Following is some insightful comments from a well known and respected member of the online rosacea community, Rick.
The use of low doses of accutane to treat rosacea is a little controversial; firstly the drug is strictly controlled because of its negative side effects and secondly because high doses of accutane can worsen or induce rosacea like symptoms in some patients.
Always good to read some real world experiences from someone who has tried accutane and found a dosage and regime that worked for them.
From: Rdl000@_.com
Date: Wed May 16, 2001 6:33 pm
I must say that I am astonished (yes, astonished) with the impact low-dose accutane has had on reducing my rosacea symptoms.
I have had rosacea now for nearly 2.5 years. Symptoms are daily flushing and burning, always around mid-day, moderate background redness, some telangiectasia (throught to be mostly from sun damage), and relatively mild ocular rosacea characterized by bloodshot eyes. Over this time, I have tried the usual oral + topical antibiotics, antihistamines, beta blockers, TCAs, and, most recently, a 5-treatment photoderm series (using Bitter Sr protocol). None of these, including photoderm, has had anything resembling the impact that low-dose accutane has had. (See previous post for details on my photoderm experience.)
At any rate, I was quite intriqued by the discussion concerning accutane in Geoffrey’s book, in particular the fact that investigators have noted that accutane has
- resulted in a reduction of facial skin temperature by up to 1 degree C within 3 days of treatment,
- led to a 40 percent reduction in blood flow through the cheeks (as measured by laser doppler)
- eliminated facial burning in 18 patients within several weeks of taking accutane.
This last observation is contained in the paper: Efficacy of Low-Dose Isotretinoin in Patients With Treatment-Resistant Rosacea, (Archives of Dermatology, Vol. 134 No. 7, July 1998).
After reading this paper, I was convinced that it was worth trying another round of accutane. My derm had put me on 40-60 mg/day 6 months after I was diagnosed, and this high dosage really dried out my face, and increased the flushing and burning. I briefly tried low-dose accutane last summer, but did not pursue since I wanted to start the photoderm ASAP.
My first experiment was to initially take 40 mg/day and see what impact this would have, now that my rosacea symptoms have advanced since my initial experience nearly two years ago. I did this for 6 days, until I started to feel my face drying out, and then did not take any accutane for the following 7 days. Here is what I observed: at about day 3, the facial burning subsided quite noticeably, and I am certain this was due to the accutane. However, in the following days, as the plasma concentration of accutane increased, the burning returned, and indeed, for several days right after stopping accutane (when plasma concentration was presumably at its highest), my flushing and burning were essentially as bad as ever. Then, as the plasma concentration gradually decreased, I noticed a reduction in burning just as I had at day 3. Obvious conclusion is that there is a rather narrow range of plasma concentration that significantly reduces burning and flushing. Corollary is that typical weight-derived dosage produces concentrations that are way too high, and indeed leads to increased flushing.
So, after the 6 days at 40 mg/day, and the 7 days off, I began taking 20 mg of accutane every two days. This 10 mg/day is precisely the dosage given to the 22 participants in the study in the above reference. (These people were selected because they had rosacea for mean time of 6 years, and nothing else had worked.). I am now 20 days into this dosage, and I am seeing reduced redness each day. The daily facial burning is completely gone, and my face feels remarkably cooler even during my normal daily flush cycles. For first time in longer than I can remember, my face actually feels normal throughout the day, with maybe some slight tingling if I am concentrating really hard (my flushing appears to be sns-mediated, and flushing during mental calculation is typical of this). This dwarfs any minor improvement I had seen as result of the photoderm. The bottom line is that I am seeing exactly what had been reported in literature: a substantial cooling of the facial skin, and complete elimination of the incessant daily burning.
Two other observations: my ocular rosacea has also improved in that my eyes are much less bloodshot, presumably due to reduced flushing. And, again due to decreased flushing, my telangiectasia are much less prominent. This improvement is much more pronounced than that achieved via 5 photoderm treatments.
I strongly believe that the key is to find one’s personal “sweetspot” in terms of accutane dosage and hence corresponding plasma concentration to achieve optimal reduction of rosacea symptoms. One way is to increase dosage to point that your lips are just a little dry (nothing that can’t be contained with a good chapstick …), but face does not feel unusually dry. The weight-derived dosage that derms prescribe for cystic acne is WAY off this optimal point. Even Singer’s 1998 review paper on drug therapy for rosacea says that accutane should be administered at 0.5 mg/day per kg of body weight, which is still 35 mg/day for 150 lb individual. (Personal note: I am 6 ft 5 inches tall and weigh 200 lbs – this would be 45 mg/day for me.)
