A novel therapeutic approach combining Intense Pulsed Light (IPL) and Botulinum neurotoxin Type A (BoNT/A) has demonstrated promising results in treating erythematotelangiectatic rosacea, according to recent research conducted on Latin American patients.
The study, which marks the first investigation of this combination therapy in Latin American populations with Fitzpatrick skin type III, enrolled 14 patients struggling with facial redness and visible blood vessels characteristic of rosacea. The patient cohort consisted of 13 women and one man, with an average age of 43.7 years.
Therapeutic Mechanism and Implementation
The treatment protocol integrated two distinct mechanisms of action. IPL therapy, operating at 560 nm with 14 joules, targets erythematous telangiectasia through broad-spectrum light emission (500–1200 nm). This approach works by stabilizing mast cell membranes and reducing inflammatory mediators, including histamine, MMP-9, and LL-37.
BoNT/A complemented the IPL treatment by inhibiting acetylcholine release and modulating crucial neuropeptides, including vascular endothelial growth factor and calcitonin gene-related peptide. This neurological intervention helps reduce vasodilation and inflammation, with effects becoming noticeable within three days and reaching peak efficacy around two weeks post-injection.
Significant Clinical Improvements
The study's results revealed remarkable improvements in rosacea severity. Initial assessments classified two patients as severe, six as moderate, five as mild, and one as normal on a scale from 0 to 3. Following treatment, the average Global Physician Assessment (GPA) score improved significantly from 1.64 (SD 0.84) to 0.86 (SD 0.66).
Most notably, no patients remained in the severe category after treatment, with 12 of the 14 participants achieving mild or normal status. Three patients experienced complete normalization of their condition. Patient satisfaction surveys reinforced these clinical observations, with 11 out of 14 participants rating their improvement at 4 out of 5 or higher for reductions in erythema and telangiectasia.
Treatment Protocol Details
The intervention consisted of a single IPL session followed by strategic BoNT/A injections at 2.5 U per 0.1 mL. Treatment outcomes were evaluated through photographic analysis at baseline and four weeks post-treatment, with assessments conducted by two dermatologists using the Global Physician Assessment scale.
Clinical Implications and Future Research
While these results are encouraging, the researchers acknowledge several limitations, including the small sample size, absence of a control group, and relatively short follow-up period. These factors underscore the need for larger, controlled trials with extended observation periods to validate the findings and assess long-term safety and efficacy.
The synergistic effect observed between IPL and BoNT/A suggests this combination therapy could offer a valuable new treatment option for patients with erythematotelangiectatic rosacea, particularly in populations with Fitzpatrick skin type III. The approach shows particular promise in addressing both the inflammatory and vascular components of rosacea, potentially offering more comprehensive symptom relief than traditional monotherapies.
