The combination of pulsed dye laser and fractional microneedling radiofrequency (PDL+FMR) has demonstrated safety and efficacy in treating individuals with recalcitrant papulopustular rosacea, according to a study recently published in the Journal of Cosmetic Dermatology.

This retrospective study included 25 individuals with recalcitrant papulopustular rosacea for whom previous first-line therapies had been ineffective. Participants were treated between January 2016 and September 2018 with 3 PDL+FMR full-face treatments at 4-week intervals. Each participant took oral isotretinoin 10 mg daily for 8 weeks. Treatment was assessed 1 week after each session and 16 weeks after the final session. Evaluations included erythema measurement, lesion counts, subjective participant assessments, and dermatologist evaluations. Pre- and post-treatment data were compared using the Wilcoxon-signed rank test or paired sample t test.

Of the initial 25 participants, 23 completed the study. Between baseline evaluation and the final follow-up visit, there was a 53.5% reduction in mean erythema index (P <.05) and a 70.5% reduction in total lesions (25.3-7.5; P <.05). Physicians’ global assessments also showed a significant improvement in rosacea severity, from 19.5 to 6.6 in 3 sessions (P <.05). At the final follow-up visit, participants showed a mean improvement of 8.3±1.8 in subjective general appearance (P <.05). No serious side effects or adverse events occurred.

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Limitations to this study include a single ethnic background for participants, a lack of strict comparison between single and combined regimens, and the need for future long-term follow-up studies.

The study researchers concluded that “combination treatment with low‐dose oral isotretinoin, PDL, and FMR is effective to improve recalcitrant [papulopustular rosacea] with reasonable safety profiles. Thus, this novel regimen could be a viable option in the treatment of this recalcitrant subtype of rosacea.”

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Kwon HH, Jung JY, Lee WY, Bae Y, Park GH. Combined treatment of recalcitrant papulopustular rosacea involving pulsed dye laser and fractional microneedling radiofrequency with low-dose isotretinoin [published online May 18, 2019]. J Cosmet Dermatol. doi:10.1111/jocd.12982