BTW, one reason I started accutane now is that my rosacea was progressing to point of getting a few bumps. Accutane stopped these immediately, as documented in above reference as well as essentially all other accutane studies. If you have any bumps when you start accutane, they will heal slower than usual since accutane, in course of shutting down sebaceous glands, does delay healing, which is why you need to be off it prior to photoderm or laser treatments.
As for accutane side effects, my take is that these are only an issue at standard dosages, except that it is very clear that women must never get pregnant on ANY dose of accutane. A leading rosacea researcher even mentioned to me in a private communication that he does not do usual blood work at low dosages, and indeed feels long-term, low-dose accutane treatment is safer than long-term use of systemic antibiotics. I plan to continue current regimen for at least 6 months, and possibly a year depending how it goes. There is evidence that symptoms remain in remission after accutane is stopped.
Accutane is indeed an astonishingly effective drug for treating nearly all rosacea symptoms. (Its effectiveness on acne is why the Am Derm Society has fought the FDA’s attempts to much more tightly regulate accutane prescriptions.) In the final analysis, it is the only thing that has produced significant improvement for me. As Heidi has observed, it may be difficult to convince your derm to prescribe accutane if you are woman of child-bearing age, particulary if your symptoms are relatively mild. In this case, you may have to agree to do standard oral antibiotics + Noritate for a couple of months before derm agrees to accutane. But you might have some success in this argument if you show your derm the above paper, and argue that side effects (with obvious exception of impact on pregnancy) at this low dosage are MUCH reduced relative to those reported at the much higher dosages (up to 100 mg/day) for acne treatment.
Rick
From: Rdl000@_.com
Date: Thu May 17, 2001 4:06 am
Subject: Re: Dramatic results with accutaneHi,Although isotretinoin (accutane) and tretinoin (e.g. Retina-A) are similar chemically, tropical tretinoin is strictly off-limits for rosaceans because it increases erythema and accelerates formation of telangiectasias. You may be referring to the article by Ertl etal, which was roundly criticized by Wilkin for the above reasons.
Rick
From: Rdl000@_.com
Date: Thu May 17, 2001 2:08 am
Subject: Re: Dramatic results with accutane
Jim,
Actually, I think low-dose accutane, tuned to individual response, is likely to help a very large number of resistant cases.A major trigger for me is daily stress, not so much from meetings and presentations, but just working hard in my office. I still feel a flush kind of coming on, but (a) my face feels MUCH cooler to touch, and (b) if I look in mirror, I am amazed at how little red I am showing even though my system is “trying to flush”.Probably my biggest trigger is driving home in car after full day of skiing in cold Northeast. Too late in year to test that one, but I have wondered myself if it will mitigate this as well. I think there is a chance, given points in my original post concerning lower facial temperatures and reduced facial blood flow as result of accutane.Related comment: if I am in cynical mood about photoderm (which I am), why is it that photoderm “researchers” (term used loosely here) have never published laser doppler measurements of facial blood flow to document claims of reduced flushing after photoderm? Peter Drummond, who studies sns-mediated flushing, routinely uses this technique, as did the authors of the aforementioned study on accutane.
Best,
Rick
— In rosacea-support@_.> wrote:
Hi Rick,
Thanks for relating this. It is likely to help some members. When you are on the low dose accutane, how do your flushing symptoms respond when you are exposed to such triggers as exercise and heat?
Sincerely,
Jim
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Hey Amanda – I know it’s a big decision and I found it a little scary. I am actually anglo-indian so my skin is brown (albeit not super dark) but rosacea is not as common in darker skinned people so I kept thinking mine was pretty mild compared to others and thought I would respond well to the less invasive mainstream treatments. Cant believe my luck that it’s been the complete opposite experience. Getting more and more despondent as we continued to check off all the different treatments with little or no lasting results.
I must be about 6 weeks in now. I feel the biggest change for me is the heat in my face and very little itching – the sides of my cheeks used to come up in the little bumps really quickly from one day to the next but that has not happened to date. Although I can feel my face heat up quickly if I am stressed at work it does not stay as flushed or hot and happens a lot less in general.
I get these red patched across the tops of my cheeks but I would not say they have reduced in colour. Not too noticeble with makeup on but I know they are there and am probably still self conscious about them. I am not sure if there will be any improvement there over time.
