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AAD 2024: Low-Dose Isotretinoin an Effective Treatment Option for Rosacea
89 percent of patients across six studies had complete or significant improvement
FRIDAY, March 15, 2024 (HealthDay News) -- Low-dose isotretinoin is an effective treatment for rosacea, according to a study presented at the annual meeting of the American Academy of Dermatology, held from March 8 to 12 in San Diego.
Marcus Tan, M.D., from the University of Ottawa in Ontario, Canada, and colleagues conducted a systematic review and meta-analysis investigating isotretinoin use in rosacea. Randomized and nonrandomized studies were included evaluating the effectiveness of low-dose isotretinoin as a rosacea treatment, excluding studies that were incomplete, case reports, case series, or written in a language other than English. Sixteen studies involving 1,454 patients were analyzed. The average isotretinoin dose was 0.30 mg/kg per day, or 7.03 mg per day, with a mean duration of therapy of 18.6 weeks.
The researchers found all four rosacea subtypes -- erythematotelangiectatic, papulopustular, phymatous, and ocular -- improved with low-dose isotretinoin therapy. In six studies, 89 percent of patients experienced complete or significant improvement with low-dose isotretinoin. Low-dose isotretinoin demonstrated efficacy in reducing erythema (P = 0.01) and lesions (P = 0.03) with a large effect (standardized mean difference [SMD] >0.8). Low-dose isotretinoin also was associated with larger reductions in lesion count (P = 0.03) but not erythema (P = 0.18) versus 0.025 percent tretinoin and one percent metronidazole cream, with a moderate effect (SMD >0.5). Compared with doxycycline, low-dose isotretinoin was less effective in reducing ocular rosacea (P = 0.03). Thirty-seven percent of patients saw improvements and 9 percent saw worsening symptoms with low-dose isotretinoin compared with 45 percent with improvements and zero with worsening symptoms on doxycycline.
The relapse rate following treatment was 38 percent at 5.5 months. Low-dose isotretinoin was well-tolerated overall, with 0.36 percent of participants reporting adverse events. Forty-four percent of patients on low-dose isotretinoin experienced conjunctivitis. One percent of patients experienced worsening of rosacea. After switching from a regular isotretinoin dose (>0.5 mg/kg/day) to a low dose, 70 percent of patients saw improvements in ocular side effects.
“Our combined systematic review and meta-analysis supports the use of low-dose isotretinoin (i.e., ≤0.5 mg/kg/day) as an effective treatment for moderate-to-severe or recalcitrant rosacea with good tolerability and safety,” Tan told Elsevier’s PracticeUpdate. “Monthly blood work monitoring is no longer necessary, but females of childbearing potential should continue to be counseled on the safe use of contraception to avoid pregnancy and should be monitored accordingly.”
Tan added, “Larger randomized controlled trials comparing low-dose isotretinoin … to doxycycline or other antimicrobials are necessary to solidify the findings from our study and establish [low-dose isotretinoin] as a safe and reliable option for rosacea.”