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
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.
“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.
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.