Treatment of rosacea fulminans with isotretinoin and topical alclometasone dipropionate

Five adult Caucasian women with rosacea fulminans (RF) were treated with isotretinoin and a low-potency topical corticosteroid, alclometasone dipropionate. All patients had been previously treted at other centres with contraceptives, and systemic and topical antibiotics: these drugs produced only partial remissions of short duration. Isotretinoin was used at the dosage of 0.5 mg/kg/day for 1 month and 0.7 mg/kg/day for the next 3 months. Contraception was effected using the cyproterone acetate - ethinyloestradiol association. Alclometasone dipropionate was employed as a cream (2 applications/day for 10 days and 1 application/day for the subsequent 10 days). No other topical or systemic drugs were used. In particular, systemic corticosteroids were not used because of patients' refusal (2 cases) or the presence of concomitant diseases (3 cases) which could be worsened by corticosteroids. In all patients a marked improvement was observed after about 1 month and the complete disappearance of the lesions after 4 months. No side effects were either reported or observed. No laboratory abnormalities were recorded. No recurrences were seen (follow up duration: 14-19 months; median: 17.6 months). RF is slightly or not at all sensitive to contraceptives, and systemic and topical antibiotics, while it is markedly sensitive to isotretinoin. The use of systemic corticosteroids may be avoided: these may be substituted by low-potency topical corticosteroids.