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Low-dose isotretinoin versus minocycline in the treatment of rosacea
Avner Shemer1,2, Aditya K Gupta3,4, Riad Kassem1,2
1Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Tel Aviv University, Ramat-Gan, Israel.
Abstract:
Rosacea is a common inflammatory facial skin condition affecting the adult population. Its papulopustular subtype is mainly treated pharmacologically by topical and oral antibiotics. For severe or antibiotics-recalcitrant disease, daily low-dose isotretinoin has also been reported to be effective. However, no previous study has assessed the efficacy of once-weekly administered isotretinoin for papulopustular rosacea. For this purpose, a retrospective comparative study was conducted. For severe rosacea, 40 mg/week isotretinoin (24 patients) was administered. For mild to moderate rosacea, once-weekly 20 mg/week isotretinoin (28 patients) was compared with 100 mg/day minocycline (24 patients). Treatment courses lasted 4 to 7 months. Forty milligrams per week isotretinoin was highly effective for severe rosacea, achieving complete response (over 90% improvement) in 62.5% of patients and partial response (50%-90% improvement) in additional 29.2% of patients. Twenty milligrams per week isotretinoin and hundred milligrams per day minocycline showed comparable efficacy for mild to moderate rosacea (complete response of 10.7% vs 8.3% and partial response of 28.6% vs 33.3%, respectively). This study demonstrates that that the use of a weekly low-dose isotretinoin is an effective treatment for papulopustular rosacea, including among patients with severe disease.
Insights
Weekly low-dose isotretinoin effectively treats papulopustular rosacea. Both severe and mild-to-moderate cases showed significant improvement, offering a new therapeutic option for this common inflammatory skin condition.
Area of Science:
- Dermatology
- Pharmacology
Background:
- Rosacea is a prevalent inflammatory facial skin condition in adults.
- Papulopustular rosacea is typically managed with antibiotics.
- Low-dose isotretinoin is an option for severe or antibiotic-resistant cases.
Purpose of the Study:
- To evaluate the efficacy of once-weekly administered isotretinoin for papulopustular rosacea.
- To compare weekly isotretinoin with daily minocycline for mild to moderate disease.
Main Methods:
- Retrospective comparative study design.
- Severe rosacea treated with 40 mg/week isotretinoin (24 patients).
- Mild to moderate rosacea treated with 20 mg/week isotretinoin (28 patients) or 100 mg/day minocycline (24 patients).
- Treatment duration ranged from 4 to 7 months.
Main Results:
- 40 mg/week isotretinoin achieved complete response in 62.5% and partial response in 29.2% of severe rosacea patients.
- 20 mg/week isotretinoin demonstrated comparable efficacy to 100 mg/day minocycline in mild to moderate rosacea.
- Complete response rates were 10.7% for weekly isotretinoin vs. 8.3% for minocycline.
- Partial response rates were 28.6% for weekly isotretinoin vs. 33.3% for minocycline.
Conclusions:
- Once-weekly low-dose isotretinoin is an effective treatment for papulopustular rosacea.
- This regimen is effective even for patients with severe disease.
- Weekly isotretinoin offers a viable alternative treatment for rosacea management.
