Is Low-Dose Accutane Treatment for Rosacea Safe?

ishonest: Many people with rosacea swear by Accutane, but there's a risk of severe side effects. What's your opinion on low-dose Accutane treatment?

Jessica Wu, MD (

Many of those with rosacea have enlarged oil glands, and isotretinoin (previously available as Accutane; now only available in the generic Claravis, Amnesteem, and Sotret) is the only medication that is proven to shrink oil glands. While isotretinoin definitely makes your skin smoother and blemish- free, there are definite and potentially serious side effects associated with it, so it shouldn't be taken or prescribed lightly. For my patients, low-dose isotretinoin is a last-resort treatment. I only use it when all else fails, and if patients agree to see me monthly to monitor their bloodwork, symptoms, and possible side effects. Even then, I limit the duration to six to eight months. Most of my patients are able to control their symptoms reasonably well without isotretinoin.

Elizabeth Tanzi, MD (

Low dose Accutane (isotretinoin) can be very effective and the risk of side effects is small when the dose is low. However, it's somewhat inconvenient because bloodwork must be done once per month to confirm there is no effect on the liver or cholesterol levels and, obviously, pregnancy is out of the question.

Howard Murad, MD (

Accutane can be helpful for some patients, but it is really up to the physician and the patient to determine what would work best for treatment.

Macrene Alexiades-Armenakas, MD (

Same concerns, side effects, and complications. Therefore, I treat severe cases with photodynamic therapy with excellent success. Usually, two to three monthly treatments suffice.

Jeannette Graf, MD (

I feel that when other treatments fail, low-dose Accutane is quite effective, which when monitored properly has a low incidence of side effects and is quite safe.

Neil Sadick, MD (

Low-dose Accutane is a waste of time. Rosacea comes back, and becomes resistant and less responsive to Accutane dosing. If used for acne or rosacea, it should be at full dose.

Marta Rendon, MD (

Isotretinoin (Accutane) is not typically used for rosacea but is used for severe cystic acne. Some rosacea patients have very severe outbreaks and do not respond to topical treatments or oral antibiotics. In those cases, isotretinoin can be considered at low doses and monitored closely by their dermatologist. Isotretinoin does have potential side effects and should not be given to pregnant women or those women considering pregnancy.

H.L. Greenberg, MD (

Accutane is a wonderful therapy; however, given the governmental restrictions surrounding its usage, I am only writing for it in my patients with severe or nodulocystic acne. Low-dose Accutane may work, and may work quite well to treat rosacea.

Sarah Swanson (

We don't recommend Accutane as there is limited data supporting its use. Rather, we use topical retinoids, which have proven efficacy and a lower risk of side effects.

Eric Schweiger, MD (

Due to the potential side effects, I only consider Accutane in patients with severe pustular, acne-like rosacea that is non-responsive to oral and topical antibiotics and laser therapy. In patients with rosacea who require Accutane therapy, we usually do the standard dose for six months. It is very challenging to do Accutane at low doses currently because blood monitoring and patient visits are required every month. Most of my rosacea patients don't have time to for doctor visits and blood testing monthly for two years or longer.

Nelson Lee Novick, MD (

Accutane is a very potent drug, with a potential for numerous short-term and long-term side effects. Accutane has recently been linked with the late development (up to two decades later) of a severe colon disease, ulcerative colitis. Its link to severe depression is also being actively investigated. Years ago, I reported a case of permanent spinal bone problems related to its use. For these reasons, I am reluctant to give Accutane in any but the most severe, nodulocystic, potentially scarring forms of acne or rosacea that have not responded to any of the most aggressive topical and oral therapies available. Since current treatments generally prove quite successful, I seldom find its use necessary to prescribe it.

Darrell W. Gonzales, MD (

There is no doubt that rosacea is a frustrating skin problem and patients will often be willing to try extreme measures to treat rosacea. Accutane is an oral medication FDA-approved for the treatment of nodulocystic acne. At low doses it has been found to help improve rosacea for some individuals. Unfortunately, this medication has a long list of potential side effects even at low levels. Besides being potentially toxic to the liver, it can cause an elevation in triglycerides, increased sensitivity to sunlight, and birth defects should a woman get pregnant while on the medication. There is some concern that Accutane may also be associated with possible mood changes or inflammatory bowel disease.

The medication requires monthly bloodwork and a physician office visit to verify that the individual is tolerating the medication well. Although I may see some benefit with persons with severe forms of rosacea, I am not a major proponent of Accutane for my patients as I prefer less toxic and in most cases equally effective medications.

William Ting, MD (

Long-term low dose Accutane for acne rosacea is not advisable by most reputable dermatologists and is frowned upon by the FDA given its side effect profile.

Dina Strachan, MD (

Accutane is an excellent drug for both acne and rosacea, however the long term benefits are not as consistent for rosacea. Yes, there is a risk of side effects, but if this drug is managed with respect, serious side effects can usually be avoided. I tend to use the standard dose if I use it.

Brad Abrams, DO (

Accutane has proven to work great. A low-dose treatment and follow up visits are recommended to monitor the result and prevent/control any severe side effect.

Eric Huang, MD (

In severe rosacea, topical medications and oral antibiotics may not be effective in controlling symptoms. In these cases isotretinoin (Accutane) in low to moderate doses may be an option. The mechanism of action in rosacea is not understood, and long term remission of symptoms is unfortunately not common. The risks of isotretinoin therapy are real, but are probably overstated. A true link between isotretinoin use and the development of inflammatory bowel disease is not clear at this time, with inconsistent study results. Low dose therapy decreases the likelihood of side effects such as dryness, liver or lipid abnormalities, and mood changes.

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