A Randomized Controlled Pilot Study: Combined 595‐nm Pulsed Dye Laser Treatment and Oxymetazoline Hydrochloride Topical Cream Superior to Oxymetazoline Hydrochloride Cream for Erythematotelangiectatic Rosacea

Abstract

Background and Objectives We evaluated if oxymetazoline therapy combined with 595‐nm pulsed dye laser (PDL) will be more beneficial than topical oxymetazoline alone for the improvement of erythematotelangiectatic rosacea. Study Design/Materials and Methods This was a randomized, controlled, prospective clinical trial approved by an independent Institutional Review Board, which enrolled 34 patients with moderate to severe clinical erythema (CEA) into a two‐arm study of PDL with concomitant oxymetazoline cream (Arm 1) and oxymetazoline cream alone (Arm 2). Patients in Arm 1 were treated with 3 monthly laser sessions, which were started after 1 month of topical oxymetazoline cream. Thirty subjects continued with the study, and 25 subjects (Arm 1: 14, Arm 2: 11) completed the 6‐month follow‐up. With photographic comparison to baseline images, efficacy endpoints were based on clinical on‐site grading by both the investigator and the patient, using the grading tools for CEA, Global Aesthetic Improvement (GAI) assessment, vessel size improvement, and subject self‐assessment. These scales were assessed at baseline and/or at each clinical follow‐up at 1, 2, 3, and 6 months. Subject satisfaction as well as post‐treatment immediate response and treatment‐associated pain scores were also evaluated. Results Statistically significant improvement in CEA was seen in both arms at the 1‐, 2‐, and 3‐month post‐baseline visits (P < 0.01). Only Arm 1 presented statistically significant improvement in CEA (P < 0.001) at 6 months post baseline with a mean score of 1.6 (almost clear‐mild) compared with 3.2 at baseline. Arm 1 showed significantly greater mean vessel size improvement at 3 months (P < 0.01) and 6 months (P < 0.05) post baseline compared to Arm 2. Significantly greater improvement (P < 0.05) in the investigator GAI score was reported at the 2‐ and 6‐month follow‐ups compared with Arm 2. Subject GAI scores showed statistically significant greater improvement in Arm 1 compared with Arm 2 at both the 3‐ and 6‐month follow‐ups (P < 0.01). There were no complications or long‐term effects associated with PDL or topical oxymetazoline treatments. Conclusion The prospective trial verifies a safe, enhanced clinical outcome with the combination of PDL therapy and topical oxymetazoline for the treatment of erythematotelangiectatic rosacea patients. Lasers Surg. Med. © 2021 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals LLC.

Benefits and safety of Oxymetazoline cream 1% on rosacea‐associated erythema: A systematic review and analysis of clinical evidence

“…Recently, some studies showed that even the treatment of combining topical Oxymetazoline cream with energy-based therapy (pulsed dye laser or potassium titanyl phosphate or intense pulsed light) was also safe and well tolerated for the patients. [21][22][23] With regard to the dermal tolerability, compared to the vehicle, Oxymetazoline cream 1.0%…”

A randomized split‐face comparative study of long‐pulsed alexandrite plus low‐fluence Nd:YAG laser versus pulsed‐dye laser in the treatment of rosacea

“…At the short-term and long-term follow-up visits, five-point global aesthetic improvement scale (GAIS) was assessed by two blinded investigators (excellent improvement; good improvement; moderate improvement; slight improvement; no improvement). 17 Patient satisfaction was scored on the last visit using a quintile grading scale (excellent; good; fair; little or no change; and aggravated). Any adverse events during the study period were documented.…”

“…A higher number indicates more severe redness, therefore, decrease in erythema index means improvement of the erythema. At the short‐term and long‐term follow‐up visits, five‐point global aesthetic improvement scale (GAIS) was assessed by two blinded investigators (excellent improvement; good improvement; moderate improvement; slight improvement; no improvement) 17 . Patient satisfaction was scored on the last visit using a quintile grading scale (excellent; good; fair; little or no change; and aggravated).…”

Efficacy Comparison of Pulsed Dye Laser vs. Microsecond 1064-nm Neodymium:Yttrium-Aluminum-Garnet Laser in the Treatment of Rosacea: A Meta-Analysis

“…Recently, pulsed dye laser (PDL) has been widely used to treat rosacea-related erythema and telangiectasia ( 13 , 14 ). PDL emits pulsed laser energy at wavelengths of 585 or 595 nm, which is absorbed by oxyhemoglobin to inhibit endothelial cell formation, reduce angiogenesis, and destruct the existing vessels ( 15 ).…”