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Efficacy of Treatment With Low-Dose Isotretinoin in Patients With Rosacea
TAKE-HOME MESSAGE
- This systematic review and meta-analysis evaluated the efficacy and safety of low-dose isotretinoin (LDI; ≤0.5 mg/kg/day) for the management of patients with rosacea (erythematotelangiectatic, papulopustular, phymatous, and ocular rosacea). Treatment with LDI significantly reduced lesion counts and erythema with a large effect. LDI outperformed topical treatments in reducing lesion counts. At 16 weeks after treatment with LDI, the lesion count and erythema remained reduced by 70% and 47%, respectively. The effects on patients with ocular rosacea were unclear.
- LDI may be a safe and effective therapy for patients with recalcitrant rosea; however, further randomized controlled trials focusing on maintenance therapy are needed.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Rosacea is a chronic, relapsing inflammatory dermatosis predominantly affecting the central face and can result in significant psychosocial impacts. Isotretinoin has been studied for rosacea due to its anti-inflammatory and sebum reduction properties, but its use remains limited likely due to its off-label use and potential adverse events.
OBJECTIVE
This systematic review and meta-analysis investigated the efficacy and safety of low-dose isotretinoin (LDI; ≤0.5 mg/kg/day) for the four main types of rosacea: erythematotelangiectatic, papulopustular, phymatous and ocular rosacea.
METHODS
Randomized and non-randomized studies evaluating LDI for rosacea were included. Incomplete studies, non-English studies and case reports were excluded. Study quality was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation scale.
RESULTS
Of 435 studies, and 16 studies involving 1445 patients were included. LDI decreased lesion count (p = 0.03) and erythema (p = 0.01) with large effect [standardized mean difference (SMD) > 0.8]. Compared to topical retinoids and topical antimicrobials, isotretinoin had larger reductions in lesion count (p = 0.03) with moderate effect (SMD > 0.5). Mean lesion count and erythema remained reduced by 70% and 47%, respectively, at 16 weeks after LDI cessation. Relapse rate was 35% at 5.5 months post-isotretinoin, and three patients (0.4%) experienced worsening of rosacea. Three patients (0.4%) experienced serious adverse events.
CONCLUSIONS
Study design heterogeneity limited more comprehensive comparisons. Overall, low-dose isotretinoin may serve as an effective treatment for rosacea with good tolerability and safety.
Additional Info
Low-dose isotretinoin for the management of rosacea: A systematic review and meta-analysis
J Eur Acad Dermatol Venereol 2024 Sep 06;[EPub Ahead of Print], A King, MG Tan, C Kirshen, SN TolkachjovFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Rosacea is a common chronic inflammatory skin condition involving four main subtypes; however, patients can exhibit features of multiple types. Given the prevalence and chronic nature of rosacea, it is important to offer a range of effective treatment options and educate patients on avoiding environmental triggers.
This systematic review and meta-analysis including data from 16 studies (of which four were randomized controlled trials) assessed the efficacy of low-dose isotretinoin (LDI) in treating patients with rosacea. Notably, 75% of the participants had recalcitrant rosacea with no response to other therapies. Patients received a generally low average dose of isotretinoin (0.3 mg/kg/day) over a mean period of 18.5 weeks.
The meta-analysis showed an 85% improvement in rosacea after 16 weeks of LDI therapy. Improvements in papulopustular and phymatous rosacea were noted in all studies, with an 82% reduction in lesion count at 12 weeks, and 61% of the patients experienced an improvement in rhinophyma. Erythema decreased by 64% at 12 weeks; however, the results for ocular rosacea were inconclusive. The relapse rates varied by disease subtype but were the lowest for papulopustular rosacea. LDI therapy also outperformed topical metronidazole in reducing lesion counts. LDI therapy at a dose ≤0.5 mg/kg/day may be preferred over higher doses owing to better tolerability and a lower risk of adverse events, with less than 0.5% of the patients in these studies reporting significant adverse effects.
The heterogeneity of study designs and outcome measures limits this review. Additionally, long-term use, particularly in women of childbearing potential, presents challenges owing to pregnancy-related risks and the need for monitoring. However, this analysis overall supports considering LDI as an effective treatment for appropriate patients.