A randomized, controlled, split‐face study of botulinum toxin and broadband light for the treatment of erythematotelangiectatic rosacea

Abstract

To study the efficacy and safety of botulinum toxin (BTX) combined with broadband light (BBL) in the treatment of rosacea‐related erythema and flushing. A randomized, single‐blind, split‐face controlled study including 22 patients with erythemato telangiectatic rosacea were enrolled. Both cheeks were randomly divided into experimental group and control group. They were treated three times with an interval of 1 month. In the first treatment, the experimental group received BBL treatment and intradermal injection of BTX, and the control group received BBL treatment and intradermal injection of the same amount of normal saline; in the second and third treatments were both groups received the same BBL treatment. The patients were evaluated before the first treatment and 1, 2, 3, and 6 months after the treatment. Compared with the control group, the hydration in the experimental group increased and the global flushing symptom score (GFSS), VISIA red value, erythema index, transepidermal water loss, and sebum secretion decreased. The differences were statistically significant (p < 0.05). In the experimental group, at 3 months after the first treatment, compared with before treatment, the GFSS, VISIA red value, erythema index, transepidermal water loss and sebum secretion decreased the hydration increased. The sebum secretion returned to the pretreatment level in 6 months after treatment, and the other indexes maintained the level in 3 months after treatment. One patient had a slight lifting limitation of the corners of his mouth after 10 days of BTX injection, without special treatment, and recovered after 1 month. BTX intradermal injection combined with BBL has a definite therapeutic effect on the improvement of rosacea related erythema and flushing, which is better than simple BBL, and has high safety. It is worthy of clinical promotion.

Long‐term maintenance treatment of rosacea: experts' opinion

“…In a recent randomized clinical trial, 22 patients with erythematotelangiectatic rosacea were randomized to be treated with three sessions of injectable BoNT‐A or saline solution. After the last injection treatment, the global flushing, VISIA red value, erythema index, skin physiological indexes, and skin hydration improved, with results maintained for 3 months 24 . Another alternative is the off‐label use of beta‐blockers.…”

“…Injectable BoNT‐A has been shown to inhibit vasodilator neuropeptides and vasoactive intestinal peptides, decreasing mast cell count and cathelicidin LL‐37‐induced skin erythema which could also downregulate matrix metalloproteinases, which are mechanisms involved in the pathogenesis of rosacea. Small sample size studies 24,34 have shown a reduction in erythema and an improvement in patient satisfaction in the short and medium term after BoNT‐A injections, however, few studies have assessed patients over the long term. In a recent randomized clinical trial, 22 patients with erythematotelangiectatic rosacea were randomized to be treated with three sessions of injectable BoNT‐A or saline solution.…”

“…Injectable BoNT-A has been shown to inhibit vasodilator neuropeptides and vasoactive intestinal peptides, decreasing mast cell count and cathelicidin LL-37-induced skin erythema which could also downregulate matrix metalloproteinases, which are mechanisms involved in the pathogenesis of rosacea. Small sample size studies 24,34 Most studies included had low-quality evidence due to small sample size and a retrospective design, but the results have shown they could be effective in treating patients with facial erythema and flushing that does not respond to conventional therapy. 26 In the long-term maintenance phase, three case reports have shown that the use of b-blockers for up to 28 months in cases of erythema might improve facial temperature and patient satisfaction.…”

“…Oral beta-blockers and injectable botulinum toxin type A (BoNT-A) seem to have a role in treating some cases of erythema. [23][24][25][26][27][28] Additional comments…”

Off-Label Use of Botulinum Toxin in Dermatology—Current State of the Art

“…Recently, Tong et al [ 30 ] tried to assess the efficacy and safety of BoNT combined with broadband light (BBL) in the treatment of rosacea-related erythema and flushing. The authors enrolled 22 subjects with erythematotelangiectatic rosacea.…”