Ann Dermatol.  2018 Dec;30(6):688-693. 10.5021/ad.2018.30.6.688.

A Pilot Study to Evaluate the Efficacy and Safety of Treatment with Botulinum Toxin in Patients with Recalcitrant and Persistent Erythematotelangiectatic Rosacea

• Park KY
• Kwon HJ
• Kim JM
• Jeong GJ
• Kim BJ
• Seo SJ
• Kim MN

• KMID: 2428924
• DOI: http://doi.org/10.5021/ad.2018.30.6.688

Abstract

BACKGROUND
There are few pharmacologic options to reduce erythema and flushing in patients with recalcitrant erythematotelangiectatic rosacea (ETR). We previously reported two cases of refractory flushing and erythema of rosacea that were successfully treated with intradermal botulinum toxin injection, and additional research is needed to prove the efficacy and safety of this treatment.
OBJECTIVE
To report the efficacy and safety of botulinum toxin injection as an aid in persistent erythema of rosacea patients.
METHODS
A total of 20 Korean patients with recalcitrant ETR were enrolled to receive treatment by injection of botulinum toxin. Patients received one treatment of intradermal botulinum toxin injection and were assessed 1, 2, 4, and 8 weeks after treatment. The severity of erythema and telangiectasia was investigated by a non-treating physician, and the Erythema Index (EI) was assessed by mexameter at each visit. Patient satisfaction and any adverse events were also assessed at each visit.
RESULTS
17 patients completed all follow-up visits and were included in the analysis. Intradermal injection of botulinum toxin significantly reduced erythema severity and EI in ETR patients. Patients reported a satisfaction score of 2.94±0.56 at 8 weeks after treatment. Except for three patients who discontinued the study early due to inconvenience of facial muscle paralysis, 17 patients participating in the final analysis did not report side effects except injection pain at the time of the procedure.
CONCLUSION
Intradermal injection of botulinum toxin can be used as an effective and relatively safe adjuvant agent for recalcitrant and persistent erythema of ETR patients.

Keyword

Botulinum toxin; Erythema; Rosacea; Telangiectasia

MeSH Terms

Botulinum Toxins*
Erythema
Facial Muscles
Flushing
Follow-Up Studies
Humans
Injections, Intradermal
Paralysis
Patient Satisfaction
Pilot Projects*
Rosacea*
Telangiectasis
Botulinum Toxins

Figure

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  Fig. 1 Two representative cases of clinical photographs. (A) and (C) before the treatment. (B) and (D) clinical improvement of rosacea after 8 weeks of botulinum toxin injection.

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  Fig. 2 Comparison of mean difference of repeated measure variables of baseline Erythema Index (EI), 1 week EI, 2 week EI, 4 week EI, and 8 week EI expressed as mean±standard deviation in right (R) cheek (A) and left (L) cheek (B).

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  Fig. 3 Comparison of mean difference of repeated measure variables of baseline erythema severity (ES), 1 week ES, 2 week ES, 4 week ES, and 8 week ES expressed as mean±standard deviation.

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  Fig. 4 Comparison of mean difference of repeated measure variables of baseline telangiectasia severity (TS), 1 week TS, 2 week TS, 4 week TS, and 8 week TS expressed as mean±standard deviation.

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