isotretinoin and Rosacea

Morbihan disease (MD) is considered a rare complication of rosacea, which is difficult to diagnose and challenging to treat. Here, we performed a systematic review of available case reports and case series to summarize key clinical and pathologic features of and successful treatment regimens for MD. We conducted a search of the PubMed/MEDLINE, EMBASE, and Cochrane electronic databases from their inception to the date of search on March 6, 2023. We found that MD affects patients in the fifth decade of life on average, more commonly reported in male than female (69% vs 31%). Clinically, MD affects the eyelids, cheeks, and forehead most commonly, presenting as non-pitting, erythematous edema or an edematous plaque. On biopsy, the pathologic features, such as dermal edema, sebaceous hyperplasia, perivascular and periadnexal inflammatory infiltrate, and granulomatous reaction, are frequently reported. Out of 55 patients who were able to achieve complete response without recurrence, 35% of patients were treated with isotretinoin and 22% were treated with tetracycline antibiotics with a daily dosage range of 20-80 mg and 40-200 mg, respectively. Out of those 55 patients, 22% and 7% were treated successfully with surgical intervention and intralesional injection of steroids, respectively. Additionally, lymphatic drainage has been shown to be an effective adjunctive therapeutic tool. More studies are necessary to understand the disease mechanism to improve the diagnosis of and develop evidence-based therapies for MD.

Topics: Edema; Erythema; Female; Humans; Isotretinoin; Male; Rosacea; Treatment Outcome

Over the past 15 years, numerous clinical, epidemiological and physiopathological articles have been published on rosacea. There is now increasing evidence that rosacea is an inflammatory disease characterised by abnormal innate immune response, major vascular changes, and increased colonisation by Demodex mites, along with a genetic predisposition and multiple external aggravating factors. It is thus possible to define treatment targets and possible treatments: 1) permanent vascular changes (medical and instrumental treatments); 2) flushing (betablockers, botulinum toxin); 3) innate immunity (antibiotics, nonspecific antioxidants and anti-inflammatory molecules); 4) a neurovascular component (analgesics, antidepressants); 5) Demodex (antiparasitic drugs); 6) microbiome; 7) skin barrier impairment (cosmetics and certain systemic drugs); 8) sebaceous glands (isotretinoin, surgery); 9) environmental factors (alcohol, coffee, UV exposure). Treatment recommendations are now available in many countries and benefit from the new phenotypic approach to rosacea, in which every sign or symptom is considered separately rather than having to deal with overlapping subtypes. Since the 2000s, many good quality clinical trials have been published in the field of rosacea and many others are still ongoing. Rosacea is a complex disease involving many different mechanisms and with numerous possible treatments, but there are still some important unmet needs with regard to optimal care.

Topics: Animals; Antiparasitic Agents; Humans; Isotretinoin; Ivermectin; Mite Infestations; Mites; Rosacea; Sebaceous Glands

Exacerbation of rosacea may occur during pregnancy and there are multiple associated cases of rosacea fulminans (RF). Treatment during pregnancy poses a significant challenge as many rosacea treatments are contraindicated or have limited evidence regarding potential adverse fetal effects.. Review the pregnancy categories of various treatments and develop algorithms for treating pregnant patients with rosacea and RF.. Rosacea treatments showing efficacy in randomized controlled trials were searched through DailyMed to review pregnancy labelling. Searching the PubMed/MEDLINE database for English articles using keywords "rosacea fulminans AND pregnancy" without publishing-time restrictions yielded 8 articles. We summarized treatments used in cases of RF during pregnancy.. Topical ivermectin was more effective than metronidazole, but has a more concerning pregnancy category. Three pregnant women with RF were treated successfully with topical metronidazole in combination with other therapies. Azithromycin is the only oral rosacea therapy that is considered safe for pregnant patients and it has been used to treat RF.. This review highlights the challenging aspects of treating pregnant patients with rosacea, as there is limited pregnancy-related treatment efficacy and safety data. The pregnancy categories of therapeutic options are summarized. Further studies are needed to learn which therapies are effective and safe for use during pregnancy.

Topics: Adult; Algorithms; Animals; Anti-Bacterial Agents; Azithromycin; Brimonidine Tartrate; Dermatologic Agents; Dicarboxylic Acids; Doxycycline; Female; Humans; Isotretinoin; Ivermectin; Metronidazole; Mice; Minocycline; Phototherapy; Pregnancy; Pregnancy Complications; Randomized Controlled Trials as Topic; Rosacea; Tetracyclines; Treatment Outcome

BACKGROUND Retinoid-induced myositis is a rare condition encountered in clinical practice. Its occurrence implies a diagnostic challenge due to the multiple causes associated with myopathic syndromes. The most common clinical presentation is generalized affection. Focal myositis is even less frequent and easily misdiagnosed as muscular disease of other etiology. CASE REPORT We describe a case of 45-year-old male with a history of nephrolithiasis and rosacea diagnosed by dermatology, who was management with isotretinoin 1 mg/kg per day in 2 doses with clinical improvement. Later, he presents muscle pain in the upper limbs with marked functional limitation associated by choluria, without muscular pains in other location; he had no history of using another medication. At his physical examination, vital signs were normal, with edema and pain in the bilateral bicipital region associated with limitation for flexion-extension of shoulders and elbows and high levels of creatine phosphokinase (CPK). He was transferred to the intensive care unit where he received fluid therapy because of the high risk of deterioration of renal function, very high CPK levels, and a history of obstructive uropathy. One year after this hospitalization, the cutaneous symptoms worsened and the patient voluntarily restarted isotretinoin and 5 months later he presented again with the same symptoms of the first episode. CONCLUSIONS Drug-induced myositis should be taken into consideration in the differential diagnosis of myopathic syndromes. Retinoids have the potential to cause varying degrees of myositis and their rapid identification could prevent major complications.

Topics: Dermatologic Agents; Diagnosis, Differential; Humans; Isotretinoin; Magnetic Resonance Imaging; Male; Middle Aged; Myositis; Rosacea

Due to the ever-increasing demands for the personalized care, people seek for the tailored management according to the accurate identification of their skin type. The Baumann Skin Type Indicator, which was proposed by Leslie Baumann, is composed of four parameters: oily or dry, resistant or sensitive, pigmented or nonpigmented, and wrinkled or tight. Among these, oily sensitive skin experiences significant discomfort and resists ordinary treatment.. In this article, we will review the clinical manifestations, underlying pathogenesis and recommendations on treatment options that may be utilized to help patients with oily sensitive skin.. Literature search was conducted using PubMed. The literature concerning Baumann Skin Type Indicator and oily sensitive skin type were considered.. Oily sensitive (OS)-type skin is a complex of oily and sensitive skin that causes significant discomfort and undergoes stubborn resistance to treatments. Sebum dysfunction and hypersensitivity may play a key role in the development of sensitive skin. Considering the pathogenesis of OS-type skin, treatment should focus on both seborrhea and hypersensitivity.. Clinicians can effectively treat the oily sensitive skin by understanding underlying pathogenesis of it. Further investigations are necessary to reach a consensus on the basic pathophysiology and optimal management guidelines for oily sensitive skin.

Topics: Acne Vulgaris; Administration, Cutaneous; Administration, Oral; Anti-Bacterial Agents; Botulinum Toxins; Cosmetic Techniques; Dermatitis, Contact; Dermatitis, Seborrheic; Humans; Injections, Intradermal; Isotretinoin; Keratolytic Agents; Practice Guidelines as Topic; Rosacea; Sebum; Skin; Treatment Outcome

Rosacea fulminans is a rare inflammatory condition of the central face marked by the abrupt onset of erythematous coalescing papules, pustules, nodules, and draining sinuses. Due to infrequent reporting in the literature, the pathophysiology, classification, and nomenclature of this condition remain controversial. This comprehensive review evaluated a total of 135 cases of rosacea fulminans for clinical and histopathologic features and reported treatment strategies. Patients were 91% female with an average age of onset of 31.3 years. Only 19% of cases reported duration of symptoms longer than 3 months, and reports of recurrence were uncommon. A majority of patients had history of rosacea or flushing, and common triggers included hormonal shifts, emotional stress, and medications. Extrafacial or systemic involvement was rare. Though oral and topical antibiotics were frequently utilized to treat rosacea fulminans, there was a clear shift in reported treatments for rosacea fulminans following the introduction of isotretinoin use in 1987, marked by increased reliance on isotretinoin in addition to topical and systemic corticosteroids. Newer treatments were associated with superior improvement compared with antibiotic monotherapy, most notably dramatically reduced rates of scarring, though reduced rates of disease recurrence were not evident. Several patterns revealed through this review reinforce the classification of rosacea fulminans as a severe yet distinct variant of rosacea and highlight key distinguishing clinical features and treatment options for optimal management.

Topics: Acne Vulgaris; Administration, Cutaneous; Administration, Oral; Anti-Bacterial Agents; Cicatrix; Dermatitis; Diagnosis, Differential; Drug Therapy, Combination; Facial Dermatoses; Glucocorticoids; Humans; Isotretinoin; Recurrence; Rosacea; Skin

While the use of isotretinoin has revolutionized the treatment of acne vulgaris, isotretinoin is increasingly recognized as a useful therapeutic option for many other cutaneous conditions. We review the evidence underlying the use of isotretinoin for a variety of dermatological indications including hidradenitis suppurativa, sebaceous gland pathology, rosacea, scarring alopecia, cosmetic dermatology, and non-melanoma skin cancer prophylaxis amongst other uses, and thus consider alternative uses within dermatology practice. The studies found benefit of isotretinoin, however most trials lacked statistical power and in many cases the use was limited to case series. Isotretinoin, if used within the correct cohort with appropriate pretreatment counseling regarding side-effects, is a well-tolerated medication with potential as either an adjunctive treatment or a second-line agent in those recalcitrant cases unresponsive to first-line therapy.

Topics: Acne Vulgaris; Dermatitis, Seborrheic; Dermatologic Agents; Hidradenitis Suppurativa; Humans; Isotretinoin; Rosacea; Warts

Rosacea is a chronic inflammatory disease with facial erythema and papulopustules. It is common in middle-aged/elderly persons and often affects self-perception and social well-being. It is generally classified into four subtypes. Improved understanding of pathophysiology has resulted in novel treatment approaches, but routine management in health care usually follows old trails. Most patients are managed in primary care. Greater attention to the reduced skin barrier, avoidance of exacerbating factors, better topicals and encouragement to topical maintenance treatment should reduce the use of oral tetracyclines. Low-dose isotretinoin is reserved for treatment-resistant patients, but relapses are frequent unlike its use in acne. In order to reduce antibiotic use, we propose that patients should be referred to a dermatologist for optimization of therapy including consideration of isotretinoin following tetracycline treatment of a maximum of 4-6 months.