About 2 weeks ago I developed what I thought was a rash. The chemist said it looked like a staff infection and could be the roaccutane. I finally went back to my derm today and he said it’s from the sun. The roaccutane makes you exrtremely sun sensitive – again I figured with darker skin I would be ok and this “rash” was only across tops of my shoulders and arms. Why wouldnt it be on my face if it was the medication? He said my shoulders are not as dark and dont see as much regular sun so my first trip walking in a singlet style top a couple of weeks ago (no sunscreen!) is the most likely cause. Hydrozone cream will clear it up but lesson learnt – especially as we head in to hot West summer.
Dry nose and lips are a bit annoying , seem to be really bad for a few days then good for a couple of weeks and so on, but again i just keep a chapstick at hand and apply throughout the day.
I have not had gastro issues as some others have so I am grateful for that. For me this has been the right step.
I never thought I would start to feel better about myself again as it’s been over a year and a half for me to get to this point. I remember not ever wanting to look in the mirror and feeling sick when I would take my make up off at night only to see this red dotty face staring back at me. Yet here I am, I may not look the same as I did before but I’ve come along way so all I can say is hang in there and I hope you get some results.
Take care I hope to see a post from you in a few months updating as to how you are looking and feeling better!
PLEASE CAN ANYONE TELL ME IF THEY EXPERIENCED ANY HAIR LOSS ON ACCUTANE .. AS IVE BEEN ON THE HIGHER COURSE AND LOST A LOT OF HAIR AND SO DID MY FRIEND AND BROTHER WHO WAS ALSO ON THE HIGH (40MG PER DAY EVERY DAY) AND THIS WAS ONLY FOR 3 MONTHS AND I LITERALLY LOST HALF OF MY EXTREMELY THICK!!!! HAIR I WOULD NOW SAY I HAVE THIN HAIR… ALTHOUGH I CAN SEE IT GROWING BACK.. 2 YRS LATER!!! AND ALSO MY SKIN IS SO OILY AND SWOLLEN AGAIN.. I HATE IT!!!!!!! IVE BEEN TOLD THE LOW DOSE COULD WORK FOR ME ALSO BUT IM VERY CURIOUS ID ANYONE HAS HAD A HAIR LOSS SIDE EFFECT…. ????? X
I was on it for 6 months in 2009 feb to august. (40 mg dose, which my PA told me that was low and they usually dosed at 80.) During treatment and post treatment and currently (almost 3yrs later) I flush in the heat, my face needs lotion every morning, I need to drink a ton of water and break out in red marks all over my body (especially the neck and chest) whereas before treatment I had oily skin and mild acne, no red face or anything like that. I will say though, that I had sensitive skin, when scratched turned red but went away after 15 minutes. The accutane has increased the occurance of blotchy skin from maybe once a week before on the med to minimum 4 times daily. Because I did not try any alternative before trying accutane I wish I had never used the drug to begin with. I have no hair loss, and aside from the more frequent blotchy skin on neck and chest, I have to drink about a gallon per day and put lotion on my face twice daily. Almost forgot to mention I have acne on my arms whereas I did not before.
All the negatives I listed above, positive is that my face is clear.
Do yourself a favor, just try alternatives, including a healthy diet before even considering this drug.
Dear Mandy and all,
I too have been on low-dose isotretinoin for going on 12 years, with breaks of 2-3 months every few years. I’ve had no side effects barring some very mildly chapped lips and very mild skin dryness. It has changed my life. I’d love to get in touch with others who have also been on accutane or generic isotretinoin for a long time. I’m planning a pregnancy in the next three years and wondering what the necessary cooling off period will be for me. Does anyone know if there are tests to determine levels of isotretinoin still in one’s body after treatment? If I recall correctly, it can be deposited in fatty tissue. Thanks and good luck with your skin!
PS I’m also supplementing with folic acid, based on this
http://www.ncbi.nlm.nih.gov/pubmed/23135667
hi maria can we talk ? im a 27 year old male which has very fair skin .. constant flushing and redness .. so much heat in my upper trunk area(neck face head) i was on accutane 10 years ago which i think brought my roscea on .. id like to talk about low dose accutane .. id appreciate your help and experiences
michael
Hi everyone
I have the exact same condition as stated above. Light rosacea around my forehead and I have ocular rosacea as well. I had it for about 6 months, tried anti dandruff shampoos as recommended by my DR. I got a referal and saw my dermatologist who gave me a very low dose of roaccutane. I take one 20mg tablet 3 times a week. And it’s all now completely gone. I agree you need to find your sweat spot, lips just starting to feel a bit dry and the treatment is very effective. I’ve been on this medication for the two years. My dermo told me to stop for a while to see if I still needed to take it but it came back within 4 weeks of stopping so I’m back on roaccutane again. I get a regular liver check to make sure long term use doesn’t do my damage and it hasn’t.
