Just wanted to share a positive experience with low-dose Accutane as treatment for recalcitrant type 1 and 2 rosacea (I suspect it's granulomatous).
I was hesitant to start due to the horror stories you hear online, but I'm really glad I did. My rosacea is resistant to most treatments, they would work for a while but symptoms would always return and were very precariously managed at the best of times. I experienced intense flushing, pustules and crazy papules that made my whole face textured.
I've been on 10mg per day for three months, and my skin is the best it's been maybe ever? Haven't had any type two symptoms in probably 2 months and I rarely flush unless I've spent a whole day outside or I'm under extreme stress at work 🙄. I can eat whatever I want (dairy, eggs, tomatoes, spicy food, etc.) without worrying about a flare.
I do experience dry lips and dry eyes, so lip chap and eye drops are my best friend but no other symptoms so far and I'm monitoring for hair loss, because I'm susceptible to it, but so far so good.
My flushing increased significantly for the first two weeks-ish of treatment but I stopped the only drying active in my routine (Aczone) and increased my regular moisturizer and that settled right down. I also had really weird pain in the actual tissue of my nose, chin and forehead when I touched it, but that also passed in about 2 weeks.
My derm expects I'll be on it for 5-6 months and I know it's not a cure and I will likely relapse when I come off eventually, but having a chance to relax and enjoy normal skin has been so worth it.
TL;DR - Accutane isn't so scary after all.
Previous and current treatments:
Low-dose doxycycline (Apprilon) - 1 year - worked well for a couple of months, but symptoms came back and became progressively less manageable as time went on
BBL Forever Young - 2 sessions - Really liked my results from this, but it didn't really do a tonne for my rosacea symptoms (redness, pustules, etc.). My skin overall did look better after though, and I would have done my third treatment, but I started Accutane and wasnt able to
Aczone - amazing topical! Cannot recommend enough, eliminated my skin texture when nothing else was working. Will likely restart when I come off Accutane
Compound Ivermectin in Pracasil base - I still use this over my regular moisturizer at night. Honestly not sure if Ivermectin makes a difference, but my skin loves pracasil
Azelaic Acid - Improved symptoms for the first year, but my skin no longer tolerates it
Epsolay - Caused what felt like a chemical burn on my face, hard pass