Topics: Administration, Topical; Adult; Aged; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Inflammatory Agents; Comorbidity; Dermatologic Agents; Humans; Isotretinoin; Middle Aged; Recurrence; Rosacea

Rosacea is a chronic facial inflammatory dermatosis characterized by background facial erythema and flushing and may be accompanied by inflammatory papules and pustules, cutaneous fibrosis and hyperplasia known as phyma, and ocular involvement. These features can have adverse impact on quality of life, and ocular involvement can lead to visual dysfunction. The past decade has witnessed increased research into pathogenic pathways involved in rosacea and the introduction of novel treatment innovations. The objective of these guidelines is to offer evidence-based recommendations to assist Canadian health care providers in the diagnosis and management of rosacea. These guidelines were developed by an expert panel of Canadian dermatologists taking into consideration the balance of desirable and undesirable outcomes, the quality of supporting evidence, the values and preferences of patients, and the costs of treatment. The 2015 Cochrane review "Interventions in Rosacea" was used as a source of clinical trial evidence on which to base the recommendations.

Topics: Anti-Infective Agents; Consensus; Dermatologic Agents; Dicarboxylic Acids; Doxycycline; Eye Diseases; Humans; Intense Pulsed Light Therapy; Isotretinoin; Ivermectin; Laser Therapy; Metronidazole; Outliers, DRG; Practice Guidelines as Topic; Rosacea; Tetracycline

Rosacea is a chronic disease with a profound impact on quality of life. Although there are a range of treatments for its many manifestations, some cases are difficult to treat. Sbidian et al. show in this double-blind, randomized, placebo-controlled trial that low-dose isotretinoin can be effective in treating difficult-to-treat and frequently relapsing papulopustular rosacea.

Topics: Clinical Trials, Phase II as Topic; Cohort Studies; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Female; Humans; Isotretinoin; Keratolytic Agents; Male; Prognosis; Randomized Controlled Trials as Topic; Reproducibility of Results; Risk Assessment; Rosacea; Severity of Illness Index; Treatment Outcome

Acne and rosacea are common conditions seen every day by dermatologists. This review will discuss the most recent therapeutic options for patients with these conditions. Specifically, for acne, there will be a discussion of the use of isotretinoin at higher cumulative doses as well as a new formulation of isotretinoin, isotretinoin-lidose. Adult women with acne represent a growing population of patients who present for treatment of acne; the use of hormonal therapies as well as topical dapsone gel will be reviewed for these patients. For rosacea patients, the new topical agents - brimonidine gel and ivermectin cream - will be reviewed, with a discussion on possible rebound phenomenon from brimonidine. Finally, future treatments in the pipeline will be discussed.

Topics: Acne Vulgaris; Brimonidine Tartrate; Dapsone; Dermatologic Agents; Dermatology; Gels; Humans; Isotretinoin; Ivermectin; Rosacea; Skin Cream; Treatment Outcome

Rosacea fulminans, previously called pyoderma faciale, is an inflammatory disease considered a dramatic form of rosacea rather than of acne. Typical features are: exclusive facial involvement of young women, sudden onset of large nodules without other signs of acne, remission without scarring or with minimal scars, no recurrences or systemic symptoms. Oral isotretinoin associated with a short course of systemic and topical corticosteroids represent the recommended treatment. Personal observation of 5 cases has induced us to make a review of worldwide literature in order to better define this clinical entity. In our opinion, rosacea fulminans is a valid diagnosis, but clinical criteria should be rigorously respected to fully exclude rosacea conglobata and acne fulminans.

Topics: Acne Vulgaris; Acute Disease; Administration, Cutaneous; Adolescent; Adult; Dermatologic Agents; Female; Glucocorticoids; Humans; Isotretinoin; Rosacea; Young Adult

We review rosacea fulminans, a rare condition that may cause facial scarring and disfigurement. All physicians and health care professionals must be aware of this form of rosacea to treat or refer the patient. Early treatment of rosacea fulminans is essential to avoid scarring.

Topics: Administration, Oral; Cicatrix; Dermatologic Agents; Facial Dermatoses; Glucocorticoids; Humans; Isotretinoin; Quality of Life; Rosacea; Time Factors

Lupoid or granulomatous rosacea is classified as a special form of rosacea which along with the typical rosacea symptoms features monomorphic yellow-brown and red papules and nodules on the cheeks and periorificial areas. Histology shows noncaseating epithelioid cell granulomas with surrounding mononuclear cell infiltrates. It is difficult to treat. Currently, the only officially approved systemic treatment is tetracycline. However, there is a broad experience with off-label use of isotretinoin (10-20 mg daily). We describe a patient with an excellent response to 20 mg isotretinoin daily.

Topics: Dermatologic Agents; Erythema; Facial Dermatoses; Female; Humans; Isotretinoin; Middle Aged; Off-Label Use; Rosacea; Treatment Outcome

Morbihan disease is classified as a special form of rosacea, which presents with persistent facial erythema and solid edema because of marked involvement of the lymphatic vessels. The cheeks, nose and forehead are particularly affected. Currently, the treatment options of this cosmetically very disturbing disease are limited. However, every attempt should be made to provide treatment because of the great emotional suffering of the patients. We review some new currently available therapeutic options for Morbihan disease. In our patient, we were able to achieve a significant improvement with systemic isotretinoin 30 mg/day over a period of 12 months.

Topics: Dermatologic Agents; Erythema; Facial Dermatoses; Female; Humans; Isotretinoin; Middle Aged; Rosacea; Treatment Outcome

The production of cathelicidin, an antimicrobial peptide is strongly increased in rosacea. Cathelicidin activates innate immunity, inflammation and angiogenesis. Cutaneous proteases produce inflammatory fragments of cathelicidin. UV-B irradiation and microbial components increase vitamin D3 and TLR2 expression in keratinocytes leading to an increase of cathelicidin production. Retinoids and doxycycline inhibit inflammation, proteases, angiogenesis and TLR2 expression. A multicenter study 2010 proved that isotretinoin with a dose of 0,3 mg/kg/d for 12 weeks and doxycycline with the dose of 100 mg/d for 14 days followed with 50 mg/d were equally effective. Doxycycline 40 mg/d is also effective in milder cases.

Topics: Anti-Bacterial Agents; Antimicrobial Cationic Peptides; Cathelicidins; Cholecalciferol; Dermatologic Agents; Doxycycline; Humans; Isotretinoin; Keratinocytes; Multicenter Studies as Topic; Rosacea; Toll-Like Receptor 2; Ultraviolet Rays

Rosacea fulminans (RF) is a rare facial dermatosis characterized by the sudden onset of severe facial inflammation consisting of numerous pustules, cystic swellings and coalescing sinuses. The standard treatment is the retinoid drug isotretinoin in combination with systemic corticosteroids or with high-dose oral tetracycline antibiotics. We report three recent cases of RF in pregnancy with differing obstetric outcomes: an intrauterine death, a termination of pregnancy, and a normal vaginal delivery. The pathogenesis of RF is considered and therapeutic options in pregnancy are reviewed.

Topics: Abortion, Induced; Acne Vulgaris; Adult; Anti-Bacterial Agents; Dermatologic Agents; Diabetes, Gestational; Drug Therapy, Combination; Erythromycin; Facial Dermatoses; Female; Fetal Death; Glucocorticoids; Humans; Isotretinoin; Oligohydramnios; Prednisolone; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Rosacea; Treatment Outcome

Acne vulgaris is a common skin disorder that affects most individuals at some point in their lives. It may result in significant morbidity, including cutaneous scarring and psychological impairment. Current treatments include topical retinoids, benzoyl peroxide, topical and systemic antibiotics, and systemic isotretinoin. There are growing concerns of rising antibiotic resistance, significant side effects of isotretinoin therapy, and lack of safe and effective treatment for pregnant females. Recent advances in the pathogenesis of acne have led to a greater understanding of the underlying inflammatory mechanisms and the role the Propionibacterium acnes and biofilms. This has led to the development of new therapeutic targets. This article reviews emerging treatments of acne, including topical picolinic acid, topical antibiotic dapsone, systemic zinc salts, oral antibiotic lymecycline, new formulations of and synergistic combinations of benzoyl peroxide, photodynamic therapy with topical photosensitizers and potential acne vaccines.

Topics: Acne Vulgaris; Acneiform Eruptions; Administration, Cutaneous; Administration, Topical; Anti-Bacterial Agents; Benzoyl Peroxide; Dose-Response Relationship, Drug; Female; Folliculitis; Humans; Isotretinoin; Practice Guidelines as Topic; Practice Patterns, Physicians'; Pregnancy; Quality of Life; Rosacea

There are many options for the treatment of acne rosacea, including topical and systemic therapies, laser and light-based therapies, and surgical procedures. A classification system for rosacea identifies 4 subtypes (ie, erythematotelangiectatic, papulopustular, phymatous, and ocular), which may help guide therapeutic decision making. Until recently, the pathophysiology of acne rosacea has been poorly understood and limited to descriptions of factors that exacerbate or improve this disorder. Recent molecular studies suggest that an altered innate immune response is involved in the pathogenesis of the vascular and inflammatory disease seen in patients with rosacea. These findings may help explain the benefits of current treatments and suggest new therapeutic strategies helpful for alleviating this disease. The goals of therapy include reduction of papules, pustules, erythema, physical discomfort, and an improvement in quality of life. Standard topical treatment agents include metronidazole, azelaic acid, and sodium sulfacetamide-sulfur. Second-line therapies include benzoyl peroxide, clindamycin, calcineurin inhibitors, and permethrin. There are also various systemic therapy options.

Topics: Administration, Oral; Administration, Topical; Anti-Bacterial Agents; Dermatologic Agents; Dicarboxylic Acids; Humans; Isotretinoin; Metronidazole; Phototherapy; Rosacea; Sulfacetamide

Rosacea, a common disease in adults, has an extremely variable presentation. Severity is also highly variable and, to some degree, the location of mild end of the rosacea spectrum is in the eye of the beholder. Rosacea has been noted since at least the Middle Ages. The red-faced drunk and the swollen nose of the self-indulgent are images from Shakespeare and Chaucer that have been used in modern political cartoons as well. This association with alcohol and excess is unfortunate since most patients are neither alcoholic nor dissipated.

Topics: Anti-Bacterial Agents; Dermatologic Agents; Diagnosis, Differential; Humans; Isotretinoin; Rhinophyma; Rosacea

Rosacea is one of the most common dermatoses of adults. In recent years many studies have contributed to a better understanding of the pathophysiology of rosacea. They suggest that an altered innate immune response is involved in the vascular and inflammatory manifestations seen in rosacea. A good understanding of the disease and its special features is necessary for the differential diagnosis of the many clinical subtypes and for a stage- and phase-specific treatment approach. Topical treatments that are widely accepted are metronidazole and azelaic acid; agents under investigation that show promise include permethrin, calcineurin inhibitors and sulfur compounds. For systemic therapy antibiotics (tetracyclines, macrolides) and recently doxycycline in anti-inflammatory rather than anti-microbial dosages are used, as well as isotretinoin in severe cases. Findings such as rhinophyma and telangiectases can be treated using different laser systems or dermabrasion. This article gives an overview regarding rosacea, a challenging condition with multiple therapeutic options.

