Nathan Weir MD, PhD, FAAD

I'm a 68 yo man. I have blond hair and fair sun sensitive skin. I have rosacea which may be treated, but not cured. Bottom line up front: Oral Isotretinoin worked for me. (Accutane)
My acne started in my teens some 50+ years ago as pimples and blackheads on my nose. Over my adult life the cystic acne and rosacea progressed to thicken the skin of my nose and eyelids.
In addition to my rosacea, I have carpal tunnel syndrome and osteoarthritis. A rosacea flare-up would trigger a painful reaction in my wrists and arthritic joints. Canker sores often compounded the misery. I was not a happy camper. It should come as no surprise that an inflammation in one part of your body affects the rest of your body.
In 2010, my eyelids drooped enough to cover my eyes, so I had them trimmed. (blepharoplasty) The surgeon commented, that my eyelids were tough as leather.
Dermatologists had prescribed treatments from sulfur based creams to antibiotics. Most were interested in shaving off a couple of benign moles every six months for a biopsy. Nothing really addressed my rosacea.
In 2011 I met Elizabeth Muennich, MD. She prescribed a six month course of oral isotretinoin. THIS WORKED.
Word of warning. It ain't easy. Isotretinoin is a powerful drug. You need blood tests to assure your liver tolerates it well. Females need to be on double birth control. It's heavy. BUT IT WORKS. It works by accelerating the rate that you shed skin. It dries up your skin oil production and shrinks sebaceous glands.
The first few weeks were the roughest. I started at 20mg daily for a month. My acne flared as the drug started to take effect. BE PATIENT. It got better. Along about the second month the dose rate stepped up to 40mg daily. My skin, lips and eyes were all dry. I used lip balm, eye drops and sun screen all the time. I wore a hat whenever I was outside. My skin was fragile. Washing my face with a wash cloth was like using course sandpaper. I used gentle cetafil with my hands to clean my face. My calluses all wore away.
In the second month my rosacea was much more under control. Zits and flares became infrequent. My big lumpy nose got smaller. My leathery eyelids got thinner and more supple. I persisted with the six months of treatment, monthly blood tests and overall dryness.
After the end of treatment, I was very happy to find the rosacea stayed away. After another six months, Dr. Muennich prescribed topical isotretinoin cream and antibiotics to control inflammation.
I was happy with the way my rosacea was controlled for 8 years. In 2019 the rosacea began to flare up frequently and so I began a second course of oral isotretinoin under the care of Dr. Nathan Weir, MD. who is Dr. Muennich's partner. I'm now in the sixth month of the treatment and living with dry sun sensitive skin, dry eyes and lips. AND CLEAR SKIN.
Now my zits appear to be caused by sun exposure. Even with frequent application of Blue Lizard sensitive skin sun screen I'm getting roasted in the sun. My skin does not get pink, but a day after exposure, my skin is thicker and sebaceous oil production goes way up. So far, these sun exposure events are only causing a single zit and not a general rosacea flare. It's a good thing I don't work outside.
Dr. Weir tells me that the desired treatment is to achieve a cumulative 125 mg / kg of body weight. I'm hanging in for a total of eight months it will take me to get to that dose level. It works.

Updated on 2 Feb 2020:
It is now roughly 6 months since my last dose of Isotretinoin. I stayed the course until I had consumed 125 Mg / Kg of body weight. This is the current wisdom on the total dose needed to achieve long lasting results. My previous round did not achiever this total dose level, but knowledge advances.

IT WORKED! My skin has been 99.9% blemish free since my last dose. My only maintenance is to wash my face with Cetaphil cleanser and cold water. Never soap. Every other day or so, I use a clean wash cloth to gently clean my face.

I'm still using sun screen and a hat. But I don't need lip balm and eye drops every hour or so like I did when taking isotretinoin.

There are occasional times where one or two of my old deep scars fill up with sebum. THese spots and I know each other very well. They show up mostly if I've been in the sun or a very hot dirty place. A hot shower, Cetaphil and washcloth and a gentle squeeze drains the sebum without ever forming a cyst.or getting red/sore.

Based on my long history with the affliction of rosacea, I count this as a miraculous cure. I'll never be beautiful, (never was) but I'm not breaking out anymore. I don't know if this cycle will last more than 8 years or not, but I'm ready to wait and see. Based on the results, I'd do it again when I need to.

Isotretinoin is expensive. My insurance wouldn't cover it. I've used the GoodRx app to get a much better discount on the prescription. Despite all that $$$ it's worth it. Shop around YMMV.