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Very low‐dose isotretinoin in mild to moderate papulopustular rosacea; a retrospective review of 52 patients
Author(s) -
Rademaker Marius
Publication year - 2018
Publication title -
australasian journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.67
H-Index - 53
eISSN - 1440-0960
pISSN - 0004-8380
DOI - 10.1111/ajd.12522
Subject(s) - isotretinoin , medicine , rosacea , acne , papulopustular , adverse effect , azelaic acid , metronidazole , population , psoriasis , retrospective cohort study , dermatology , gastroenterology , surgery , antibiotics , environmental health , biology , microbiology and biotechnology , genetics
Background/Objectives Rosacea is a chronic inflammatory disorder that affects up to 10% of the population. Standard treatments include topical azelaic acid and metronidazole or systemic tetracyclines. Isotretinoin has generally been restricted to severe disease, often at a dose of 0.5–1.0 mg/kg/day. Method Retrospective review of open‐label isotretinoin (initial dose 20 mg/day, with dose adjustments according to response), in patients with mild to moderate papulopustular rosacea. Results Altogether 52 patients (33 women), mean age 48 years (range 18–86) were treated with isotretinoin over a 5‐year period. All patients were commenced on 20‐mg isotretinoin/day which was reduced to 10–20 mg once to five times a week (equivalent to 5 mg/day) in 67%, but increased in 15% (who all had additional acne) to 30–40 mg/day. In terms of dose/kg/day, 29% received ≤ 0.1 mg/kg/day, 46% received 0.11–0.25 mg/kg/day and 10% received > 0.5 mg/kg/day. Treatment was continued for 57 weeks (range 9–223). Six patients (12%) did not attend follow up. Of the remainder, in 91% (42/46) the rosacea had cleared or was excellent. One patient stopped isotretinoin because of its adverse effects. Two‐fifths (44%) suffered no adverse effect. The most common side‐effect was cheilitis in half (52%), which was mild in all but one patient. Conclusion Very low‐dose isotretinoin (e.g., 10–20 mg once to five times a week, equivalent to 5 mg/day) is an effective treatment for mild to moderate papulopustular rosacea and is well tolerated.