) as well as persistant cheek redness/ruddiness. I think I have the flushing type of rosacea on my cheeks only.
My first derm wanted to put me on 40 mg for 4 months. She told me the redness would not worsen. This seemed high to me (I am 5 foot 2, 105 pounds) so I saw a second derm who is starting me out at 20 mg every other day for two weeks, then we will bump up until I hit 40 mg.
Lisa,
I started on 10mg five times a week for a month and a half was skin was drastically better bump wise and redness wise adn then it started to change.
My forehead got really irritated and bumpy and burned alot. I lost my ability to wear makeup. I have heard this happens to alot of people even those without rosacea.
So I ended up going off of it completely by six months taking only 10mg three times a week. I also developed hives ( a side effect of accutane) and skin rash. My derm saw several other patients with this too so he didn’ tdoubt it.
I am much better now, bc, the accutane is reduced in my system it takes four full months to be out and I am not wearing makeup other than a bit of concealer undereye. My skin is best when I don’t irritate it by trying makeup. I recommend gentle skin care for me I get “acne” but really it is a reaction to the wrong products. I use la roche posay dermo cleanser adn avene thermal intolerance lotion. My looks pretty good and I don’t feel warm anymore.
Be careful on accutane do nto start out on a high dose, I think you should do 10mg three times a week at your weight. IF you experience a worsenign after time then considering tappering it.
Hope this helps.
Hi all,
Normally my face is slightly red/irritated/dark looking compared to my neck. It also burns a little and tends to develop edema. I have oily skin too, and I get more pronounced red areas in the chin area and around the edges of my nose.
A while back, I started on 20 mg. twice a week for a couple of weeks, then I went down to 20 mg. once a week. After 3 weeks to a month, my skin looked dramatically better than it had in years! My skin looked lighter, less red, healthier overall. Also, my eyes (which are usually pretty red) became clear. About 6 weeks into it, however, I suddenly became extremely depressed. Worried that it might be the accutane (which is known to cause depression in some people), I went off it. I feel better now, and I’m still not sure if it was the accutane . I’m starting it again today, because I’m not convinced that such a tiny amount of accutane was the cause of my depression. There were a couple of other factors that could easily have been the cause too. Anyway, my face looked so great that I’m willing to try again. Of course, if the depression returns, I’ll have to give it up for good. I’m crossing my fingers!
I have very oily skin as well as rosacea and am interested in getting in contact with a doctor who is understands and supports the use of low does accutane. My doctor was wary of prescribing it to me due to regulations that are in place. Can anyone recommend a doctor who is in line with this approach as a viable treatment for rosacea to me?
I forgot to mention that I am in PA in the U.S. any help anyone could give me would be great. Thanks.
-Jake
I am a 62 year old Brit with mild/moderate rosacea. I restore antique furniture and I think the dust and sometimes the stress make the symptoms worse. Sunshine is not a great problem here.
I took 10mgs per day for 6 months-it cleared it but it returned when I stopped.Went down to 10mgs every 2 days-it controlled it but still there
Switched to Finacea cream-forehead-once a problem now crystal clear-some spots around the eyes and bridge of the nose.Just starting IPL-that hurts but looking promising.
Hoping to go out soon in daylight without scaring small children. Not that bad really.
Roaccutane side effects were minimal-don’t read the patient insert-it’s terrifying
Hi John,
Thanks for sharing your experiences. Great to hear that you managed to find a dosage and regime that is working for you. The possible side effects of roaccutane are scary, but hopefully in low doses and also with the support of a good doctor, it can be a useful option.
davidp.
I’ve been using 40mg/day for the past few months now and absolutely no improvement whatsoever. I was also on accutane years ago with the same problems, and it cleared up some what but then came right back. Pictues and blogs from recent months proving this.
My dermatologists are quacks. They continue to prescribe the same garbage, or garbage similar to the crap before with no results, then tell me there’s nothing wrong with my skin, as it seems almost everybody has been through. The family doctor tried to shovel the same bull towards me until he gave in and prescribed accu. However, I think it’s pretty clear I’m taking way too much after finding several legit sites telling me to take a lower dose. Just because you have your doctor’s PHD or whatever, doesn’t mean you know anything about skin.
With that said, there’s obvious reasons why I can’t go back and ask for a smaller dosage.
Anyway, the point of my whole rant …..
Is it possible to take a tablet about every 3 or 4 days and hope to acheive the same results as a 10mg’er? attempting to level out the dose. I have literally been on every kind of treatment there is and with 0 improvement. It’s incredibly frustrating and if it doesn’t work, I honestly have no idea what else to do. Sometimes I just think i’m destined to have a face beat red like a tomato. Extremely embarrasing.
The 10 mgs every two then every three days kept it down but there were outbrakes and it quickly came back as 40% do according to my Derm.
Finacea cream was what worked for me-that does the spots and the IPL is starting to do the veins so I am getting it under control.It’s nice to apply
The IPL followed by 30 minutes of LED light is a good idea and helps you get over the pain of the IPL
Don’t give up!
Keep trying different approaches
Hydrochloric acid with your food was suggested to me the other day-the skin is an organ of excretion so why not!
40 mgs a day is more like an acne doseage than rosacea-I think
My rosacea seems to have come about when I discontinued the hormone pill Diane35 which I was taking for mild acne. It came on immediately and aggressively.
I have been taking 10 mg daily for four months now. My flushing has been reduced by about 80 percent. My skin is less oily and nearly free of blemishes. I have experienced no side effects other than dry lips and dry skin.
My flushing triggers include fermented foods, some alcohol, stress, going from cold to warm environment. I still flush occasionally, more so with the winter weather now upon us, but all-in-all the isotretinoin has been a miracle for me because my vision and facial swelling was getting so bad before I started taking it.
I plan to continue taking this drug for the rest of my life if need be.
I also find isotretinoin works great while on it (low dose - 10mg every other day) but oiliness and breakouts return soon after. It also have no redness/flushing or ocular rosacea symptoms while taking this drug - it is amazing in that respect. It has been the only thing that has worked for me to this degree.
Side effects have been minimal - dry lips (which I think pretty much everyone gets to some degree) and I have also had some intermittent scalp irritation which may or may not be due to the isotretinoin.
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