Rosacea Benefits From Synergistic Effect of Pulsed Dye Laser, BoNTA

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Combination laser and intradermal botulinum toxin therapy for the management of rosacea is reported in this novel study.

A combination of pulsed dye laser (PDL) and intradermal botulinum toxin type-A (BoNTA) injection is safe and effective in patients with rosacea and flushing, burning sensation, and pruritus, according to findings from a study published in Dermatologic Therapy.

A total of 20 patients with moderate to severe erythema and flushing were treated with this combination approach. The primary outcome was a reduction in the severity and frequency of flushing and erythema, and the secondary outcome was an improvement or reduction in pruritus and burning sensation along with an increase in patient satisfaction scores.

Laser treatment with the PDL involved a single pass over the treated areas of the face. Parameters for each patient varied and were based on the skin type, amount of chromophore, skin response, and anatomic area treated. After the laser treatment, the researchers used abobotulinum in a 5-mL dilution of 500 units, usually 20 to 50 units per cheek, or onabotulinum at 2.5-mL dilution in 100 units, with doses ranging from 10 to 20 units per cheek.

Patients received 3 treatments at intervals of 4 to 6 weeks, and post-treatment measurements were completed a minimum of 2 weeks after the third treatment to allow for post-treatment erythema to subside.

All patients had improvement in erythema, telangiectasia, flushing, pruritus, and symptoms of burning sensation. “Patients experienced high satisfaction with the treatment with minimal side-effects beyond expected reactive erythema and edema for few days post laser treatment,” noted the investigators.

One patient had mild purpura lasting 10 days with no residual sequelae. At the 3- and 9-month follow-up, patients showed sustained improvement in reduction of erythema.

Study limitations included the small number of participants and the lack of a control group.

“We observed a synergistic benefit from combining the PDL with BoNTA injections with a reduction in both the erythema and flushing grading scores as well as a drop in the erythema index measurement using our 3D camera analysis,” commented the researchers.

The study authors proposed that “the combination of PDL followed by intradermal BoNTA injections in patients with rosacea and symptoms of flushing, burning sensation, and pruritus is safe and effective with a synergistic effect compared to either treatment performed individually.”


Al-Niaimi F, Glagoleva E, Araviiskaia E. Pulsed dye laser followed by intradermal botulinum toxin type-A in the treatment of rosacea-associated erythema and flushing [e-pub ahead of print]. Dermatol Ther. doi: 10.1111/dth.13976