I have acne rosacea on my cheeks and nose. I've used many things from antibiotics(minocycline,tetracycline) to topical antibiotics( erytromicin, clindamicin) to azelaic acid and metro-gel( metronidazole) and IPL lasers. I'm 22 and i have these symptoms for 10 years now. When i use the antibiotics it gets better when it comes to the acne but the redness doesn't go away!! Am i a good candindate for a low dose Accutane? Or is there a better option?
Acne Rosacea and Accutane?
Doctor Answers (3)
Give Accutane a Try
Accutane is a very good choice if you have the more papular-pustular rosacea. This form of rosacea, which is more common in males, sometimes leads to the disfiguring condition, rhinophyma (potato-nose..W.C. Fields, J. P. Morgan, Rep. Claude Pepper). Much of the problem with this form of rosacea has to do with hypertrophied oil (sebaceous) glands. The Demodex mite and other factors probably aggrevates this form of rosacea. ( A somewhat unorhtodox treatment which sometimes works here might be topical Lindane, once a week for two weeks).
If you have more of the erythematous type of Rosacea you might try Accutane, but it is much less likely to be successful.
The dose should be low, maybe 10 mg. a day or every other third day, and your dermatologist will be looking for flares. Realize too, if you are a female that you should still utilize two means of contraception.
Another rather unique way of treating this type of rosacea might be topical Afrin. The ingredient in this, oxymetazolline, is a fairly strong blood vessel constrictor. Two dermatologists studied this on eight patients and had good results. However, they are developing a cream version and as they freely concede this might prejudice their study. Still it is an intersting idea. Please watch out for inflammation. Also, there is evidence, some of it quite recent, that the calcineurin inhibitors, elidel and protopic might work. Last week, I had a patient who refused to fill a prescription and changed dermatologists because her dermatogist prescribed this: I told her it was fine and to give it a try.
If the above measures fail to work for the erythematous type of rosacea you might seek out the nd YAG 1064 laser. However, be sure you have been off the Accutane for at least six months, preferably a year.
Accutane is a good last resort option
Thanks for your question.
You have mentioned most of the best treatments for stage 1 and stage 2 rosacea, but when those treatments are tried and have failed, it is a good idea to try accutane. The low dose treatment regimen ranging from a low daily dose to a low dose several times per week will help with both the rosacea and the acne rosacea. I would still consider doing further IPL or Vbeam treatments, and would also consider possibly adding Elidel or Protopic as a possible adjunct to your treatment. Although these two medications haven't been proven to treat rosacea, there may be an underlying benefit due to their anti-inflammatory effects.
Acne rosacea and accutane
A few things you may want to consider trying: there is a low-dose doxycycline treatment (Oracea) that functions as an anti-inflammatory you may wish to try. also, as far as the redness is concerned, you may benefit from the Nd:YAG 1064 laser.
I have successfully treated some rosacea patients with Accutane. While Accutane can help with redness, in certain case it actually worsens the redness. You should be prepared for this possibility. I would consider starting you on a regimen of 10 mg 3 times per week and see how you respond.
Consider discussing these options with your dermatologist.
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