Topics: Adult; Animals; Anti-Bacterial Agents; Antimicrobial Cationic Peptides; Cathelicidins; Dermatologic Agents; Diagnosis, Differential; Disease Models, Animal; Female; Humans; Isotretinoin; Male; Mice; Niacinamide; Rhinophyma; Risk Factors; Rosacea; Skin; Telangiectasis; Ultraviolet Rays

This article will examine oral therapies utilized in the treatment of rosacea. Important topics include recognizing which types of rosacea can benefit from oral therapy and concerns regarding the emergence of bacterial resistance.

Topics: Administration, Oral; Anti-Bacterial Agents; Drug Resistance; Flushing; Humans; Isotretinoin; Macrolides; Rosacea; Tetracyclines

Systemic isotretinoin has been used to treat severe acne vulgaris for 20 years. However, isotretinoin also represents a potentially useful choice of drugs in many dermatologic diseases other than acne vulgaris. Diseases such as psoriasis, pityriasis rubra pilaris, condylomata acuminata, skin cancers, rosacea, hidradenitis suppurativa, granuloma annulare, lupus erythematosus and lichen planus have been shown to respond to the immunomodulatory, anti-inflammatory and antitumor activities of the drug. Isotretinoin also helps prevent skin cancers such as basal cell carcinoma or squamous cell carcinoma. A combination of systemic isotretinoin and interferon-alpha-2a may provide a more potent effect than isotretinoin alone in the prevention and treatment of skin cancers.Systemic isotretinoin may be considered as an alternative drug in some dermatologic diseases unresponsive to conventional treatment modalities. However, randomized clinical trials aimed at determining the role of systemic isotretinoin therapy in dermatologic diseases other than acne vulgaris are required.

Topics: Acne Vulgaris; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Inflammatory Agents; Condylomata Acuminata; Dermatologic Agents; Drug Therapy, Combination; Granuloma Annulare; Hidradenitis Suppurativa; Humans; Isotretinoin; Keratolytic Agents; Lichen Planus; Lupus Erythematosus, Systemic; Pityriasis Rubra Pilaris; Psoriasis; Rosacea; Sebaceous Glands; Skin Diseases; Skin Neoplasms

The goal of this article is to highlight recent developments in the treatment of acne and rosacea. An update on the use of isotretinoin, minocycline, topical retinoids, and hormones in the treatment of acne are presented. Highlights of research findings that may lead to future acne therapies are discussed. New in the management of rosacea are studies demonstrating the efficacy of 1% topical metronidazole in the treatment of rosacea, reports on the successful maintenance of remissions of rosacea with 0.75% metronidazole gel, and data regarding the controversial association of rosacea with Helicobacter pylori infection.

Topics: Acne Vulgaris; Aged; Anti-Bacterial Agents; Helicobacter Infections; Helicobacter pylori; Humans; Isotretinoin; Metronidazole; Middle Aged; Retinoids; Rosacea

Phymas are slowly progressive, disfiguring disorders of the face and ears that represent the end stage of rosacea, a common centrofacial dermatosis. Phymas are probably caused by the sequelae of chronic edema and its related connective tissue and sebaceous gland hypertrophy. Rhinophyma is the commonest among them. Analogous swellings may occur on the chin (gnatophyma), forehead (metophyma), one or both ears (otophyma), and eyelids (blepharophyma). Although rhinophyma has been traditionally associated with alcoholism, there is no evidence to support this association. Four variants of rhinophyma (glandular, fibrous, fibroangiomatous, actinic) can be recognized on clinical and histological basis. The development of skin cancer, such as basal cell carcinoma or squamous cell carcinoma, in rhinophyma appears to be a matter of accidental coincidence of different diseases. Although phymas are best treated surgically, they may be a worthwhile indication for nonsurgical treatment modalities such as systemic isotretinoin. Phymas do not resolve spontaneously.

Topics: Anti-Bacterial Agents; Chronic Disease; Dermatologic Agents; Eye Diseases; Humans; Isotretinoin; Prognosis; Rhinophyma; Rosacea; Sunscreening Agents

Topics: Administration, Topical; Anti-Inflammatory Agents; Female; Glucocorticoids; Humans; Isotretinoin; Keratolytic Agents; Male; Middle Aged; Rosacea

The draining sinus is an unpleasant complication of acne conglobata, acne fulminans, acne inversa, rosacea conglobata and rosacea fulminans (pyoderma faciale). It is most common on the face, especially in the nasolabial folds, and on the neck below the mandibular line. Clinically, it is an elongated (2-5 cm long), elevated, periodically inflamed lesion, which sporadically discharges pus. The lesion persists with no tendency to spontaneous regression. Histopathologically, it consists of elaborate, epithelialized galleries connected to the skin surface at multiple points. It contains corneocytes, hairs, bacteria, serum, inflammatory cells and epitheloid granulomas. A surgical thread placed into the skin provides a model in which the generation of sinus tracts can be studied. Therapy is difficult. Intralesional corticosteroid injection, cryosurgery and isotretinoin are not always very effective. Sometimes complete excision of the lesion is necessary. The draining sinus is a special form of scar analogous to the pilonidal cyst.

Topics: Abscess; Acne Vulgaris; Adolescent; Adrenal Cortex Hormones; Adult; Animals; Combined Modality Therapy; Cryosurgery; Cutaneous Fistula; Female; Humans; Injections, Intralesional; Isotretinoin; Male; Rosacea; Skin

Topics: Administration, Oral; Adult; Female; Humans; Isotretinoin; Male; Middle Aged; Rosacea; Time Factors

Isotretinoin is a new orally active retinoic acid derivative for the treatment of severe refractory nodulocystic acne. The pharmacological profile of isotretinoin suggests that it acts primarily by reducing sebaceous gland size and sebum production, and as a result alters skin surface lipid composition. Bacterial skin microflora is reduced, probably as a result of altered sebaceous factors. Isotretinoin 1 to 2 mg/kg/day for 3 to 4 months produces 60 to 95% clearance of inflammatory lesions in patients with severe, recalcitrant nodulocystic acne, with evidence of continued healing and prolonged remissions in many patients after treatment withdrawal. Doses as low as 0.1 mg/kg/day have also proven successful in the clearance of lesions; however, with such low doses the duration of remission after discontinuation of therapy is usually shorter. Encouraging results have also been seen in small numbers of patients with rosacea, Gram-negative folliculitis, Darier's disease, ichthyosis and pityriasis rubra pilaris, the response in keratinising disorders resembling that with the related drug etretinate. While long term follow-up studies in these patients have not been reported, prolonged remission after withdrawal of isotretinoin in disorders of keratinisation is unlikely, as with other drugs used in these conditions. Isotretinoin is only partially effective in psoriasis, in contrast to etretinate which is very effective in psoriasis but ineffective in severe acne. Some encouraging results have also been reported with isotretinoin in patients with squamous and basal cell carcinomas, but isotretinoin has proven unsuccessful in non-squamous cell epithelial and non-epithelial cancer. Side effects affecting the mucocutaneous system occur in nearly all patients receiving isotretinoin, but rarely lead to drug withdrawal. Raised serum triglyceride levels are also commonly reported. The possibility of long term spinal or skeletal bone toxicity may restrict the use of isotretinoin in severe disorders of keratinisation requiring prolonged administration. Isotretinoin is strictly contraindicated in women of childbearing potential due to its severe teratogenic properties, unless an effective form of contraception is used. Thus, isotretinoin offers an effective advance on the treatment options available in a difficult therapeutic area - those patients with severe, nodulocystic acne not responding to 'traditional' therapy.

Topics: Acne Vulgaris; Animals; Anti-Inflammatory Agents; Carcinogens; Cell Differentiation; Cell Division; Humans; Immunity; Isotretinoin; Kinetics; Mutagens; Psoriasis; Rosacea; Sebaceous Glands; Skin; Skin Absorption; Skin Diseases; Skin Neoplasms; Teratogens; Tissue Distribution; Tretinoin

Rosacea is a kind of chronic inflammatory skin disease that usually occurs in the middle of the face. Diammonium glycyrrhizinate (DG), an effective monomer component extracted from licorice, has extensive anti-inflammatory, antioxidant, anti-allergic, and immunomodulatory effects. There is no research on its therapeutic effect on rosacea. In this study, we divided rosacea patients mainly characterized by papules and pustules randomly into three groups. Group A received clarithromycin 500 mg once a day, isotretinoin 10 mg once a day; Group B received DG 150 mg three times a day, other medicines were the same as Group A; Group C received clarithromycin 250 mg once a day, isotretinoin 10 mg once every 2 days, and DG 150 mg three times a day. All patients' symptom scores and laboratory tests were evaluated when followed up. We found that DG combined with clarithromycin and isotretinoin in the treatment of rosacea was more effective and quicker than clarithromycin and isotretinoin alone. Moreover, half common dosage of clarithromycin and isotretinoin combined with DG could achieve the same therapeutic effect as the conventional dose, and brought about lower incidences of adverse events (AEs). Therefore, it is recommended to use half common dosage of routine medication combined with DG for rosacea patients mainly characterized by papules and pustules.

Topics: Clarithromycin; Double-Blind Method; Exanthema; Glycyrrhizic Acid; Humans; Isotretinoin; Rosacea

While a considerable number of cases with papulopustular rosacea (PPR) are resistant to conventional medications, therapeutic regimens are not currently established. Pulsed dye laser (PDL) and fractional microneedling radiofrequency (FMR) have previously demonstrated satisfactory results for anti-angiogenesis, anti-inflammation, and dermal remodeling.. To evaluate the efficacy and safety of novel combination regimen with low-dose oral isotretinoin, PDL, and FMR in the treatment of recalcitrant PPR.. A retrospective study was undertaken for recalcitrant PPR patients to evaluate the clinical course of novel combination regimen. Twenty-five PPR patients who had failed in previous first-line therapies were enrolled. They were treated with three sessions of PDL and FMR consecutively at 4-week intervals, maintaining daily oral administration of 10 mg isotretinoin for 8 weeks. Objective assessments, erythema index measurement, and patients' subjective satisfaction were evaluated at each visit and 16 weeks after the final treatment.. At the final follow-up visit, the number of papules and pustules decreased by 71%, and erythema index by 54% compared with baseline (P < 0.05 for both). Physician's global assessment based on rosacea severity score and patients' subjective assessments paralleled with these results. No serious side effect was observed during whole study periods.. This novel combination regimen demonstrated satisfactory efficacy with reasonable safety profiles for the treatment of recalcitrant PPR.