I can safely say for me roaccutane has been the most effective treatment for my rosacea.
Thanks
Tony
Australia
Maria, I’m interested in knowing dosing details throughout these 12 years. Can you please email me. I will certainly appreciate it.
Hi everyone, ive just found this sight and have read a few comments on here and now have some concerns 🙁 ive had rosacea for approx 5/6 years with it getting worse each year. I have been on 60mg of roaccutane for 5months now. The changes are amazing!! My face burns alot more but with that being a side affect of rosacea AND of roaccutane, I expected as much. My face and lips have dried out but with plenty of e45 and lip balm they are manageable. The major difference ive found is the lumps, I had so many that just wouldn’t go away that I looked like a had awful acne but it was just lumps. They have all completely gone!! Washing my face and feeling smooth skin is something I thought I would never feel again… Which brings me to my concern! A few of the comments ive read have said people who have come off roaccutane have found these issues to return! 🙁 has anyone found it successful with no returns??? I believe they will be taking me off the drug on my next visit, thanks for any help
Hi Maria, I was on 40mg per day for 6 months and my skin was completely clear of bumps. I never believed it to be a lifetime cure, I was correct. I was clear for a further year before the lumps and bumps started to come back. I would not worry about it returning and just accept that it probably will. At low dose the drug is not harmful to most, unless you are looking to fall pregnant, simply make an appointment with your Derm and go back on it for a while. The way I justify it to myself is that there are many people who suffer from a variety of illnesses and many of these people are required to take certain drugs for the rest of their life. Those of us with this horrible disease need to control it as best we can. I feel that we tend to be a little embarrassed to make a big deal about our situation thinking it is just cosmetic and not life threatening, it is life changing however so don’t be afraid to keep asking for it. If the drug works for you why suffer. It may permanently prevent acne but from what I have learned it is very unlikely to have the same results with our disease, the best we can hope for is to maintain control, if maintaining control means going back on roaccutane then just go back on it.
David,
It seems as though unless you were on Accutane consistently, after a few months, the results wore off. Is that correct?
Have you experienced any long term side effects from being on it consistently?
In my case, I’m not sure what my triggers are. I have Type 2 and Type 4 rosacea. My biggest issue is that my sebaceous glands on my forehead (and above – I’m bald on top) break out. I have what look like red pimples. Hot water definitely aggravates them and my dermatologist told me I also have heat hives. Often times, the pimples clear up during the day. Having Type 4 rosacea, my eyes sometimes get bloodshot. Sometimes, they get very bloodshot in one area and the rest of the eye is clear.
I actually was on a full strength dosage of Accutane a few years ago for 6 months, BEFORE I had all of these Rosacea symptoms, because I used to get a lot of shaving bumps. Also, I used to get adult acne around my nose. My dermatologist wanted to dry out my oil glands. The treatment worked. The side effect I experienced was dryness. She also was very conservative and made sure to send me for a blood test every month to check my liver.
Since then, I’ve tried Metrogel, Finacea, and Oracea for my Rosacea symptoms. Nothing has gotten rid of them. However, compared to some, my Rosacea symptoms are mild. Some days I’m completely clear. Other days I’m not. Also, when I travel up north during the winter (I live in FL), my skin gets dryer and my eyes usually get more red.
Now my dermatologist is recommending putting me back on a 10 mg dosage of Accutane for 6 months. She said it’s helped some of her other patients.
Before I try that, I’m going to try something called DermaClear Rx, which contains an ingredient called praventin, which is supposed to help with sebaceous glands. It won’t do anything for my eyes though.
http://stores.intuitwebsites.com/FKulinsky0/-strse-59/DERMA-CLEAR-RX-120CAPS/Detail.bok
Any thoughts? Thanks.
