Low Dose Isotretinoin

[Guide]

Accutane (Isotretinoin) has been used for many years to treat acne rosacea in higher doses so if you are taking high dose Accutane (20-40 mg or higher daily) you should read this Accutane Article.

Low Dose Isotretinoin (2.5 mg to 10 mg) 

Please post your comments on isotretinoin in this thread by clicking on the REPLY button. Low dose isotretinoin has been successfully used to treat recalcitrant cases of rosacea: 

"Low-dose isotretinoin was an effective therapeutic option for difficult-to-treat papulopustular rosacea."

A Randomized-Controlled Trial of Oral Low-Dose Isotretinoin for Difficult-To-Treat Papulopustular Rosacea
Presented in part at the Journées Dermatologiques de Paris Congress, Paris, 7–11 December 2010.
Emilie Sbidian, Éric Vicaut, Henri Chidiack, Elie Anselin, Bernard Cribier, Brigitte Dréno6, Olivier Chosidow

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"As previously discussed, isotretinoin is a viable alternative for recalcitrant cases of rosacea. In a large-scale, placebo-controlled, randomized, 12-week, multicenter study, Gollnick et al demonstrated complete remission in 24% and marked improvement in 57% of patients with isotretinoin 0.3 mg/kg therapy daily, in contrast with remission in 14% and marked improvement in 55% of patients treated with doxycycline 100 mg daily for 14 days, then 50 mg daily. Patients treated with isotretinoin rated treatment results at the end of the study as “excellent improvement” more frequently, at 32.6% in comparison with 24.2% for patients treated with doxycycline."

Clin Cosmet Investig Dermatol. 2015; 8: 159–177.
Published online 2015 Apr 7. doi: 10.2147/CCID.S58940
PMCID: PMC4396587 PMID: 25897253
Update on the management of rosacea
Allison P Weinkle, Vladyslava Doktor, and Jason Emer

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"For severe cases of inflammatory papules and pustules or for inflammatory papules and pustules that do not respond to oral antibiotics or that recur after the discontinuation of oral antibiotics, treatment with low-dose oral isotretinoin (0.25 to 0.30 mg per kilogram of body weight per day) for 12 to 16 weeks has been shown to be effective in two randomized, controlled trials."

N Engl J Med 2017; 377:1754-1764
DOI: 10.1056/NEJMcp1506630
Rosacea
November 2, 2017, Esther J. van Zuuren, M.D.

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"Continuous “microdose” isotretinoin (CMI) treatment (0.04–0.11mg/kg/day) has been shown to be sufficient to control persistent adult acne vulgaris....Oral isotretinoin was then reduced to an individual continuous minimal dose, which ranged from 0.03 to 0.17mg/kg/day (mean, 0.07mg/kg/day). Group 2 had different grades of untreated rosacea....Available data suggests that oral isotretinoin may be used in selected cases of recalcitrant PPR, with a suggested daily dose of 0.3mg/kg."

J Clin Aesthet Dermatol. 2011 Sep; 4(9): 54–61.
Use of Oral Isotretinoin in the Management of Rosacea
Hyunhee Park, DO and James Q. Del Rosso, DO, FAOCD

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"Low-dose isotretinoin was an effective therapeutic option for difficult-to-treat papulopustular rosacea."

A Randomized-Controlled Trial of Oral Low-Dose Isotretinoin for Difficult-To-Treat Papulopustular Rosacea
Presented in part at the Journées Dermatologiques de Paris Congress, Paris, 7–11 December 2010.
Emilie Sbidian, Éric Vicaut, Henri Chidiack, Elie Anselin, Bernard Cribier, Brigitte Dréno6, Olivier Chosidow

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"Very low-dose isotretinoin (e.g., 10–20 mg once to five times a week, equivalent to 5 mg/day) is an effective treatment for mild to moderate papulopustular rosacea and is well tolerated."

Australasian Journal of Dermatology, DOI: 10.1111/ajd.12522
Very low-dose isotretinoin in mild to moderate papulopustular rosacea; a retrospective review of 52 patients
Marius Rademaker, DM.

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"Using isotretinoin for 1-2mg/kg/day for 3-4 months produces 60%-95% clearance of inflammatory lesions in patients with acne. Doses as low as 0.1mg/kg/day have also proven successful in the clearance of lesions. Encouraging results have also been seen in small numbers of patients with rosacea, Side effects affecting the mucocutaneous system and raised serum triglyceride levels occur in most patients receiving isotretinoin."

Profiles Drug Subst Excip Relat Methodol. 2020;45:119-157
Isotretinoin.
Khalil NY, Darwish IA, Al-Qahtani AA

2.5 mg Generic Isotretinoin

Anecdotal Reports on Low Dose Isotretinoin for Flushing Avoidance

patrick33 reports that his flushing is completely gone after taking low dose (2.5 mg 'for the first month followed by 2.5mg every other day for the following three months'). We may hear more reports about this since most rosaceans who want flushing avoidance may try this route. 

Weekly 20 to 40 mg Low Dose Isotretinoin

One report indicates that using a low dose 20 to 40 mg weekly of isotreionoin results in "an effective treatment for papulopustular rosacea, including among patients with severe disease." This is considered low dose because it is taken WEEKLY not daily. 

The DAILY dosage is calculated at dosage of 0.3-1 mg/kg/day.

Low-dose isotretinoin vs. minocycline in the treatment of rosacea

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[Guide]

"Inflammatory conditions such as rosacea, granuloma annulare, and hidradenitis suppurativa benefit from lower oral isotretinoin dosage of 0.3-1 mg/kg/day, whereas, hyperkeratotic diseases such as psoriasis and pityriasis rubra pilaris, consistently respond better to higher dosages of up to 2-4 mg/kg/day for lesion clearance."

Arch Dermatol Res. 2020 Nov 05;:
Oral isotretinoin for the treatment of dermatologic conditions other than acne: a systematic review and discussion of future directions.
Chu S, Michelle L, Ekelem C, Sung CT, Rojek N, Mesinkovska NA

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"We hypothesized that isotretinoin induces remission of acne by normalizing the innate immune response to the commensal bacterium P. acnes. Compared to normal subjects, peripheral blood monocytes from acne patients expressed significantly higher levels of TLR-2 and exhibited significantly greater induction of TLR-2 expression following P. acnes stimulation. Treatment of patients with isotretinoin significantly decreased monocyte TLR-2 expression and subsequent inflammatory cytokine response to P. acnes by one week of therapy. This effect was sustained six months following cessation of therapy, indicating that TLR-2 modulation may be involved in the durable therapeutic response to isotretinoin. This study demonstrates that isotretinoin exerts immunomodulatory effects in patients and sheds light on a potential mechanism for its long-term effects in acne."

J Invest Dermatol. Author manuscript; available in PMC 2013 Apr 2.
Published in final edited form as:
J Invest Dermatol. 2012 Sep; 132(9): 2198–2205.
Systemic isotretinoin therapy normalizes exaggerated TLR-2-mediated innate immune responses in acne patients
Melanie C. Dispenza, Ellen B. Wolpert, Kathryn L. Gilliland, Pingqi Dai, Zhaoyuan Cong, Amanda M. Nelson, and Diane M. Thiboutot1,