Botulinum Toxin A Alleviates Persistent Erythema and Flushing in Patients with Erythema Telangiectasia Rosacea
Tóm tắt
The persistent erythema and flushing seen in some cases of rosacea do not respond effectively to, or may easily relapse after, oral medication or light-based therapies (laser or intense pulsed light). Intradermal botulinum toxin A (BTX-A) injection can be used to treat intractable erythema and flushing, but studies with large samples and long-term observation have not been conducted to determine its effectiveness and safety. The aim of this study is thus to investigate the effective duration and safety of intradermal BTX-A injection for intractable erythema and flushing. Sixteen patients with rosacea with erythema telangiectasia were injected with BTX-A at 1-cm intervals between each point. Clinician Erythema Assessment (CEA) scores were obtained at baseline and 1 month after injection. Flushing assessment and survey using the Dermatological Quality of Life Index (DLQI) questionnaire were conducted at baseline and at 1, 3, and 6 months after injection. At 1 month after injection, CEA scores revealed significant improvements in erythema and flushing; the results of the questionnaire on flushing and DLQI indicated that the improvement of flushing usually lasted for 3–6 months, but the effect decreased significantly at 6 months, and individual patients needed another treatment. BTX-A significantly improves the symptoms and quality of life of patients with refractory rosacea with few adverse effects.
Tài liệu tham khảo
Gether L, et al. Incidence and prevalence of rosacea: a systematic review and meta-analysis. Br J Dermatol. 2018;179(2):282–9.
Schaller M, et al. Recommendations for rosacea diagnosis, classification and management: update from the global ROSacea COnsensus 2019 panel. Br J Dermatol. 2020;182(5):1269–76.
Huynh TT. Burden of disease: the psychosocial impact of rosacea on a patient’s quality of life. Am Health Drug Benefits. 2013;6(6):348–54.
Hofmann MA, Lehmann P. Physical modalities for the treatment of rosacea. J Dtsch Dermatol Ges. 2016;14(Suppl 6):38–43.
Zhang Y, et al. A decade retrospective study of light/laser devices in treating nasal rosacea. J Dermatolog Treat. 2020;31(1):84–90.
van Zuuren EJ, et al. Interventions for rosacea based on the phenotype approach: an updated systematic review including GRADE assessments. Br J Dermatol. 2019;181(1):65–79.
Zhang H, Tang K, Wang Y, Fang R, Sun Q. Use of botulinum toxin in treating rosacea: a systematic review. Clin Cosmet Investig Dermatol. 2021;30(14):407–17.
Scala J, Vojvodic A, Vojvodic P, Vlaskovic-Jovicevic T, Peric-Hajzler Z, Matovic D, Dimitrijevic S, Vojvodic J, Sijan G, Stepic N, Wollina U, Tirant M, Thuong NV, Fioranelli M, Lotti T. Botulin toxin use in rosacea and facial flushing treatment. Open Access Maced J Med Sci. 2019;7(18):2985–7.
Bloom BS, et al. Impact of intradermal abobotulinumtoxinA on facial erythema of rosacea. Dermatol Surg. 2015;41(Suppl 1):S9-16.
Eshghi G, Khezrian L, Alirezaei P. Botulinum toxin A in treatment of facial flushing. Acta Med Iran. 2016;54(7):454–7.
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. Dermatol Ther. 2020;33(6): e13976.
Bharti J, Sonthalia S, Jakhar D. Mesotherapy with botulinum toxin for the treatment of refractory vascular and papulopustular rosacea. J Am Acad Dermatol. 2018. https://doi.org/10.1016/j.jaad.2018.05.014.
Friedman O, et al. The toxic edge-A novel treatment for refractory erythema and flushing of rosacea. Lasers Surg Med. 2019;51(4):325–31.
Gallo RL, et al. Standard classification and pathophysiology of rosacea: the 2017 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol. 2018;78(1):148–55.
Tan J, et al. Reliability of clinician erythema assessment grading scale. J Am Acad Dermatol. 2014;71(4):760–3.
Norquist JM, et al. Validation of a questionnaire to assess niacin-induced cutaneous flushing. Curr Med Res Opin. 2007;23(7):1549–60.
Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI)—a simple practical measure for routine clinical use. Clin Exp Dermatol. 1994;19(3):210–6.
Ballan A, Nasr M, Jabbour S. An unusual tell sign of botulinum toxin injection in patients with facial flushing: incorporating a new questionnaire in the evaluation of botulinum toxin patients. J Cosmet Laser Ther. 2021;23(1–2):24–5.
Wilkin JK. The red face: flushing disorders. Clin Dermatol. 1993;11(2):211–23.
Gu H, et al. Guidelines for the diagnosis and treatment of rosacea in China (2021 edition). Int J Dermatol Venereol. 2021;4.
Drummond PD, Su D. Endothelial and axon reflex vasodilatation to acetylcholine in rosacea-affected skin. Arch Dermatol Res. 2012;304(2):133–7.
Kellogg DJ, et al. Nitric oxide and receptors for VIP and PACAP in cutaneous active vasodilation during heat stress in humans. J Appl Physiol. 2012;113(10):1512–8.