Novel Combination Regimen Safe, Effective in Treating Recalcitrant Papulopustular Rosacea

Papulopustular rosacea
Combination treatment with low‐dose oral isotretinoin, pulsed dye laser, and fractional microneedling radiofrequency is effective to improve recalcitrant papulopustular rosacea with reasonable safety profiles.

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