– Matt
I suffered from rosacea phase lll for 15 years. It started when I was 15. It has been the main reason for stress in my life. I had blotchiness, super oily T-zone with horrible open and closed comedones, red papules and pustules with lots of flushing, itchiness and hot sensation on my cheeks. Sugar in any form, tea, coffee, sour, pungent, spicy and thermally hot foods, stress, emotions, laughing, crying, sex and every damn thing made me break out. I tried everything available in the market, both OTC and prescription but nothing controlled it. Then my new dermatologist started me on low dose (10mg/day) of Accutane. My face almost cleared up in 2 weeks. But to take care of my stubborn jawline pustules, he increased it to 20mg/day. And OMG! In just one week, I got this new life with extremely beautiful and glowing skin. Not even one…yes not even a sign of redness or warmth or papules/pustules. This man and this medicine has been more than a God-sent for me. I am Indian by origin but has type 2-3 skin. He gave me some glycolic peels and phototherapy sessions too and my skin looks awesome. After 6 months he reduced my dose to 20mg every other day. Triggers? what triggers? My skin is ever glowing no matter what I eat or do. I use microsphere isotretinoin locally to keep the pores on my nose clear and as anti-aging too. For occasional freckles, I use hydrocurcumin cream. I am a happy girl with normal skin.
Hi Sakshi…which dermatologist did you go to?
Hi Pinky! Sorry for the late reply. I went to Dr.Sachin Dhawan in Gurgaon. You can find his contact details online very easily. I discontinued Sotret about 6 months back because it had made my skin extremely sensitive. My rosacea papules and pustules have come back. I can’t use anything on my face except cold water. Every facewash including the non-foaming ones break me out in red bumps. I am using finacea gel 15% these days and it seems to help but stings like crazy and makes my skin dry too. I use Curel ultra healing intensive lotion as a moisturizer. It is non-comedogenic but guess it would be quite heavy for oily skin. Mine is combination skin now. Please feel free to ask me any other questions that you might have. I would love to help as much as I can.
Sakshi.
Hi Sakshi! :o)
I was intrigued when reading your posts. How are you doing now?It sounds like you had great success with the accutane and with it clearing your skin–I was so happy for you! But then you said you stopped the accutane and now your skin is very sensitive and the bumps have come back. Have you managed to get them under control? I developed rosacea over the last 7 months after coming off an SSRI (I know crazy huh?!?) and am now looking into low dose accutane. I tried metro gel but that was very drying and didn’t really work. I am currently taking doxycycline which helps a little and am also using finacea (only for a couple weeks). Let me know how you are doing!
Laura:)
Hi Laura! Yes I am off Accutane for the last 6 months or so and do get rosacea papules and pustules if break my rules. My skin remains clear if I don’t use anything on my face except cold water, stay indoors with no sunlight peeping through and stay away from sugar and processed and spicy foods. I like using finacea every night because it helps with the eliminating any dead skin and is an anti-inflammatory too. I am struggling to find a facewash that can remove my sunscreen without flaring up my rosacea. I think my skin has become overly sensitive because I took Accutane for 4 years. The thing is that low dose Accutane can’t cure it. It just controls it as long as you take it. People with extremely oily skin might be able to tolerate high dose accutane which is believed to cure acne vulgaris. It might be due to the extremely dry Phoenix climate too that my skin has become drier in some parts making it even more sensitive. These days I am washing my face with Cera Ve hydrating face wash and using Cera Ve moisturizer once a day. Its a lifelong pain what can I say. I was also on SSRIs for some time. I don’t think that contributed to my rosacea in anyway. Please stay connected. I like talking to people who are in the same boat. FYI, there is a rosacea video by Dr. Sam Bunting on youtube. Its a priceless advice. Watch it if you can. Take care.
Hi Laura! Yes I am off Accutane for the last 6 months or so and do get rosacea papules and pustules if break my rules. My skin remains clear if I don’t use anything on my face except cold water, stay indoors with no sunlight peeping through and stay away from sugar and processed and spicy foods. I like using finacea every night because it helps with the eliminating any dead skin and is an anti-inflammatory too. I am struggling to find a facewash that can remove my sunscreen without flaring up my rosacea. I think my skin has become overly sensitive because I took Accutane for 4 years. The thing is that low dose Accutane can’t cure it. It just controls it as long as you take it. People with extremely oily skin might be able to tolerate high dose accutane which is believed to cure acne vulgaris. It might be due to the extremely dry Phoenix climate too that my skin has become drier in some parts making it even more sensitive. These days I am washing my face with Cera Ve hydrating face wash and using Cera Ve moisturizer once a day. Its a lifelong pain what can I say. I was also on SSRIs for some time. I don’t think that contributed to my rosacea in anyway. Please stay connected. I like talking to people who are in the same boat. FYI, there is a rosacea video by Dr. Sam Bunting on youtube. Its a priceless advice. Watch it if you can.
