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.
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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.
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.
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 🙂
I am a long term user of low dose accutane (10 mg per 2 days). It is effective though not bringing my rosacea/seb derm into remission. A side effect which i have is extremely slow wound healing leading to scarring. Even the slightest scrape of my arm takes weeks to heal and leaves a mark. This as a warning to accutane users. There always seems to be a catch, pffff. In my holiday i will try to revert back to doxycycline and see how it holds back the rosacea.
I have just started on low dose accurate – 10mg once a week. My derm said try it for a few weeks, then if you feel it’s not doing anything, up it to twice a week. I’m really taking it for oil control and so far it seems to be working well. And no dryness like you get with normal dose to accurate. My oily skin seems to be the reason for my acne rosacea, pastules and pimples so as long as I can reduce the oil, everything else clears up. I have reduced the redness in my cheeks by having laser (Candela V-beam Perfecta) twice, 8 weeks apart, and will probably need 2 more sessions, then a maintenance session once a year. At 44 I was feeling depressed there was no hope for me and it was just going to get worse as time went on. Now I’m feeling positive about this (although still too scared to be too optimistic!)
I suffered from pastular-pustular rosacea and tried every medicine including Oracea, Financea, Metrogel,
Doxycycline and Soolantra.
I read an article about low dosage Accutane and went on 20mg a day for 5 months.
The results were amazing-by preventing my oil glands from secreting sebum, my skin is now 100% clear and oil-free.
The problem is finding a dermo who is willing to prescribe Accutane. It’s astonishing to me that they cite the danger of pregnancy side effects as a reason even though I am a 62 year old man.
I’ve been on low-dose Accutane (10mg/daily) for just over a year now, after suffering from moderate to severe papulopustular rosacea for over a year. I tried rozex and minocycline but neither helped at all. My skin was painful, red and raw and getting worse every day.
I was very reluctant and scared about using Accutane – but was reassured after consulting with multiple dermatologists. They all told me that the information on the internet is not all correct, and that long term low-dose Accutane is perfectly safe. As a precaution I’m getting regular blood tests and not ONE thing has changed in more than 12 months. My only side effects are dry lips, skin and eyes, but these are easily controlled with lip balm, regular moisturiser and eye drops when I go to bed.
And the best thing is that my rosacea is totally controlled by this medication. I have the odd flare-up but it’s usually due to stress or eating badly – which is what my skin was like before the rosacea hit anyway and as far as I know most people’s skin looks bad if they’re stressed or following a bad diet. So I feel like I’m actually back to “normal” – although I still follow a strict cleansing routine with Cetaphil, plus Cetaphil moisturiser and rosacea-friendly sunscreen, and I never go in the sun without a hat. But low-dose Accutane has worked for me.
Having said all that, I’m not comfortable taking a controversial pill every day. I’m seeing my dermatologist tomorrow and will talk to him about trying Soolantra, as I’m hearing some pretty amazing things about that for people with PP rosacea.
Cheers
Kathy
I used Accutane, 20 mg each day for 6 months. It made a huge difference. I remained clear for 12 months and the skin is still much improved. Three years later my skin is still much improved, however I am now starting to have a few issues once again. I have no issues with going back on the drug if I feel I need it.