Botulinum Toxin Type A Effective for Treating Rosacea Facial Flushing

The use of a novel nonlaser thermomechanical system, Tixel (Novoxel), to increase skin permeability for the intradermal injection of botulinum toxin type A has been shown to be safe and effective for treating the facial flushing and erythema of rosacea. A retrospective review of 16 patients, aged 23 to 45 years, with Fitzpatrick skin types II to IV and facial erythematotelangiectatic rosacea treated by Tixel, followed by topical application of abobotulinumtoxin 100 U, was conducted, with results published in Lasers in Surgery and Medicine.

The investigators sought to assess the efficacy and safety of thermal decomposition of the stratum corneum with use of a novel nonlaser thermomechanical system to increase skin permeability for the delivery of botulinum toxin to treat the facial flushing of rosacea. A standardized, high-definition digital camera photographed the participants at baseline and then at 1 month, 3 months, and 6 months after the last treatment. Objective and subjective assessments of the participants was performed via use of the following instruments: Mexameter (Evalulab); the Clinicians Erythema Assessment and Patients Self-Assessment scores, and the Dermatology Life Quality Index.

Average Mexameter, Clinicians Erythema Assessment, and Patients Self-Assessment  scores at 1 month, 3 months, and 6 months were all significantly improved compared with baseline values (P <.001 for all). Dermatology Life Quality Index scores also improved significantly, with an average score of 18.6 at baseline and 9.6 at 6 months after treatment (P <.001). Moreover, self-rated patient satisfaction with the treatment was high. No occurrences of motor function adverse effects or facial drooping were reported.

The investigators concluded that using the Tixel device for thermal breakage of the stratum corneum increases skin permeability for delivery of botulinum toxin type A to treat erythema and facial flushing of rosacea both safely and effectively. Additional research is warranted to elucidate the mechanism of action by which botulinum toxin improves erythema and facial flushing among patients with rosacea.

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Friedman O, Koren A, Niv R, Mehrabi JN, Artzi O. The toxic edge-A novel treatment for refractory erythema and flushing of rosacea [published online October 12, 2018]. Lasers Surg Med. doi: 10.1002/lsm.23023