Btw, which face wash do you use? Cera Ve doesn’t irritate my skin but it doesn’t remove mineral sunscreen at all. I liked skinceuticals physical fusion and sheer, both, but since they are water resistant, removing them is a nightmare. So I am in search of a good mineral tinted sunscreen that can be easily washed off with a gentle non-foaming face wash. Which face wash and sunscreen do you use?
Take care.
hey sakshi
sorry i did not get right back to you–for some reason I don’t get notified through my email if someone responds to me. Anyway, I had a question for you—when you first started low dose accutane, did you notice your pustules/papules got a little worse before they got better?
Thanks!!
Laura”)
Laura,
No, my Rosacea didn’t get worse at all when I started Accutane. In fact, it started clearing up in a few days. My skin became much less oily. I started 10mg daily but after 3 weeks my dermatologist increased it to 20mg daily because of resistant jawline pustules. Then it all healed. After 6 months, he decreased my dose to 20mg on alternate days to lessen the drying effects. I maintained that dose for rest of the time.
Good luck!
Wow thats awesome!! I just started low dose (10mg every other day) about 11 days ago and it seems as though it is drawing out some papules/pustules. It is bringing them out in my problem areas though (mainly my cheeks) so I’m not sure if this is the “purge” that some people talk about. I know some people get better right away, whereas others seem to have a breakout period and then heal. So I figured I would ask you and find out what your experience was. Thanks!!! 🙂
I have been suffering a pimple-disease on my chin and less on my cheeks (dermatologist said its rosacea and not acne though I do not have itching or redness..).. for 10 years. It started when I decided to go for intra uteral hormonal device for contraception Used tons of antibiotics to spread on my face and took several courses of doxycylin.. I was so tired of feeding the cometic cabinets and pharmacies….I am a doctor of another speciality myself.. so I kind of doubt her decision about rosacea but her main message was that she thinks the only way out is Accutane. So now I am on the treatment for 5 weeks and results are showing. I started with 10 mg, then after 2 weeks 20 mg and now I am doing 40 mg per day. I am over the dose what is usually recommended for rosacea (0.3 mg/per kg), I am taking 0.68 mg per kg once per day. The side effects are of course burning and dry lips but I am using dr. Hauschka lip balm.. what works like a miracle. The result I am so happy about are: pustules and pimples almost gone, kind of reducing in size, no ugly new ones . I can see the traces of them fading – that all is happening to my chin. On the sides of my cheeks I have developed some under skin pimples and they will obviously clean up soon as has happened on my chin. Funny.. but my overall complexion is looking pinkish and really smooth. I am soon 36 but this treatment gives me glow and shine into face 😀 I think I will continue with 40 mg therapy for another month. Then depending if any new spots will show up. I could increase the dosage for another month and then my doc suggested to start gently reducing the dosage until back on 10 mg. And the trying one pill on every other day… until I forget taking it..;) and hopefully I am free of my skin issue.. and can start worring about wrinkles ..:D 😀 Luckily I have already 2 children and I think I will not be thinking about new pregnancy at all. When it comes to alcohol.. then I am already asking diluted apple juice for wine and Sprite or apple juice with sparkling water for dinner party and cocktails 😀 😀 Good luck everyone!
I have also been on Accutane for nearly 6 months now. Monthly basis, started with 10g, 20g, 30g, 20g, 20g. The results were astonishing. I had never seen my face look this good in my adult life.
At start of month 6, went down to 10g. At week 2, I started to notice redness coming back, white heads popping up, & slight burning. Went back to 20g which stopped all that and put thing back under control. Forehead redness, per my derm, was diagnosed as Seborrheic Dermatitis. Using hydrocotizone to alleviate redness and scaling. Some studies pointed that a ‘cumulative dose’ must be reached before daily dose can be reduced. For acne patients, my derm hits 10,000 mg/6 months. For rosacea, around 5000g. However, he later told me this does not apply to rosacea. I’m not sure.
The short lived-relapse after reducing to 10g was a setback. It made me think of an ‘exit’ strategy to at least get back to to where I was before starting it. For now, I’ll finish month 6 at 20g to stabilize my condition. Afterwards, I’ll go 15g daily.
I’m searching for this sweet spot. I know 10g daily did not do it & I’m not sure if it will regardless of how long I stay on 20g. I’m also not sure if 10g daily is therapeutically different than 20g every other day.
I will have to go through this and find out. The journey is not fun at all.
Thanks