Topics: Administration, Oral; Adult; Combined Modality Therapy; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Humans; Isotretinoin; Lasers, Dye; Low-Level Light Therapy; Male; Middle Aged; Needles; Patient Satisfaction; Radiofrequency Therapy; Retrospective Studies; Rosacea; Severity of Illness Index; Treatment Outcome

Rosacea is a chronic inflammatory facial skin disease with psychosocial impact. Oral cyclines are recommended for moderate-to-severe papulopustular rosacea. Oral isotretinoin was found valuable for difficult-to-treat cases in several reports. This multicenter, double-blind, randomized-placebo-controlled trial compared oral isotretinoin (0.25 mg/kg/day) with placebo (2:1 ratio) for difficult-to-treat papulopustular rosacea. Included patients had at least eight papulopustular lesions. The primary endpoint after the 4-month treatment period was the response rate: at least 90% reduction of the number of papules/pustules compared with baseline. Secondary outcomes included measures on quality of life (Skindex score). Between February 2007 and August 2009, 156 patients were randomized to receive either isotretinoin (n = 108) or placebo (n = 48). In the intention-to-treat population, 57.4% of isotretinoin recipients reached the primary endpoint, compared with 10.4% of those taking the placebo (absolute difference, 47 percentage points; 95% confidence interval, 34.3-59.7; P < 0.0001). To consider therapy successful, 2.1 (95% confidence interval 1.7-2.9) patients had to be treated. Skindex scores had improved significantly more for isotretinoin- than placebo-treated patients. Rosacea relapsed in 27 (58.3%) of 51 patients who accepted 4 months of continued follow-up, with a median of 15 weeks to recurrence. The percentages of patients in each arm who stopped their treatment because of adverse event(s) did not differ. Low-dose isotretinoin was an effective therapeutic option for difficult-to-treat papulopustular rosacea. Further studies should investigate the value of a minimal effective isotretinoin dose to maintain these remissions.

Topics: Administration, Oral; Adult; Aged; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Female; Follow-Up Studies; France; Humans; Isotretinoin; Keratolytic Agents; Logistic Models; Male; Middle Aged; Multivariate Analysis; Patient Selection; Risk Assessment; Rosacea; Severity of Illness Index; Treatment Outcome; Young Adult

Systemic isotretinoin has been known for decades to be effective in the treatment of severe forms of rosacea, but it must be used off-label because of the lack of evidence-based data.. 573 patients with rosacea subtype II and III received one of three different dosages of isotretinoin (0.1 mg, 0.3 mg, or 0.5 mg per kg body weight), doxycycline (100 mg daily for 14 days, then 50 mg daily) or placebo in a double-blinded, randomized way for 12 weeks in 35 German centers.. Isotretinoin 0.3 mg/kg proved to be the most effective dose with significant superiority versus placebo. Isotretinoin 0.3 mg/kg showed also significant non-inferiority versus doxycycline with reduction of lesions of 90 % compared to 83 % with doxycycline. Investigators diagnosed complete remission in 24 % and marked improvement in further 57 % of patients with isotretinoin treatment, in contrast to remission in 14 % and marked improvement in 55 % of patients treated with doxycycline. Isotretinoin 0.3 mg/kg revealed a similar safety profile as for the treatment of acne. Isotretinoin 0.5 mg/kg showed more dermatitis facialis as compared to 0.3 mg/kg.. Isotretinoin 0.3 mg/kg is an effective and well-tolerated therapy option for the treatment of rosacea subtype II and III and can therefore be used successfully as an alternative to therapy with oral antibiotics.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Dermatologic Agents; Double-Blind Method; Doxycycline; Female; Humans; Injections, Intra-Arterial; Isotretinoin; Male; Middle Aged; Placebo Effect; Rosacea; Treatment Outcome

Twenty-two patients with severe or recalcitrant rosacea were divided into three treatment groups in a randomized, double-blind trial that compared low-dose oral isotretinoin (10 mg/d), topically applied tretinoin (0.025% cream), and the combined use of both isotretinoin and tretinoin. For the first 16 weeks of the trial, subjects received one of these three trial regimens. For the final 16 weeks, isotretinoin was withheld while tretinoin cream or a placebo cream was continued.. Twenty subjects completed the trial. Each treatment produced therapeutic benefits with regard to the number of papules and pustules and erythema. Treatment with oral isotretinoin appeared to give a more rapid onset of improvement, but there were no differences between the groups after 16 weeks. This level of improvement continued during the succeeding 16 weeks of observation whether the subjects used the tretinoin or the placebo cream. Adverse events were minimal and well tolerated in all groups.. Low-dose oral isotretinoin and topical tretinoin cream therapy appear to be beneficial in the treatment of severe or recalcitrant rosacea. No additive benefit is noted with the combined use of these two modalities.

Topics: Administration, Oral; Administration, Topical; Adult; Aged; Dose-Response Relationship, Drug; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Isotretinoin; Male; Middle Aged; Rosacea; Tretinoin

Rosacea should no longer be considered a follicular skin disease. It is a vascular disease of the face characterized by a significant evolution towards local complications such as telangiectasias, papular and aseptic pustular lesions, lupoid granulomas, chronic facial oedema and seboglandular hyperplasia. The basic abnormality seems to be a microcirculatory disturbance of the function of the facial angular veins directly involved in the brain-cooling vascular mechanism. The first clinic hallmark of this dysfunction is the occurrence of flushing, which may be spontaneous or induced by alcohol, intake of hot food, emotional stress and sudden variations in temperature. Tetracycline, metronidazole and isotretinoin are very useful for therapy but they only influence the cutaneous and ocular complications and do not act upon the basic vascular trouble. Current therapeutic research is directed towards drugs having an alpha-sympathomimetic activity and inhibiting the endogenous opioid mediators of flushing such as naloxone or clonidine.

Topics: Body Temperature; Clinical Trials as Topic; Clonidine; Female; Humans; Isotretinoin; Male; Metronidazole; Naloxone; Rosacea; Tetracyclines

A follow up investigation was done on forty-seven patients of the German multicenter study with severe and long standing rosacea who had been treated with isotretinoin (0.5 mg/kg bw/day) over twelve or twenty weeks. During the post-treatment follow up which lasted an average of fifty-seven weeks, seven relapses were registered whereas forty patients remained in remission. After drug withdrawal, both the percentage of patients without inflammatory lesions (pustules, papules or nodules) as well as the mean values of inflammatory lesions remained almost constant over the whole observation period.

Topics: Clinical Trials as Topic; Female; Follow-Up Studies; Humans; Isotretinoin; Male; Recurrence; Rosacea; Time Factors; Tretinoin

A multicenter trial of isotretinoin in severe papulopustular rosacea in adult patients was undertaken to evaluate the efficacy and safety of this treatment. A 20-week course of therapy was instituted in 92 patients from 11 dermatology departments. At the end of the study period, isotretinoin was found to be highly effective in the clearing of refractory rosacea lesions.

Topics: Administration, Oral; Adolescent; Adult; Aged; Blepharitis; Cholesterol; Clinical Trials as Topic; Conjunctivitis; Female; Humans; Isotretinoin; Male; Middle Aged; Rosacea; Tretinoin; Triglycerides; Uveitis, Anterior

Isotretinoin (Accutane) is a lately developed synthetic oral retinoid for treatment of severe forms of cystic acne resistant to therapy. Its pharmacological effect principally consists in decreased size of the sebaceous glands, reduced sebum production, as well as alteration of the bacterial micropopulation. At a dosage of 0.5 mg up to 1.0 mg/kg body weight daily, isotretinoin led to significant reduction of the inflammatory skin eruptions and long-lasting remission after discontinuation of the drug. With regard to 18 patients suffering from rosacea, the application of Accutane brought about satisfactory results, as well. Mucocutaneous side-effects were almost compulsory, but did never lead to discontinuation of the treatment. Because of its teratogenity, isotretinoin must not be applied in case of gravidity. Accutane offers new modes of therapy with respect to patients suffering from nodulocystic acne or severe rosacea which did not respond to common forms of treatment.

Topics: Acne Vulgaris; Adolescent; Aged; Clinical Trials as Topic; Etretinate; Female; Humans; Isotretinoin; Male; Middle Aged; Rosacea; Tablets; Tretinoin

Good to excellent clinical results have been obtained in the treatment of severe inflammatory acne (acne conglobata, acne fulminans, and acne conglobata with hidradenitis and dissecting cellulitis of the scalp) with orally administered isotretinoin (13-cis-retinoic acid). Similar promising results have been obtained in patients with severe rosacea and gram-negative folliculitis. Isotretinoin probably has multiple modes of action, including (1) inhibition of sebaceous gland activity, (2) inhibition of the growth of Propionibacterium acnes within the follicle, although the retinoid is not antibacterial, (3) inhibition of inflammation, and (4) alteration of the pattern of keratinization within the follicle, as demonstrated by light and ultrastructural studies.

Topics: Acne Vulgaris; Adolescent; Adult; Clinical Trials as Topic; Enterobacteriaceae Infections; Female; Folliculitis; Humans; Isomerism; Isotretinoin; Male; Rosacea; Skin; Tretinoin

Topics: Humans; Intracranial Hypertension; Isotretinoin; Rosacea

Topics: Acne Vulgaris; Dermatologic Agents; Humans; Isotretinoin; Rosacea

Demodex spp. mites are the most complex resident of the human skin microbiome. Although they are considered commensals, they can be pathophysiologically relevant in inflammatory skin diseases like rosacea. Until now, there is no culture system available for these mites except for using live vertebrate hosts.. Our aim was to establish an ex vivo culture of human Demodex mites and to characterize the sebogenesis-dependent mite density.. Demodex mites were cultivated in pilosebaceous units of human skin explants, called human organotypic skin explant culture (hOSEC). Furthermore, different sebogenesis-modifying additives were evaluated. Mites and mite survival were evaluated using light and fluorescence microscopy.. After 90 days of incubation, living Demodex mites - including eggs, larvae and nymphs - were detected in the dissected skin samples. Incubation for 30 days with anabolic steroids (testosterone and trenbolone) as well as retinol and retinoic acid (isotretinoin) yielded a reduced mite density.. With this technique, mites can be cultivated ex vivo for the first time, thereby establishing new ways to investigate Demodex spp. The sebostatic effect of isotretinoin might explain the mechanism of action in the off-label treatment of rosacea. We anticipate our findings to be the basis of an accelerated research on our most complex commensal, its life, biology and physiology.

