Low-dose isotretinoin for the management of rosacea: A systematic review and meta-analysis

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.

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.

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.

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.

Study design heterogeneity limited more comprehensive comparisons. Overall, low-dose isotretinoin may serve as an effective treatment for rosacea with good tolerability and safety.