Rosacea tretinoin

Comedonal acne and acne rosacea respond well to tretinoin. In fact, the anti-aging effect of tretinoin was first observed in patients being treated with tretinoin for comedonal acne their skin texture and skin tone were gradually seen to improve. 

Oral isotretinoin (9-a s-retinoic acid) is often used in treating severe or stubborn acne rosacea. A 1994 study compared the treatment of rosacea with 10 mg/day low-dose oral isotretinoin, 0.025% low-dose topical tretinoin and a combination of the two. The results showed that before the 16th week of treatment, isotretinoin was more effective, but that afterwards there was no difference between tretinoin and isotretinoin. The combination of systemic and topical treatment does not give any further improvement in low doses. 

Ertl GA, Levine N, Kligman AM. A comparison of the efficacy of topical tretinoin and low-dose oral isotretinoin in rosacea. Arch Dermatol 1994 130 319-24. 

Rosacea prescribe topical products containing 2-3% pyruvic acid, or 1-2% salicyhc acid, or 0.05% tretinoin for 3 weeks before the procedure to reduce thickness of the stratum comeum and improve uniform penetration of the pymvic acid. This treatment should be intermpted 3 days before the procedure. Treatment with topical metronidazole or azelaic acid can be maintained. 

It may be used at different concentrations (from 0.01% to 0.05%, although 0.025% is the concentration most frequently used in rosacea). Its efficacy is comparable with oral isotretinoin at a daily dosage of 10 mg [56]. Side effects are much more frequent and severe than all the other topical drugs used in rosacea (burning, xerosis, redness, scaling). Because of these side effects, tretinoin is a second choice in rosacea. 

Isotretinoin was also found to be highly effective in the clearing of refractory rosacea lesions. The anti-inflammatory action of isotretinoin is considered to be the responsible mechanism for efficacy in rosacea. A daily dose of 0.4 to 1 mg/kg/day for up to six months is beneficial and was reported by many authors [36, 63]. Remissions of up to two years after discontinuation have been documented. Mucocutaneous side-effects were predictable and dose-dependent and systemic side-effects were rarely problematic. A study with 22 patients with severe or recalcitrant rosacea revealed that low-dose oral isotretinoin (10 mg/d), topical applied tretinoin (0.025% cream), and the combined treatment were beneficial in the treatment of severe or recalcitrant rosacea [22]. 

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