Topics: Animals; Cell Proliferation; Humans; Isotretinoin; Mite Infestations; Mites; Rosacea

A 32-year-old man presented with multiple reddish and skin-colored asymptomatic skin lesions over his face and ears present for a year. These lesions appeared in crops at variable intervals, healing with scarring over the next few months. He had received doxycycline and azithromycin for about 6 months without any relief. No history of flushing, worsening of lesions on sun exposure, or eating spicy food, was reported. He had no chronic illness or prolonged usage of any medication. The patient neither had abdominal pain, respiratory distress, or uveitis to suggest sarcoidosis nor accounted any personal or family history of tuberculosis. (

Topics: Adult; Facial Dermatoses; Granuloma; Humans; Isotretinoin; Male; Rosacea; Sarcoidosis

Papulopustular rosacea is notoriously a challenge to treat, and treatment options are scarce. Only limited data exist on the use of azithromycin in treatment of papulopustular rosacea. However, the unique pharmacokinetics of azithromycin may have several indications in the treatment of papulopustular rosacea. We here report a case of hard-to-treat papulopustular rosacea which was successfully treated with pulsed oral azithromycin in addition to maintenance isotretinoin.

Topics: Administration, Oral; Azithromycin; Humans; Isotretinoin; Rosacea

Topics: Facial Dermatoses; Humans; Isotretinoin; Rosacea

Lupus miliaris disseminatus faciei is an uncommon type of granulomatous rosacea characterized by a papular eruption in the central regions of the face. A 43-year-old woman presented with an asymptomatic papular eruption on the face that had developed over a period of five months. Physical examination revealed multiple, small, reddish-brown papules, distributed symmetrically on the central area of the face. A biopsy was taken, showing dermal epithelioid cell granulomas with central necrosis and surrounding lymphocytic infiltrate with multinucleate giant cells. No foreign bodies were found in granulomas and no mycobacterial or fungal components were detected. On the basis of these findings, the diagnosis of lupus miliaris disseminatus faciei was made. The patient was given oral isotretinoin 20mg/day with initial slow response. After 6 months' treatment the lesions completely disappeared. Many authors consider this entity to be a variant of granulomatous rosacea. It is a chronic condition that primarily affects young adults. Treatment is usually unsatisfactory. Therapies with corticosterois, tetracyclines, retinoids, clofazimine or topical tacrolimus have been described but there is a lack of controlled studies and convincing results. Our success with a 6-month course of low dose isotretinoin suggests consideration of a longer trial prior to abandoning this as treatment.

Topics: Administration, Oral; Adult; Dermatologic Agents; Drug Administration Schedule; Facial Dermatoses; Female; Humans; Isotretinoin; Rosacea

Rosacea is a common inflammatory facial skin condition affecting the adult population. Its papulopustular subtype is mainly treated pharmacologically by topical and oral antibiotics. For severe or antibiotics-recalcitrant disease, daily low-dose isotretinoin has also been reported to be effective. However, no previous study has assessed the efficacy of once-weekly administered isotretinoin for papulopustular rosacea. For this purpose, a retrospective comparative study was conducted. For severe rosacea, 40 mg/week isotretinoin (24 patients) was administered. For mild to moderate rosacea, once-weekly 20 mg/week isotretinoin (28 patients) was compared with 100 mg/day minocycline (24 patients). Treatment courses lasted 4 to 7 months. Forty milligrams per week isotretinoin was highly effective for severe rosacea, achieving complete response (over 90% improvement) in 62.5% of patients and partial response (50%-90% improvement) in additional 29.2% of patients. Twenty milligrams per week isotretinoin and hundred milligrams per day minocycline showed comparable efficacy for mild to moderate rosacea (complete response of 10.7% vs 8.3% and partial response of 28.6% vs 33.3%, respectively). This study demonstrates that that the use of a weekly low-dose isotretinoin is an effective treatment for papulopustular rosacea, including among patients with severe disease.

Topics: Adult; Anti-Bacterial Agents; Dermatologic Agents; Humans; Isotretinoin; Minocycline; Retrospective Studies; Rosacea

Rosacea fulminans is a rare and severe inflammatory dermatosis which affects predominantly childbearing women. It is characterized by sudden onset and it usually localizes exclusively on the centrofacial areas, presenting with numerous fluctuant inflammatory nodules and papules which may coalesce. Treatment with isotretinoin in combination with topical and systemic corticosteroids is successful. Clearance of lesions may be obtained under systemic treatment with no or minimal scarring outcomes. Due to rare incidence its pathophysiological mechanisms, diagnosis and management remain controversial. We report two cases of rosacea fulminans arisen in otherwise healthy people and completely healed after treatment. Our aim is to share our experience about this disease in order to increase knowledge about its diagnosis, management and its treatment. We also make a review of the literature of this peculiar dermatosis.

Topics: Administration, Oral; Adolescent; Adult; Dermatitis; Dermatologic Agents; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Isotretinoin; Male; Remission Induction; Rosacea

Lupus miliaris disseminates faciei (LMDF) is a rare inflammatory dermatosis characterized by an asymptomatic papular eruption in the central face, of which the etiology and pathogenesis are not clear. There is a lack of standard treatment recommendations, especially for severe cases. Here we report a new case of successful treatment of severe LMDF by the combination therapy of oral isotretinoin and methylprednisolone.

Topics: Facial Dermatoses; Granuloma; Humans; Isotretinoin; Methylprednisolone; Rosacea

Topics: Anti-Bacterial Agents; Doxycycline; Eye; Humans; Isotretinoin; Rosacea

Topics: Administration, Cutaneous; Adult; Drug Therapy, Combination; Facial Dermatoses; Female; Humans; Isotretinoin; Metronidazole; Necrosis; Prednisolone; Rosacea; Skin; Treatment Outcome

Rhinophyma is a form of rosacea and is often cosmetically disfiguring. There are various therapeutic ablation modalities. Surgery is often associated with down-time and side-effects. We describe successful treatment with low-dose isotretinoin as a safe alternative with a lower risk of complications. We also discuss the advantages and disadvantages of various therapeutic modalities.

Topics: Dermatologic Agents; Humans; Isotretinoin; Rhinophyma; Rosacea

New topical therapies have demonstrated efficacy in patients with moderate or severe acne who might otherwise have required therapy with systemic antibiotics or isotretinoin. Increasing knowledge about the pathogenesis of acne has facilitated the development of therapies with novel modes of action. New and investigational therapies also are available or in development for the treatment of both the papulopustular and erythematous manifestations of rosacea. Semin Cutan Med Surg 37(supp3):S63-S66 © 2018 published by Frontline Medical Communications.

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Bacterial Agents; Dermatologic Agents; Drugs, Investigational; Humans; Isotretinoin; Rosacea

Rosacea is a chronic inflammatory disorder that affects up to 10% of the population. Standard treatments include topical azelaic acid and metronidazole or systemic tetracyclines. Isotretinoin has generally been restricted to severe disease, often at a dose of 0.5-1.0 mg/kg/day.. Retrospective review of open-label isotretinoin (initial dose 20 mg/day, with dose adjustments according to response), in patients with mild to moderate papulopustular rosacea.. Altogether 52 patients (33 women), mean age 48 years (range 18-86) were treated with isotretinoin over a 5-year period. All patients were commenced on 20-mg isotretinoin/day which was reduced to 10-20 mg once to five times a week (equivalent to 5 mg/day) in 67%, but increased in 15% (who all had additional acne) to 30-40 mg/day. In terms of dose/kg/day, 29% received ≤ 0.1 mg/kg/day, 46% received 0.11-0.25 mg/kg/day and 10% received > 0.5 mg/kg/day. Treatment was continued for 57 weeks (range 9-223). Six patients (12%) did not attend follow up. Of the remainder, in 91% (42/46) the rosacea had cleared or was excellent. One patient stopped isotretinoin because of its adverse effects. Two-fifths (44%) suffered no adverse effect. The most common side-effect was cheilitis in half (52%), which was mild in all but one patient.. 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.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cheilitis; Dermatologic Agents; Female; Humans; Isotretinoin; Male; Middle Aged; Retrospective Studies; Rosacea; Young Adult

Rosacea is a chronic and common cutaneous condition characterised by symptoms of facial flushing and a broad spectrum of clinical signs. The clinical presentation for rosacea is varied, and there are four primary subtypes, which may overlap - erythrotelangiectatic, inflammatory, phymatous and ocular. It is important to recognise the different subtypes because of the differences in therapy.. The objective of this article is to provide evidence-based clinical updates to clinicians, specifically general practitioners (GPs), to assist with their everyday practice, and effective assessment and treatment of rosacea.. Therapeutic modalities are chosen on the basis of the subtypes and clinical features identified; often a combination of these therapies is required.

Topics: Anti-Bacterial Agents; Brimonidine Tartrate; Diagnosis, Differential; Doxycycline; Humans; Isotretinoin; Ivermectin; Laser Therapy; Metronidazole; Rosacea

Topics: Dermatologic Agents; Facies; Humans; Isotretinoin; Male; Middle Aged; Rosacea

Rosacea fulminans is a rare disorder of unknown cause, almost exclusively affecting women. There are only a few reported cases in men. The condition is characterized by the abrupt onset of pustules and nodules predominantly affecting the cheeks or chin without any systemic upset. We report the case of a 37-year-old man who presented with papulopustules, predominantly localized to his nose. Histopathological features were consistent with rosacea fulminans. The patient was managed with treatments including oral prednisolone, isotretinoin, and trimethioprim.

Topics: Adult; Anti-Infective Agents; Anti-Inflammatory Agents; Dermatologic Agents; Drug Therapy, Combination; Facial Dermatoses; Humans; Isotretinoin; Male; Nose; Prednisolone; Rosacea; Trimethoprim

Isotretinoin is a revolutionary medicine for the treatment of acne vulgaris, with new studies showing evidence of excellent clinical outcomes in treating rosacea. After 30 years of clinical experience, new insights are being gained into dosing strategies, recurrence prevention, and dose-related side effects. Previous controversial associations with inflammatory bowel diseases and mood disorders have hampered the use of this medication in some clinical situations, with new evidence disproving these claims. The teratogenicity of this medication mandates iPLEDGE compliance with government regulations. Clinicians should be knowledgeable about this medication including its side effects, teratogenicity, and its controversies in order to adequately counsel patients, dissuade fears, and obtain the best clinical outcome when treating acne and rosacea.

