Low-Dose Isotretinoin: An Option for the Treatment of Scalp and Facial Rosacea

Extrafacial rosacea involving the scalp is an uncommon manifestation of acne rosacea, for which evidence-based treatment guidance is limited. With this retrospective study, we aimed to evaluate the effectiveness and tolerability of low-dose isotretinoin in patients with rosacea involving both the face and scalp. We conducted an observational chart review of adult male patients treated with isotretinoin for this condition at our multisite private practice between 2012 and 2022; 21 patients met inclusion criteria. Treatment courses were short with a low dose (mean cumulative dose: 81.0 mg/kg; mean daily dose: 0.67 mg/kg/day; mean duration: 3.95 months). Complete clinical clearance of facial and scalp disease was achieved in 85.7% of patients, and treatment was well tolerated, with 95.2% of patients completing a full therapeutic course. This study suggests that low-dose, short-duration isotretinoin is a viable and effective systemic treatment option for extrafacial rosacea and may fill an important gap in the management of refractory scalp disease.