SAN FRANCISCO – None of Dr. Timothy G. Berger’s patients with solid facial edema had responded to treatment with oral isotretinoin, so he was puzzled when New York dermatologists reported success in five out of five cases of patients with Morbihan disease, considered by most clinicians as a late-stage complication of rosacea. What was the secret to their success?
The answer: The successful patients took high doses for a prolonged treatment period – at least 6 months – before there was any sign of improvement.
Dr. Timothy G. Berger
"I was bailing out too soon. I didn’t treat long enough," said Dr. Berger of the University of California, San Francisco. "I’m now changing the way that I approach these patients," he said during a presentation at the annual meeting of the Pacific Dermatologic Association.
The average dose for the five patients in the report was 60 mg/day (ranging from 40 to 80 mg/day), with a mean treatment period of 16 months (and a range of 10 to 24 months). Patients received a mean cumulative dose of isotretinoin of 285 mg/kg (ranging from 170 to 491 mg/kg). The mean disease-free follow-up period was 9 months (ranging from 1 to 24 months), the researchers wrote (Arch. Derm. 2012;148:1395-8). However, the researchers noted that they saw no substantial clinical improvement in the patients until at least 6 months.
Both the daily and cumulative doses used in the study are high, Dr. Berger noted. "If you have patients with solid facial edema and you give them oral retinoids, you have to tell them ahead of time, ‘We have to get you up to this dose and we have to treat you for at least 6 months,’ " he said.
Solid facial edema "is a really difficult disease to treat," Dr. Berger said. Conventional therapy for solid facial edema includes systemic anti-inflammatory drugs, but the clinical response often is unsatisfactory, he noted. The findings were limited by the small number of patients, but the results represent an encouraging option for a challenging condition.
"This paper taught me a lot," Dr. Berger added.
Dr. Berger reported having no financial disclosures.
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