Topics: Acne Vulgaris; Dermatologic Agents; Evidence-Based Medicine; Guidelines as Topic; Humans; Isotretinoin; Recurrence; Risk Assessment; Risk Factors; Rosacea; Treatment Outcome

Rosacea is a chronic inflammatory disease that can manifest as a spectrum of symptoms including erythema, inflammatory lesions, edema, and telangiectasia. Treatment decisions need to be adapted to reflect the nature and severity of the different symptoms present. In this report, we discuss the case of a female patient diagnosed with severe, inflamed papulopustular rosacea (PPR) presenting with a large number of inflammatory lesions and severe background erythema. This patient responded well to a treatment regimen consisting of a short course of antibiotics in combination with a corticosteroid, followed by monotherapy with isotretinoin to reduce the inflammation. Brimonidine gel, used as needed, was then added to isotretinoin to target the remaining background erythema. This case of severe PPR required a combinatorial treatment regimen to effectively target all symptoms present. The patient continued to apply topical metronidazole throughout the different treatment regimens prescribed over the course of almost 1 year. Use of topical metronidazole helped to repair and protect the skin barrier, which minimized the occurrence of dermatological adverse events when topical treatments were used. We conclude that in patients with severe disease and an important inflammatory component, a rapid response can be obtained with a multimodal, tailored approach that also includes treatment to repair and protect the skin barrier.

Topics: Administration, Topical; Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents; Brimonidine Tartrate; Dermatologic Agents; Drug Therapy, Combination; Female; Humans; Isotretinoin; Metronidazole; Prednisolone; Rosacea

Ataxia-Telangiectasia is a rare multisystem autosomal recessive disorder [OMIM 208900], caused by mutations in Ataxia-Telangiectasia Mutated gene. It is characterized by neurological, immunological and cutaneous involvement. Granulomas have been previously reported in Ataxia-Telangiectasia patients, even if acne rosacea has not been described.We report a case of a young Ataxia-Telangiectasia patient with a severe immunological and neurological involvement, who developed granulomatous skin lesions diagnosed by skin biopsy as acne rosacea. Considering the severe clinical picture and the lack of improvement to multiple topic and systemic therapies, treatment with Isotretinoin was started and the skin lesions disappeared after five months. However the therapy was stopped due to drug-hepatotoxicity.Systemic treatment with Isotretinoin should be carefully considered in patient with Ataxia-Telangiectasia for the treatment of multi-drug resistant acne rosacea, however its toxicity may limit long-term use and the risk/benefit ratio of the treatment should be evaluated.

Topics: Adolescent; Ataxia Telangiectasia; Dermatologic Agents; Drug Resistance, Multiple; Female; Humans; Isotretinoin; Liver; Rosacea; Skin

Topics: Crohn Disease; Dermatologic Agents; Fusidic Acid; Humans; Isotretinoin; Male; Middle Aged; Prednisone; Rosacea

Isotretinoin is one of the therapeutic options for rosacea. However, the response of erythema to treatment with isotretinoin is usually slow and incomplete with common (0.5-1 mg/kg/day) or low (10 mg/day) doses. This study investigated the efficacy of, and relapse on, 20 mg/day isotretinoin treatment in rosacea, with the aid of instrumental measurement of facial erythema and sebum levels. A 20 mg/day dose of isotretinoin was given for 4 months, and then the dose was tapered off within the following 6 months. A total of 25 patients were included in the study. Papule and pustule counts, erythema index, sebum level, dermatologist's and patient's erythema scores, and dermatologist's sebum scores were significantly lower in the first month of therapy compared with pre-treatment values (p < 0.05). Within a median follow-up of 11 months (95% confidence interval: 8.4-13.5 months) 45% of patients had a relapse. In conclusion, 20 mg/day isotretinoin was rapidly efficient for reducing both inflammatory lesions and erythema in rosacea.

Topics: Adult; Aged; Dermatologic Agents; Erythema; Facial Dermatoses; Female; Follow-Up Studies; Humans; Isotretinoin; Male; Middle Aged; Recurrence; Rosacea; Sebum; Severity of Illness Index; Statistics, Nonparametric

Topics: Biopsy; Child, Preschool; Dermatologic Agents; Facial Dermatoses; Female; Humans; Isotretinoin; Rosacea; Treatment Outcome

A 45-year-old male presented with a 6 month history of an enlarging smooth, erythematous plaque over the central part of his face. Mild erythema of both eyes was present. Sarcoidosis, Hansen disease, lupus vulgaris, cutaneous leishmaniasis, pseudolymphoma, foreign body granuloma, granuloma faciale, discoid lupus erythematosus, and granulomatous rosacea were considered in the differential diagnosis. CBC, urinalysis, renal function tests, liver function tests, serum electrolytes, and blood sugar were all normal. Chest X-ray and ECG revealed no abnormality. Serology for syphilis and HIV, and mantoux test were negative. Slit-skin smear, tissue smear and culture for AFB and fungi were negative. Skin biopsy revealed multiple non-caseating epitheloid granulomas around the pilosebaceous unit suggestive of granulomatous rosacea. Granulomatous rosacea, a rare entity comprising only about 10 percent of cases of rosacea can mimic many granulomatous conditions both clinically and histologically making the diagnosis an enigma. It usually presents as yellowish brown-red discrete papules on the face; non-caseating epithelioid granulomas are seen on histology examination. We herein report the case because it presented in atypical fashion, as a solitary indurated plaque on the nose, likely representing Morbihan's disease or solid persistent facial edema of rosacea (rosacea lymphedema).

Topics: Anti-Inflammatory Agents; Dermatologic Agents; Diagnosis, Differential; Facial Dermatoses; Humans; Isotretinoin; Male; Middle Aged; Nose; Prednisolone; Rosacea

A range of treatment options are available in rosacea, which include several topical (mainly metronidazole, azelaic acid, other antibiotics, sulfur, retinoids) and oral drugs (mainly tetracyclines, metronidazole, macrolides). In some cases, the first choice is a systemic therapy because patients may have sensitive skin and topical medications can be irritant. Isotretinoin can be used in resistant cases of rosacea. Unfortunately, the majority of studies on rosacea treatments are at high or unclear risk of bias. A recent Cochrane review found that only topical metronidazole, azelaic acid, and oral doxycycline (40 mg) had some evidence to support their effectiveness in moderate to severe rosacea and concluded that further well-designed, adequately-powered randomised controlled trials are required. In our practice, we evaluate our patients for the presence of two possible triggers, Helicobacter pylori infection and small intestinal bacterial overgrowth. When they are present we use adapted antibiotic protocols. If not, we use oral metronidazole or oral tetracycline to treat papulopustolar rosacea. We also look for Demodex folliculorum infestation. When Demodex concentration is higher than 5/cm(2) we use topical crotamiton 10% or metronidazole.

Topics: Adapalene; Anti-Infective Agents; Cyclosporine; Dermatologic Agents; Dicarboxylic Acids; Humans; Immunosuppressive Agents; Isotretinoin; Keratolytic Agents; Metronidazole; Mite Infestations; Naphthalenes; Rosacea; Sulfacetamide; Tacrolimus; Tetracycline; Toluidines; Tretinoin

Systemic isotretinoin has been known for decades as an effective and safe therapeutic option in the treatment of severe and refractory forms of rosacea. It can also be used in special treatment-resistant forms of rosacea, e.g. granulomatous rosacea, as efficacious second-line therapy. Previously, the effect of isotretinoin in rosacea has been mainly studied in small cohorts or anecdotal reports. Recently, a big randomized double-blind dose-response and comparative study revealed that an optimized dosage of 0,3 mg/kg was superior to other dosages and non-inferior to doxycycline as gold standard of systemic rosacea treatment and proved effective and safe in papulopustular and phymatous subtypes. However, the substance is still not licensed for this indication The efficacy of isotretinoin in rosacea is probably mainly related to anti-inflammatory mechanisms as well as anti-oxidative, anti-angiogenic and antifibrotic properties. The classical antiseborrheic effect of isotretinoin might play a role in special subtypes like the phymatous type or rosacea fulminans.

Topics: Clinical Trials as Topic; Dermatologic Agents; Dose-Response Relationship, Drug; Evidence-Based Medicine; Humans; Isotretinoin; Rosacea; Skin; Treatment Outcome

A range of treatment options are available in rosacea, which include several topical (mainly metronidazole, azelaic acid, other antibiotics, sulfur, retinoids) and oral drugs (mainly tetracyclines, metronidazole, macrolides). In some cases, the first choice is a systemic therapy because patients may have sensitive skin and topical medications can be irritant. Isotretinoin can be used in resistant cases of rosacea. Unfortunately, the majority of studies on rosacea treatments are at high or unclear risk of bias. A recent Cochrane review found that only topical metronidazole, azelaic acid, and oral doxycycline (40 mg) had some evidence to support their effectiveness in moderate to severe rosacea and concluded that further well-designed, adequately-powered randomised controlled trials are required. In our practice, we evaluate our patients for the presence of two possible triggers, Helicobacter pylori infection and small intestinal bacterial overgrowth. When they are present we use adapted antibiotic protocols. If not, we use oral metronidazole or oral tetracycline to treat papulopustolar rosacea. We also look for Demodex folliculorum infestation. When Demodex concentration is higher than 5/cm(2) we use topical crotamiton 10% or metronidazole.

Topics: Anti-Infective Agents; Cyclosporine; Dermatologic Agents; Dicarboxylic Acids; Humans; Immunosuppressive Agents; Isotretinoin; Keratolytic Agents; Lasers, Dye; Metronidazole; Mite Infestations; Naphthalenes; Phototherapy; Rosacea; Sulfacetamide; Tacrolimus; Tetracycline; Toluidines; Tretinoin

Topics: Dermatologic Agents; Drug Administration Schedule; Humans; Isotretinoin; Male; Middle Aged; Retrospective Studies; Rosacea; Time Factors; Treatment Outcome

Isotretinoin is effective in the treatment of severe acne and rosacea. Both parent drug and its main metabolite 4-oxo-isotretinoin are potentially teratogenic compounds and contain a carboxylic acid moiety. In the presence of ethanol, naturally occurring as well as synthetic retinoids also containing a carboxylic acid moiety are capable of undergoing an ethyl esterification with the metabolic formation of more lipophilic compounds with a much longer terminal half-life.. To determine if isotretinoin (13-cis-RA), its main metabolite 4-oxo-isotretinoin (4-oxo-13-cis-RA), and other possible metabolites in the presence or absence of ethanol are converted to their corresponding ethyl derivatives in patients with severe acne or rosacea after multiple isotretinoin dosing. In addition, pharmacokinetic parameters of the parent drug and its 4-oxo metabolite were determined.. Eleven patients with severe acne or rosacea were treated with isotretinoin daily for 3 months and investigated pharmacokinetically during 24 h after 1 month of treatment and for up to 28 days after discontinuation of therapy. A possible influence of ethanol was evaluated using a simple self-administered questionnaire and by measuring serum ethanol levels during treatment. The concentrations of isotretinoin, 4-oxo-isotretinoin and possible ethylated and nonethylated metabolites were measured by reverse-phase high-performance liquid chromatography.. Although seven of 11 patients had a considerable weekly alcohol intake, no endogenous synthesis of ethyl derivatives of isotretinoin, the main 4-oxo metabolite or the all-trans compounds was chromatographically detectable in any of the patients' plasma samples during the treatment period. Multiple dose pharmacokinetic data for the parent drug and its main metabolite were comparable to previous studies.. The metabolism and pharmacokinetics of isotretinoin and its main metabolites are not influenced by ethanol during long-term isotretinoin treatment. After ceasing long-term isotretinoin therapy the recommended period of 1 month for using anticonceptive measures in fertile women seems adequate.

