Resistant Rosacea? Try Low-Dose Isotretinoin - Brief Article - Statistical Data Included

0 Comments | Family Practice News, Feb 1, 2000 | by Barbara Baker

MONTEREY, CALIF. -- Low-dose, long-term, pulsed oral isotretinoin therapy can be a highly effective way to combat resistant rosacea, said Dr. Richard B. Odom, chair and professor of dermatology at the University of California, San Francisco.

It's a good option for men and for women who are not capable of childbearing, he suggested at the annual meeting of the Pacific Dermatologic Association.

About 70% of patients with rosacea respond to the traditional approaches of topical metronidazole or clindamycin or oral antibiotics, such as tetracycline. But the others either just don't clear initially or eventually stop responding.

In these patients, low-dose isotretinoin usually results in resolution of papules and pustules with very mild to no erythema. The theraphy also seems to resolve telangiectasias, "which is surprising because we know the retinoids have been reported to induce angiogenesis," Dr. Odon said.

He 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.

He avoids using long-term intermittent isotretinoin therapy in women with childbearing potential because the agent is terarogenic. "I prefer to treat them with a regular, shorter course and hope they get a remission," he said.

"But these women tend to relapse when the agent is discontinued," Dr. Odom added.