Evaluation of the clinical effectiveness of pulsed dye laser, local dynamic micromassage and botulinum toxin type A in the treatment of erythematotelangiectatic rosacea

Background. Rosacea is a chronic inflammatory skin condition with a multifactorial aetiology and a wide range of clinical manifestations. Erythematotelangiectatic rosacea (ETR) is difficult to treat and maintain in remission due to the limited range of effective methods for erythema management.
Aim. To increase the effectiveness of the ETR treatment by developing a scientifically based algorithm for comprehensive restorative treatment involving physical therapy and botulinum toxin.
Materials and methods. A single‑centre open‑label prospective randomized study was conducted between 2022 and 2025. A total of 117 patients with ETR were enrolled in the study and divided into four groups. Four treatment options for ETR were analyzed: monotherapy with a pulsed dye laser (PDL, comparison group), and three options for complex therapy, including physiotherapy (pulsed dye laser, local dynamic micromassage) and botulinum toxin therapy. Follow‑up examinations were conducted over a period of 6 months at five points: before the start of treatment, 2 weeks, 2 months, 4 months and 6 months after the end of therapy. Therapy effectiveness was assessed using a dermatological index of the symptom scale, a clinical erythema assessment scale (CEA), a subjective erythema assessment scale (SSR).
Results. According to the dynamics of the dermatological index of the symptom scale, only in the group of patients receiving complex treatment with PDL, LDM and botulinum toxin type A was almost complete resolution of clinical manifestations of ETR achieved after 2 months, with minimal symptoms of dermatosis by the 4th month of dynamic observation. An intergroup comparison confirmed that the lowest dermatological index of the symptom scale scores at all control points of the study were observed in group 4, which received complex treatment with PDL, LDM and botulinum toxin type A (p<0.001). When assessing the effectiveness of the developed methods of treating ETR in relation to erythema according to the CEA and SSR scales, already at the second control point, against the background of complex treatment with PDL, LDM and botulinum toxin type A, there was complete/almost complete resolution of erythema according to both the investigator and the patients. The achieved result persisted up to 6 months of observation according to the CEA scale, while patients noted a slight progression of the skin pathological process already 4 months after the end of therapy.
Conclusion. The results presented herein demonstrated the high clinical efficacy of a complex treatment regimen for ETR, including application of a pulsed dye laser, local dynamic micromassage, and botulinum toxin type A.

1. Cribier B. Rosacea: Treatment targets based on new physiopathology data. Ann Dermatol Venereol. 2022; 149 (2): 99–107. DOI: 10.1016/j.annder.2021.11.001

2. Clinical guidelines. Rosacea [Electronic resource] Access mode: https://view.officeapps.live.com/op/view.aspx?src=https%3A%2F%2Fwww.cnikvi.ru%2Fdocs%2Fclinic_recs%2Fklinicheskie_rekomendatsii_2019–2020 (date of access: 09/21/2023). (In Russ.).

3. Rusina, T.S. Optimization of diagnostics and development of complex therapy in patients with rosacea with erythematotelangectatic subtype [Text]: dis. … Cand. of Medicine: 14.01.10: defended 28.03.22 / Rusina Tatyana Sergeevna. M., 2022. 121 p. (In Russ.).

4. Sokolova, A.V. Combination of pulsed dye laser, azelaic acid, ivermectin and botulinum therapy in the treatment of patients with rosacea / A.V. Sokolova, G.R. Fimochkina // Pharmateka. 2024; 31 (10): 76–80. (In Russ.). DOI 10.18565/pharmateca.2024.10.76–80

5. Dicker V, Serna Posada MDM, Galeano Piedrahita E, Vasquez Villegas S, Perez Madrid C. Intradermal Microdroplet Injection of Standard Diluted Incobotulinumtoxin A for the Treatment of Erythematotelangiectatic Rosacea: A Study From a Dermatology Center in Medellín, Colombia. Cureus. 2025; 17 (2): e78957. Published 2025 Feb 13. DOI: 10.7759/cureus.78957

6. Bulbul Baskan E, Akin Belli A. Evaluation of long term efficacy, safety, and effect on life quality of pulsed dye laser in rosacea patients. J Cosmet Laser Ther. 2019; 21 (4): 185–189. DOI: 10.1080/14764172.2018.1502453

7. Dayan SH, Ashourian N, Cho K. A Pilot, Double Blind, Placebo Controlled Study to Assess the Efficacy and Safety of IncobotulinumtoxinA Injections in the Treatment of Rosacea. J Drugs Dermatol. 2017;16(6):549–554.