Topics: Acne Vulgaris; Adult; Alcohol Drinking; Chromatography, High Pressure Liquid; Dermatologic Agents; Ethanol; Female; Humans; Isotretinoin; Male; Middle Aged; Rosacea; Surveys and Questionnaires; Tretinoin; Young Adult

Topics: Adrenal Cortex Hormones; Anti-Bacterial Agents; Child; Contraindications; Dermatologic Agents; Doxycycline; Female; Humans; Isotretinoin; Laser Therapy; Male; Metronidazole; Rhinophyma; Rosacea; Sunscreening Agents

Topics: Aged; Dermatologic Agents; Female; Humans; Isotretinoin; MELAS Syndrome; Rosacea; Vision Disorders; Visual Fields

Pyoderma faciale is a rare cutaneous disorder that predominantly affects women in their 20s and 30s and is characterized by the rapid appearance of coalescing nodules and draining sinuses, combined with livid erythema on the face. We describe a 40-year-old woman who presented with localized pyoderma faciale that worsened during treatment with oral and topical antibiotics and corticosteroids. Subsequent treatment with isotretinoin for 5 months resulted in dramatic and sustained improvement.

Topics: Adult; Dermatologic Agents; Female; Humans; Isotretinoin; Pyoderma; Rosacea

Rosacea fulminans is a rare and severe form of rosacea, with acute onset in women between 20 and 40 years. Although the aetiology remains unknown, pregnancy has been reported to be a triggering factor. We report a case of rosacea fulminans occurring at the onset of pregnancy and discuss a possible triggering role of endocrine factors, as well as therapeutic options.. A 32-year-old woman with no previous history of dermatological disease consulted for rosacea fulminans appearing within the first three weeks of her first pregnancy, which required hormonal stimulation with recombinant FSH (follitropin alpha, Gonal F) and an LHRH inhibitor (cetrorelix, Cetrotide). She did not use topical corticosteroids or any other medication and had no other abnormalities at clinical examination. The skin disease lasted throughout pregnancy despite different treatments. After delivery, moderate improvement was observed within two weeks. Treatment with isotretinoin 0.5 mg/kg/day was started three months after delivery and led to the disappearance of the papular and pustular lesions within three weeks, with persistence of the erythema for six months.. The patient had never previously presented from acne or rosacea and the question of the responsibility of hormonal changes induced by stimulating ovulation or pregnancy can be raised. However, since her rosacea lasted throughout pregnancy, a causal role of the drugs used for ovarian stimulation appears unlikely. We suggest that pregnancy was the major triggering factor in this case. The recurrence of the skin disease on a subsequent pregnancy would constitute a strong argument to support this hypothesis and rule out simple co-incidence.

Topics: Adult; Dermatologic Agents; Embryo Transfer; Female; Fertilization in Vitro; Humans; Isotretinoin; Pregnancy; Pregnancy Complications; Rosacea

Rosacea is a very common skin disorder in the clinical practice that primarily affects the convex areas of the face. Extrafacial rosacea lesions have occasionally been described, but extensive involvement is exceptional. In the absence of its typical clinical or histological features, the diagnosis of extrafacial rosacea may be problematic. We describe an unusual case of rosacea with very exuberant extrafacial lesions, when compared with the limited involvement of the face.

Topics: Anti-Bacterial Agents; Azithromycin; Dermatologic Agents; Diagnosis, Differential; Drug Therapy, Combination; Humans; Immunosuppressive Agents; Isotretinoin; Male; Middle Aged; Neck; Pregnenediones; Rosacea; Skin; Thorax; Upper Extremity

Rosacea fulminans (also known as pyoderma faciale) has been reported to occur in association with Crohn's disease. It is still unclear whether the papulopustules and confluent nodules of rosacea fulminans represent a manifestation of mucocutaneous Crohn's disease or whether this association is a mere coincidence. A 46-year-old woman presented with the spontaneous outbreak of rosacea fulminans and pyostomatitis/pyovulvitis. Complete remission of the mucocutaneous symptoms was achieved with 2 months combination therapy with methylprednisolone, isotretinoin and dapsone. The patient's Crohn's disease, already diagnosed for 3 years, did not flare during this period.

Topics: Anti-Infective Agents; Anti-Inflammatory Agents; Crohn Disease; Dapsone; Dermatologic Agents; Drug Combinations; Female; Humans; Isotretinoin; Methylprednisolone; Middle Aged; Rosacea; Stomatitis; Treatment Outcome; Vulvitis

A 40-year-old man developed an erythematous rash on the right side of his face 3 weeks after a herpes zoster infection at the same location. Examination revealed an erythematous papular eruption and telangiectasias along the ophthalmic and maxillary divisions of the right trigeminal nerve, exactly at the site of the consistent with previous herpes zoster infection, Wolf's isotopic response. Histological examination showed vascular ectatic dilatation and perivascular and perifollicular infiltration of lymphocytes and histiocytes consistent with rosacea. The rash was resistant to oral doxycycline and topical metronidazole 1% cream and resolved with oral isotretinoin therapy.

Topics: Adult; Face; Herpes Zoster; Humans; Isotretinoin; Male; Rosacea; Treatment Outcome

Topics: Adult; Dermatologic Agents; Fissure in Ano; Gastrointestinal Hemorrhage; Humans; Isotretinoin; Male; Middle Aged; Proctitis; Rectum; Rosacea

Topics: Administration, Topical; Adult; Anti-Bacterial Agents; Drug Therapy, Combination; Facial Dermatoses; Female; Flushing; Follow-Up Studies; Humans; Isotretinoin; Risk Assessment; Rosacea; Severity of Illness Index; Treatment Outcome

Topics: Adult; Chronic Disease; Dermatologic Agents; Female; Humans; Isotretinoin; Male; Middle Aged; Retrospective Studies; Rosacea

Topics: Administration, Oral; Child, Preschool; Dermatologic Agents; Facial Dermatoses; Female; Humans; Isotretinoin; Rosacea; Skin; Treatment Outcome

Topics: Acne Vulgaris; Cicatrix; Cosmetics; Humans; Isotretinoin; Rosacea

Topics: Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Facial Dermatoses; Female; Humans; Isotretinoin; Male; Prednisone; Prognosis; Rosacea; Severity of Illness Index; Treatment Outcome

Acne rosacea is a common dermatologic condition which is usually diagnosed by its clinical presentation. This article describes an unusual presentation of acne rosacea and the diagnosis of this condition using fine-needle aspiration biopsy. To our knowledge, the fine-needle aspiration findings of acne rosacea have not been previously described and illustrated in the cytology literature.

Topics: Adult; Biopsy, Needle; Connective Tissue; Female; Granuloma; Humans; Isotretinoin; Rosacea

The explosive onset of fluctuant facial papulonodules, usually in young women, is characteristic of pyoderma faciale. This disorder is neither a true pyoderma nor a variant of acne, but rather a severe form of rosacea. The most effective therapeutic modality appears to be isotretinoin, especially if preceded by a brief course of oral corticosteroids or a short interval of application of potent topical corticosteroids. Despite our concern about the potential adverse effects of systemic retinoids on underlying inflammatory bowel disease, isotretinoin was given to a patient with refractory pyoderma faciale. Response was dramatic, and no ill effects were encountered.

Topics: Adult; Colitis, Ulcerative; Facial Dermatoses; Female; Humans; Isotretinoin; Keratolytic Agents; Pyoderma; Rosacea; Terminology as Topic

Topics: Dose-Response Relationship, Drug; Female; Humans; Isotretinoin; Keratolytic Agents; Male; Middle Aged; Rosacea; Treatment Outcome

Topics: Drug Therapy, Combination; Histamine H1 Antagonists; Humans; Isotretinoin; Keratolytic Agents; Ketotifen; Lymphedema; Rosacea

Topics: Drug Therapy, Combination; Edema; Facial Dermatoses; Histamine H1 Antagonists; Humans; Isotretinoin; Keratolytic Agents; Ketotifen; Male; Middle Aged; Rosacea

Six patients with severe rosacea were treated with oral isotretinoin during 3 to six months and followed for two years. All had a good response with quick remission of papules and pustules. Collateral effects were minimal and tolerable. Four patients has an ophthalmological assessment (one with a severe keratitis), confirming a beneficial effect of the drug. During follow up, patients remained asymptomatic during a mean of 14.8 months.

Topics: Administration, Oral; Adult; Female; Follow-Up Studies; Humans; Isotretinoin; Male; Middle Aged; Rosacea

A young woman with a persistent eruption of small granulomas about the mouth and chin was studied and granulomatous perioral dermatitis was diagnosed. Some authorities consider that perioral dermatitis is a circumscribed variant of rosacea; the findings in this case tend to show a relationship between the two conditions. Once conventional therapies failed to result in a response, the eruption cleared, leaving pitted, atrophic scarring after a twenty week course of isotretinoin treatment.

Topics: Administration, Oral; Adult; Diagnosis, Differential; Facial Dermatoses; Female; Granuloma; Humans; Isotretinoin; Rosacea

Roakkutan was used in the treatment of 49 patients with severe acne vulgaris and 8 patients with rosacea. The treatment was highly effective. The primary and maintenance daily doses of the drug are suggested and the terms of therapy defined.

Topics: Acne Vulgaris; Adolescent; Adult; Chronic Disease; Drug Evaluation; Female; Humans; Isotretinoin; Male; Rosacea; Time Factors

We report the observation of delayed wound healing and keloid formation in three patients, following dermabrasion or Argon laser treatment administered while they were receiving isotretinoin for acne or rosacea.

Topics: Acne Vulgaris; Adult; Aged; Dermabrasion; Female; Humans; Isomerism; Isotretinoin; Keloid; Laser Therapy; Male; Rosacea; Tretinoin; Wound Healing

Twenty patients with severe rosacea were treated with isotretinoin for 3-6 months. Six patients initially received 1.0 mg/kg and 14 patients 0.5 mg/kg of isotretinoin. The response was good or excellent in all patients and the papulopustular lesions in particular cleared promptly. Patients receiving 1.0 mg/kg of isotretinoin experienced more side-effects and the dose had to be lowered in five of the six patients. Seventeen of the 20 patients had no relapses during a follow-up of one year showing that isotretinoin has a long-lasting favourable effect in rosacea.

