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Meta-Analysis
. 2025 Apr;39(4):785-792.
doi: 10.1111/jdv.20315. Epub 2024 Sep 6.

Low-dose isotretinoin for the management of rosacea: A systematic review and meta-analysis

Aliyah King  1 , Marcus G Tan  1   2   3 , Carly Kirshen  1   2 , Stanislav N Tolkachjov  4   5   6   7
Affiliations
Meta-Analysis

Low-dose isotretinoin for the management of rosacea: A systematic review and meta-analysis

Aliyah King et al. J Eur Acad Dermatol Venereol. 2025 Apr.

Abstract

Background: Rosacea is a chronic, relapsing inflammatory dermatosis predominantly affecting the central face and can result in significant psychosocial impacts. Isotretinoin has been studied for rosacea due to its anti-inflammatory and sebum reduction properties, but its use remains limited likely due to its off-label use and potential adverse events.

Objective: This systematic review and meta-analysis investigated the efficacy and safety of low-dose isotretinoin (LDI; ≤0.5 mg/kg/day) for the four main types of rosacea: erythematotelangiectatic, papulopustular, phymatous and ocular rosacea.

Methods: Randomized and non-randomized studies evaluating LDI for rosacea were included. Incomplete studies, non-English studies and case reports were excluded. Study quality was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation scale.

Results: Of 435 studies, and 16 studies involving 1445 patients were included. LDI decreased lesion count (p = 0.03) and erythema (p = 0.01) with large effect [standardized mean difference (SMD) > 0.8]. Compared to topical retinoids and topical antimicrobials, isotretinoin had larger reductions in lesion count (p = 0.03) with moderate effect (SMD > 0.5). Mean lesion count and erythema remained reduced by 70% and 47%, respectively, at 16 weeks after LDI cessation. Relapse rate was 35% at 5.5 months post-isotretinoin, and three patients (0.4%) experienced worsening of rosacea. Three patients (0.4%) experienced serious adverse events.

Conclusions: Study design heterogeneity limited more comprehensive comparisons. Overall, low-dose isotretinoin may serve as an effective treatment for rosacea with good tolerability and safety.

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Conflict of interest statement

None to report for the authors.

Figures

FIGURE 1
FIGURE 1
Flow diagram of study selection.
FIGURE 2
FIGURE 2
Forest plot comparing reduction in lesion counts for the studies' baselines to the endpoints, in patients receiving isotretinoin monotherapy.
FIGURE 3
FIGURE 3
Forest plot comparing reduction in erythema for the studies' baselines to the endpoints, in patients receiving isotretinoin monotherapy.
FIGURE 4
FIGURE 4
Forest plot comparing patient‐reported overall rosacea improvement for the studies' baseline to the endpoints, in patients receiving isotretinoin monotherapy.
FIGURE 5
FIGURE 5
Forest plot comparing reduction in lesion count in patients receiving isotretinoin monotherapy compared to topical monotherapy.
FIGURE 6
FIGURE 6
Forest plot comparing reduction in erythema in patients receiving isotretinoin alone compared to topical monotherapy.
See this image and copyright information in PMC

References

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