Aaron F. Cohen, MD; Jeffrey D. Tiemstra, MD


J Am Board Fam Med. 2002;15(3) 

In This Article

Treatment of Advanced Disease

Recalcitrant rosacea can respond to oral isotretinoin therapy. In a recent study of 22 patients with mild to moderate rosacea, major reductions in erythema, papules, and telangiectasias were noted by the ninth week of treatment.[19] Isotretinoin reduces the size of sebaceous glands and alters keratinization. Recalcitrant cases of rosacea have been successfully treated with 0.5 mg/kg/d of isotretinoin.[12] Isotretinoin, of course, has serious side-effects, most notably its teratogenic potential. Female patients of childbearing age must be strongly advised to use effective birth control. Stage IV of rosacea, involving irreversible fibrotic changes, such as rhinophyma, does not respond well to medical therapy. At that point, the patient should be referred for cosmetic surgery, such as cryosurgery and laser therapy.

In the aging US population, rosacea is an increasingly common disorder. Although rosacea causes only limited physical effects, the prominent visibility of these changes often yields intense psychosocial distress. Although the exact cause of rosacea is unknown, its progression, signs, and symptoms can be readily alleviated by the primary care physician.


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