Botulinum Toxin A Alleviates Persistent Erythema and Flushing in Patients with Erythema Telangiectasia Rosacea

Dermatol Ther (Heidelb). 2022 Oct;12(10):2285-2294. doi: 10.1007/s13555-022-00784-0. Epub 2022 Aug 4.

Abstract

Introduction: The persistent erythema and flushing seen in some cases of rosacea do not respond effectively to, or may easily relapse after, oral medication or light-based therapies (laser or intense pulsed light). Intradermal botulinum toxin A (BTX-A) injection can be used to treat intractable erythema and flushing, but studies with large samples and long-term observation have not been conducted to determine its effectiveness and safety. The aim of this study is thus to investigate the effective duration and safety of intradermal BTX-A injection for intractable erythema and flushing.

Methods: Sixteen patients with rosacea with erythema telangiectasia were injected with BTX-A at 1-cm intervals between each point. Clinician Erythema Assessment (CEA) scores were obtained at baseline and 1 month after injection. Flushing assessment and survey using the Dermatological Quality of Life Index (DLQI) questionnaire were conducted at baseline and at 1, 3, and 6 months after injection.

Results: At 1 month after injection, CEA scores revealed significant improvements in erythema and flushing; the results of the questionnaire on flushing and DLQI indicated that the improvement of flushing usually lasted for 3-6 months, but the effect decreased significantly at 6 months, and individual patients needed another treatment.

Conclusions: BTX-A significantly improves the symptoms and quality of life of patients with refractory rosacea with few adverse effects.

Keywords: Botulinum toxin A; Erythema; Flushing; Rosacea.