ABSTRACT
BACKGROUND: Facial erythema is a frequent and often distressing complaint of patients with rosacea. Treatment of facial erythema with botulinum toxin has previously been proposed and reported. However, the current literature has mixed results. OBJECTIVE: The primary objective of this study was to evaluate the safety and efficacy of intradermal abobotulinumtoxinA on facial erythema of rosacea. MATERIALS AND METHODS: Twenty-five subjects aged 35 to 70 years with Fitzpatrick skin Types I to IV and facial erythema of erythematotelangiectatic rosacea were enrolled in the trial. Subjects received 15 to 45 units of intradermal injections of abobotulinumtoxinA to the nasal tip, nasal bridge, and nasal alae. A nontreating investigator assessed the facial erythema of rosacea using a standardized grading system (0 = absent, 1 = mild erythema, 2 = moderate erythema, and 3 = severe erythema) to evaluate digital photographs at baseline, 1, 2, and 3 months after treatment. Statistical analysis of erythema grade included one-way repeated-measures analysis of variance and pairwise comparisons using SPSS (IBM Corporation) software. RESULTS: Fifteen of the 25 enrolled subjects completed all the appropriate follow-up visits. Only the 15 subjects with complete data were included in analysis. The subjects were of Fitzpatrick skin Types I to III, a mean age of 54 years, and 80% women. The mean baseline erythema grade was 1.80 (±0.56), and the mean erythema grade at 3 months after treatment was 1.00 (±0.38). The treatment resulted in statistically significant improvement in erythema grade at 1, 2, and 3 months after treatment when compared with baseline (p < .05, p < .001, and p < .05, respectively). Pairwise comparison to baseline showed a mean erythema grade improvement of 0.80 (p < .001) at 3-month follow-up. CONCLUSION: Intradermal injection of botulinum toxin for the treatment of facial erythema of rosacea seems both effective and safe. Larger, randomized, blinded, placebo-controlled studies are warranted. Additionally, further investigation is needed to elucidate the mechanism of action by which botulinum toxin improves facial flushing of rosacea.
