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.
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6 comments ↓
Dear David, after absorbing information from your extremely informative website (very well done!) for over half a year I thought it would be more than appropriate to start contributing as well. I am a Dutch born 42 year old male living a healthy life in Sweden and I am diagnosed with Rosacea Sept. 2008. I have a serious cystic acne history specifically on face and back (as my two older brothers and sister) and between the age of 15 and 23 tried the basic OTC and doctors descriptions available (from benzoyl peroxide to oral antibiotics) all of no avail. In 1989 I had my first 6 month of Roaccutane (Accutane) treatment and this totally cleared my acne and oily (sebum) skin for over a year after ending the treatment. Acne and oily skin returned but to a lesser extend and another Roaccutane treatment in 1993 helped me to manage the acne to a c. 80% improvement compared to the pre-accutane period. Around the age of 30 my scarred face and back cleared completely from acne for what I thought would be forever since my brothers and sister, without any Accutane treatment, cleared also for 95% from acne around the same age. My conclusion for the efficacy of Accutane on acne: reduction of sebum production and inhibition of the sebaceous glands. As unpleasant surprise the acne started to return 12 years later but this time together with a reddening of the face, dry skin, papules & pustules and widening facial blood vessels under both eyes. The house doctor and dermatologist diagnosis were easily made but the only part which still leaves me wondering is the red neck including inflammatory pustules and papules and the return of some acne on my back. For me its best described as a combination of Rosacea in the face together with (adult) acne on neck and back but the dermatologist prefers to call it extrafacial rosacea. I have been taking oral limecycline (tetralysal) for 3 month (600 mg for 6 weeks followed by 300mg for another 6) and already after day 3 the bumps on face and neck and to some extend on the back were gone but the facial redness, widening blood vessels together with facial ‘inward red coins’ stayed. After the 6 month of limecycline my daily regimen consists of Cetaphil mild cleanser, one drop of Jojoba Oil, Rosacea LTD3 and Rosacea care sunscreen all on face and neck. My face still clears every day (except for the blood vessels) the only problem left is a return of lesions on neck and back. I am now again taking limecycline (300 mg a day) together with the full daily regimen and again the neck lesions cleared almost immediately followed by the back lesions. I plan to stop gradually again soon with the limecycline and start experimenting with not using oil and LTD3 in the neck to see if face and neck react differently. Low – or micro dose long term antibiotics or accutane seem to offer at least a solution (to my believe both trough the ability to modulate the inflammatory response pathway) the only worry I have is the long term consequences. Especially since I have the feeling that taking Roaccutane a long time ago could be the main reason for having Rosacea in the first please. Although I have to admit directly that this is just a feeling without any scientific evidence. Thanks again for this great site and I will keep reading and contributing!
One more question for David: do you have an opinion on Rosadyn (not on the person behind it)?
I too would like to know what you think of Rosadyn–the new neutraceutical from Dr. Nase.
I too am afraid to go on accutane again for it caused the rosacea as well as my messed up nose in the first place.
My nose is lumpy and horrible and in the past 6 months have been getting papules and pustules from inflammation. There is so little info about this condition and I thank you for the steps your taking.
And isn’t it true that once you stop the accutane that the enlarged glands will just return to their enlarged states?
Hi Mik,
The official word from the expert committe on rosacea treatments says that ;
“Oral isotretinoin, used to treat severe acne, has been demonstrated to decrease nasal volume, especially in patients with less advanced disease, though the size may increase again after therapy is stopped”
So the bad news is that there is a chance that the swelling will return. Perhaps discuss the possibility of trying a lower dose of accutane.
davidp.
Update on Rhinophyma and accutane!
My initial stage 2 rosacea rather quickly developed into an early rhinophyma stage. Numerous shiny large sebaceous glands started to appear together with signs of fibrosis on both sides of the nose. Together with my dermatologist we decided to go for a low dose (ro)accutane course. 3 month 30mg/d, 2 month 20mg/d, 2 month 10mg/d and 2 month 30mg/w. My initial rosacea signs (reddening of the face, papules & pustules, burning sensation and widening facial blood vessels under both eyes) and my early rhinophyma improved significantly within 3 weeks and continued to improve until I completely lost the ‘look and feeling’ of rosacea. What’s left today is some widening blood vessels and c. 50% of the early fibrosis on the nose.
I stopped taking accutane and anticipate most signs will return at some stage. My main worry is the nose and therefore am prepared to go back on ld accutane when the glands start to grow again. The quesion for me will be: continuous low dose or interval courses. Cheers,
Peter
Thanks for your updates Peter. Great to hear that you are getting some good results.
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