Topics: Adult; Aged; Female; Follow-Up Studies; Humans; Isomerism; Isotretinoin; Male; Middle Aged; Nasal Mucosa; Recurrence; Rosacea; Time Factors; Tretinoin; Xerostomia

Acne rosacea has been considered to be a rare disease among black patients. Three cases of rosacea in blacks are described and illustrated. Acne rosacea may be more common in black patients than heretofore believed.

Topics: Black People; Humans; Isotretinoin; Male; Middle Aged; Minocycline; Rosacea; Tretinoin

Thirteen patients of both sexes, affected by a severe form of a papular rosacea, were treated with 13-cis retinoic acid (1 mg/kg/day) for two months. One patient interrupted the treatment after 15 days because of severe blepharitis. The size and number of papules were progressively reduced from the 2nd week, reaching complete regression at the 6th week. Three patients complained of mild blepharitis, nine developed dry cheilitis.

Topics: Adult; Aged; Female; Humans; Isotretinoin; Male; Middle Aged; Rosacea; Tretinoin

13 patients of both sexes, affected by a severe form of papular rosacea, were treated with 13-cis retinoic acid (1 mg/kg/day) for 2 months. One patient interrupted the treatment after 15 days because of severe blepharitis. The size and number of papules were progressively reduced from the 2nd week, reaching complete regression at the 6th week. Three patients complained of mild blepharitis, 9 patients developed dry cheilitis.

Topics: Adult; Aged; Blepharitis; Cheilitis; Drug Eruptions; Drug Evaluation; Female; Humans; Isotretinoin; Male; Middle Aged; Rosacea; Tretinoin; Triglycerides

Fifteen patients with acne and 4 with rosacea were treated topically with 0.2% isotretinoin cream twice a day for 16 weeks. Inflammatory lesions responded better (30 +/- 22 versus 15 +/- 12) than non-inflammatory lesions (23 +/- 44 versus 17 +/- 24). Neither the "causal level" (123 +/- 85 versus 130 +/- 66 micrograms/cm2 nor the "replacement sum" (70 +/- 29 versus 77 +/- 30 micrograms/cm2) were changed (lipometer assay). In 150 adult male Syrian hamsters 1-2 drops of isotretinoin in concentrations varying from 0.3% to 0.001% and arotinoid ranging in concentration from 0.3% to 0.00001% in acetone were applied to the left ventral ear or the left flank organ twice a day (5/7 days) for 21 days. In higher concentrations there was a significant reduction in sebaceous gland size. Arotinoid, however, is extremely toxic. Even in concentrations as low as 0.00001% the animals showed severe side-effects within the 1st week.

Topics: Acne Vulgaris; Administration, Topical; Adolescent; Adult; Animals; Benzoates; Cricetinae; Dose-Response Relationship, Drug; Female; Humans; Isotretinoin; Male; Mesocricetus; Retinoids; Rosacea; Sebaceous Glands; Tretinoin

Topics: Acne Vulgaris; Administration, Oral; Humans; Isotretinoin; Rosacea; Tretinoin

The paper presents clinical and laboratory data on 13-CIS-retinoic acid treatment in rosacea. Good-to-excellent results are reported for severe forms of rosacea. Side effects were tolerable and could easily be controlled. The role of sebaceous gland function was documented by both histological and skin sebum parameters. Diminution of sebaceous gland size and the decrease of skin sebum with alteration of single sebum fractions correspond with findings in acne. According to the findings the alteration of sebaceous gland function is one model of drug action in rosacea. Thus sebaceous gland dysfunction may play an important role in the pathogenesis of rosacea.

Topics: Adult; Aged; Female; Humans; Isotretinoin; Lipids; Male; Middle Aged; Rosacea; Sebaceous Glands; Sebum; Skin; Tretinoin

Topics: Adult; Humans; Isotretinoin; Male; Rosacea; Tretinoin

Topics: Adult; Female; Humans; Isotretinoin; Lipids; Liver Function Tests; Male; Middle Aged; Rosacea; Tretinoin

Seven patients with severe rosacea were treated with 1 mg/kg per day isotretinoin for 12 wk. There were significant increases in serum triglyceride (p less than 0.001) and cholesterol (p less than 0.001). Triglyceride associated with very low density lipoprotein (VLDL), low density lipoprotein (LDL) and high density lipoprotein (HDL) increased (p less than 0.01), cholesterol in VLDL and LDL increased (p less than 0.01), and levels of HDL cholesterol decreased (p less than 0.01). There were changes in indices of liver function, with increased levels of gamma-glutamyltransferase (GGT) (p less than 0.01), alkaline phosphatase (ALP) (p less than 0.01) and aspartate aminotransferase (AST) (p less than 0.01), and decreased bilirubin levels (p less than 0.05). Although levels of thyroxine and triiodothyronine were lower after treatment (p less than 0.05), there were no changes in basal levels of thyroid-stimulating hormone (TSH), luteinizing hormone (LH) or follicle-stimulating hormone (FSH), and responses to thyrotrophin releasing hormone (TRH) and luteinizing hormone releasing hormone (LHRH) were unchanged. These changes may partially be explained by induction of hepatic microsomal enzymes by isotretinoin.

Topics: Adult; Cholesterol; Female; Humans; Isotretinoin; Lipids; Lipoproteins; Liver; Liver Function Tests; Male; Middle Aged; Rosacea; Thyroid Function Tests; Thyroid Hormones; Tretinoin; Triglycerides

Forty patients suffering of different forms of acne (papulo-pustular, nodulo-cystic, conglobata, rosacea), all in severe conditions and non-responding to other treatments, have been administered 13-cis-retinoic acid p.o. The treatment resulted in a complete and ultimate healing in 31 pts (77.5%) and a marked amelioration in the remaining 9 cases. The initial drug dosage was 40 mg/die (an average of 0.66 mg/kg/die) but it was reduced along the treatment to 2.5 mg/die, a still effective dose. The average treatment duration was 24 weeks (range: 12 to 40). The tolerance was generally excellent, but some adverse effect have been recorded, mainly localized in the skin and mucosa. Increases of total serum cholesterol (66% of the cases) and of triglyceride (72%) level have been observed. This effect was reversible at the end of the treatment. As a conclusion we can confirm that the 13-cis-retinoic acid is the most effective drug for the pharmacotherapy of severe acne.

Topics: Acne Vulgaris; Adult; Alkaline Phosphatase; Alopecia; Cholesterol; Drug Tolerance; Epistaxis; Female; Humans; Isotretinoin; Male; Pruritus; Rosacea; Transaminases; Tretinoin; Triglycerides

Twenty-one patients with severe acne (acne papulopustulosa, acne conglobata, acne cystica), six patients with severe rosacea (rosacea paulopustulosa, rosacea conglobata, rhinophyma), and three patients with tuberous sclerosis were treated with 13-cis-retinoic acid for 6-48 weeks. Most patients had been previously treated with dermabrasion, antibiotics or metronidazole. Dependent on the severeness of the pathological symptoms 13-cis-retinoic acid was administered at a dose of 0.2 to 0.5 mg/kg body weight and was then reduced every 4 weeks. We confirm the sebostatic and antiinflammatory effect of the 13-cis-retinoic acid and long-lasting remissions. Side effects had not been serious.

Topics: Acne Vulgaris; Adenoma; Administration, Oral; Adolescent; Adult; Aged; Female; Humans; Isomerism; Isotretinoin; Male; Middle Aged; Rosacea; Sebaceous Gland Neoplasms; Tretinoin

Topics: Acne Vulgaris; Adolescent; Adult; Anti-Inflammatory Agents; Female; Folliculitis; Humans; Isotretinoin; Male; Rosacea; Skin Diseases; Tretinoin

13-cis-retinoic acid was given with good results to 7 patients with exceptionally severe rosacea. Side effects were transitory and of minor consequence and subsided quickly on reduction of the dosage and topical application of mild cosmetics. The long-lasting remissions recorded to date indicate that 13-cis-retinoic acid may prove a new and successful approach to the treatment of rosacea.

Topics: Administration, Topical; Adult; Aged; Female; Humans; Isotretinoin; Male; Middle Aged; Rosacea; Tetracyclines; Tretinoin

Retinoids possess regulatory influences on growth and differentiation of epithelial tissues. They induce a population of keratinozytes with normal pattern of differentiation, they have antiproliferative properties, and they show antineoplastic effects by inhibition of malignant transformation of cells in vitro. Also the dermis undergoes distinct alterations under oral administration of retinoids. By stimulating T-lymphocytes and by inhibition of neutrophil migration retinoids seem to develop immunmodulating and antiinflammatory effects. The aromatic retinoid Etretinate is therapeutically used in severe forms of psoriasis and in various genodermatoses with disorders of keratinization as for example ichthyosis, dyskeratosis follicularis Darier, and pityriasis rubra pilaris.

Topics: Acne Vulgaris; Administration, Oral; Etretinate; Humans; Isomerism; Isotretinoin; Psoriasis; Rosacea; Skin Diseases; Tretinoin

Topics: Acne Vulgaris; Adolescent; Adult; Aged; Female; Hair; Humans; Isomerism; Isotretinoin; Male; Middle Aged; Rosacea; Tretinoin

Thirteen patients with severe rosacea (rosacea papulopustolosa, rosacea conglobata, and rhinophyma) were treated orally with 0.05, 0.5, or 1.0 mg/kg body weight 13-cis-retinoic acid (isotretinoin, Ro 4-3780) for 12-28 weeks. All patients had been treated previously with high doses of tetracyclines, metronidazole, or dermabrasion, etc., with no or only limited success. The therapeutic effect following 13-cis-retinoic acid was excellent. Inflammatory lesions regressed by 50% within 2 weeks, and by over 95% within 8 weeks. 13-cis-retinoic acid acts as a potent anti-inflammatory and sebum-suppressive agent. Besides papulopustules, nodules, and hemorrhagic abscesses, the inflammatory plaques and facial edema, but to a lesser extent teleangiectasias and the chronic conjunctivitis disappeared. The severe seborrhea disappeared. Long-lasting remission, similar to patients with severe acne being treated with 13-cis-retinoic acid, can be expected, as the first patients are in full remission for over 12 months at the time of writing. Exfoliative cheilitis occurred in every patient. Serum lipids increased only slightly. For female patients a reliable contraception is mandatory as teratogenicity cannot be excluded in this drug (similar to all retinoids).

Topics: Adult; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Humans; Isotretinoin; Male; Middle Aged; Rhinophyma; Rosacea; Skin; Tretinoin

Severe forms of rosacea are a new indication for the treatment with 13-cis retinoic acid. Results of therapy and duration of remission were in five patients, treated in this way, much better than compared to standard therapeutic measurements.

Topics: Adult; Chronic Disease; Humans; Isotretinoin; Middle Aged; Rosacea; Tretinoin