Rosacea is a chronic skin condition affecting the face of adults. Rosacea usually involves red flushing of the face, small red and/or pus-filled bumps, dilated blood vessels, and/or thickening of the skin. This condition can sometimes affect the eyes and lead to chronic irritation. It is not clear why people suffer from rosacea and you can read more about the condition here.
Rosacea can have different appearances and the cause for the condition is not clear. Perhaps this is the reason treatment is often frustrating. Some patients achieve good control with gentle skin care, basic hydration, and religious sun protection. However, some require prescription strength medications. A healthcare provider can prescribe topical medications and even antibiotic pills to treat rosacea but even with the best medical care, some patients will still experience persistence of the disease. In patients with rosacea, who mainly suffer from red and pus-filled bumps (known as papulopustular rosacea), treatment with isotretinoin should be considered if it is not responding to other treatments.
Low-Dose Isotretinoin for Rosacea
Isotretinoin is a medication that is part of the retinoid family of drugs and is derived from Vitamin A. It was previously known by the popular brand name Accutane, although this brand name does not exist anymore. Isotretinoin is taken by mouth and is used commonly to treat severe acne. However, it is known that isotretinoin can be used also to treat the “bumpy” type of rosacea, known as papulopustular rosacea, and doctors have been prescribing it to rosacea patients for years. Treating rosacea only requires low doses of isotretinoin to show an effect. The use of isotretinoin has multiple effects that may contribute to its benefit in rosacea. It affects the size of the oil-secreting glands (sebaceous glands) on the face and the composition of the sebum (oils) they secrete. This change may help to fight the change in immunity that occurs in rosacea.[1,2] Isotretinoin may also directly stop the growth of new blood vessels that are causing the red color in rosacea.
Side Effects of Isotretinoin
While isotretinoin can be helpful in rosacea, it has side effects that can be managed with the help of an experienced dermatologist. Isotretinoin is a very strong medication and has profound effects on a developing fetus and can cause severe birth defects. Therefore, it should not be taken by females who are trying to conceive. People that are on isotretinoin are required to be on effective birth control methods and your dermatologist can educate you on this. People who are on isotretinoin should not donate blood, since the blood may go to a pregnant woman and lead to severe birth defects. Isotretinoin has other potential side effects but the most common include dry mouth, dry eyes, and dry skin. Therefore, it is important to follow up regularly with a doctor when taking the medication. On the other hand, when used to treat rosacea, doctors may use very low doses of isotretinoin in order for patients to experience fewer side effects. This helps patients stay on the medication and achieve long-term clearance. So if your “bumpy” rosacea is not improving with regular treatment and you are not planning to become pregnant soon, low doses of isotretinoin for rosacea may be an option to discuss with your doctor, especially if all of the standard treatments do not seem to be working.
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Borovaya A, Dombrowski Y, Zwicker S, et al. Isotretinoin therapy changes the expression of antimicrobial peptides in acne vulgaris. Arch Dermatol Res.2014;306(8):689-700; PMID: 24916439 Link to research.
Dispenza MC, Wolpert EB, Gilliland KL, et al. Systemic isotretinoin therapy normalizes exaggerated TLR-2-mediated innate immune responses in acne patients. J Invest Dermatol.2012;132(9):2198-2205; PMID: 22513780 Link to research.
Guruvayoorappan C, Kuttan G. 13 cis-retinoic acid regulates cytokine production and inhibits angiogenesis by disrupting endothelial cell migration and tube formation. J Exp Ther Oncol.2008;7(3):173-182; PMID: 19066126 Link to research.
Rademaker M. Very low-dose isotretinoin in mild to moderate papulopustular rosacea; a retrospective review of 52 patients. Australas J Dermatol.2016;10.1111/ajd.12522PMID: 27435665 Link to research.