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.
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.”
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 ?
I have had many courses of low-dose Isotretinoin, usually at 10mg daily and have found it generally to be very helpful. The cyclic nature of my rosacea/acne combination did mean that after so long the number of pustules would increase and cessation of treatment always resulted in a flare-up after about 6 weeks.
Side effects on the low dose Isotretinoin were generally manageable or minimal, however I now find that as I’ve had so many courses of Isotretinoin I seem to have side effects that are permanent (drier, more sensitive skin on the body, dry lips), even when I’ve not had Isotretinoin for a long time.
I take 20 mg once per week (mostly every 6 days to be exact) as this is for me the right balance between postule control and side effects. In the beginning I took 20 mg per day and slowly turned it down to just once per week.
I cannot believe some of the high dosages “regular” acne sufferers eat per day considering the side effects. Going for the lowest effective dose possible is the most sensible. Comparing with other posts on this website I think the general range is between (lowest to highest):
2mg per day – 20 mg per day.
(I only know of 10mg and 20mg capsules so 2 mg per day is hypothetical).
Does this help ocular rosacea?
Any thoughts on dosage for this if helpful?
evam
Studies show that accutane reduces general bloodflow to the face in people with rosacea. I would assume this would also reduce bloodflow to the eye but that is pure speculation.
The Derm prescribed Accutane for me yesterday at a low dosage, 30mg every second day, that means Im taking 15mg per day? At 0.3mg/kg and weighing 50kg exactly I should be taking 15mg per day. Seems my derm is on the right track.
Heres to a better future and a new life! 🙂
I have to say that Accutane is the best thing available to treat Rosacea ,at least in my case. I had mild Rosacea and have been in remission for the last three years. I was taking two 20 mg tablets a day. Not sure how it works, but it works. Soon I will start taking 20mg tablet once a day for maintenance. If noting else is working consider Accutane because it really works. 🙂
Zoe Jovic, can I ask why you took such a high dosage?
Was this advised by your dermatologist? 2x 20 mg per day is more a dosage you would see with people with “regular” acne.
Comment via email from Zoe.
My dermatologist advised to take that amount. I had mild Roseca which was diagnosed on time. I did not have typical blemishes associated with Rosecea, it was the persistent burnig, redness that was causing me problems. Accutane really worked for me as I have been in remission for the past three years. From what I have read, a lot of people with this condition relapse after stopping Accutane, but this has not been the case for me. It is strange. I hope this will help.
I am 17 year old my doctor priscribe 40mg isotretinon tablets and started 3 pill a day total of 120 mg aday. I am around 185 pound. I have been onthe pill about 2and a half month recently I start getting blady nose my lips are swallen and red and the worse is my eyes are blad red.I am misarable and my acne isnot even better.My test results are high too.My mom talked to the Dr and he said he likes to start with high dose for permanant result.After my moms concerns Dr drop the dose to 80 mg a day but after reading the difrent sides about the dose I am concern if this is still a high dose for me and if I can get permanent demage.