8. Al Niaimi F, Glagoleva E, Araviiskaia E. Pulsed dye laser followed by intradermal botulinum toxin in the treatment of rosacea associated erythema and flushing. Dermatologic Therapy [Internet]. 2020 Jul 27;33(6). http://dx.doi.org/10.1111/dth.13976

9. Bharti J, Sonthalia S, Jakhar D. Mesotherapy with botulinum toxin for the treatment of refractory vascular and papulopustular rosacea. Journal of the American Academy of Dermatology [Internet]. 2023 Jun;88(6): e295–6. http://dx.doi.org/10.1016/j.jaad.2018.05.014

10. Kim MJ, Kim JH, Cheon HI, Hur MS, Han SH, Lee YW, et al. Assessment of Skin Physiology Change and Safety After Intradermal Injections With Botulinum Toxin: A Randomized, Double-Blind, Placebo-Controlled, Split-Face Pilot Study in Rosacea Patients With Facial Erythema. Dermatologic Surgery [Internet]. 2019 Sep; 45 (9): 1155–62. http://dx.doi.org/10.1097/dss.0000000000001819

11. Yang R, Liu C, Liu W, Luo J, Cheng S, Mu X. Botulinum Toxin A Alleviates Persistent Erythema and Flushing in Patients with Erythema Telangiectasia Rosacea. Dermatology and Therapy [Internet]. 2022 Aug 4; http://dx.doi.org/10.1007/s13555-022-00784-0

12. Egorova O.A. Microcurrent therapy and botulinum therapy in patients with erythematotelangiectatic rosacea. Medical alphabet. 2020. No. 6. P. 54–60. (In Russ.).

13. Verbovaya E.D., Rodina A.L. Botulinum therapy in the treatment of patients with rosacea. Medical alphabet. 2022. No. 8. P. 103–106. (In Russ.).

14. Tong Y, Luo W, Gao Y, Liu L, Tang Q, Wa Q. A randomized, controlled, split-face study of botulinum toxin and broadband light for the treatment of erythematotelangiectatic rosacea. Dermatologic Therapy [Internet]. 2022 Feb 27; 35 (5). http://dx.doi.org/10.1111/dth.15395

15. Choi JE, Werbel T, Wang Z, Wu CC, Yaksh TL, Di Nardo A. Botulinum toxin blocks mast cells and prevents rosacea like inflammation. Journal of Dermatological Science [Internet]. 2019 Jan; 93 (1): 58–64. http://dx.doi.org/10.1016/j.jdermsci.2018.12.004

16. Kruglikov I. Local dynamic micromassage. Aesthetic medicine. 2012; (11): 3–8. (In Russ.).

17. Maden S. Rosacea: An Overview of Its Etiological Factors, Pathogenesis, Classification and Therapy Options. Dermato. 2023; 3 (4): 241–262. https://doi.org/10.3390/dermato3040019

18. Del Rosso JQ. Update on rosacea pathogenesis and correlation with medical therapeutic agents. Cutis. 2006; 78 (2): 97–100.

19. Tan J, Leoni M. Erythema of Rosacea: Validation of Patient’s Self Assessment Grading Scale. J Drugs Dermatol. 2015; 14 (8): 841–844.

20. Tan J, Liu H, Leyden JJ, Leoni MJ. Reliability of Clinician Erythema Assessment grading scale. J Am Acad Dermatol. 2014; 71 (4): 760–763. DOI: 10.1016/j.jaad.2014.05.044

21. Seo JK, Shin EJ, Jeong KH, Shin MK. Clinician Severity Assessment Grading Scale on Erythematotelangiectatic Rosacea. Indian J Dermatol. 2021; 66 (2): 203–205. DOI: 10.4103/ijd.IJD_611_19

22. Bloom BS, Payongayong L, Mourin A, Goldberg DJ. Impact of Intradermal AbobotulinumtoxinA on Facial Erythema of Rosacea. Dermatologic Surgery [Internet]. 2015 Jan; 41 (Supplement 1): S9–16. http://dx.doi.org/10.1097/dss.0000000000000277

23. Glanz, S. Medical and biological statistics. Moscow: Praktika, 1998. 460 p. (In Russ.).

24. D. Meyer Rogge and I. Kruglikov, «Pilot Study into Super Fractionation Treatment Strategy of Acne and Rosacea,» Journal of Cosmetics, Dermatological Sciences and Applications, Vol. 3 No. 3, 2013, pp. 197–202. DOI: 10.4236/jcdsa.2013.33030

25. Park JY, Ahn MK, Cho EB, Park EJ, Kim KH. Dual Frequency Ultrasound as a New Treatment Modality for Refractory Rosacea: A Retrospective Study. Dermatol Surg. 2018; 44 (9): 1209–1215. DOI: 10.1097/DSS.0000000000001552