Treatment of Erythematotelangiectatic Rosacea With Pulsed‐Dye Laser and Oxymetazoline 1.0% Cream: A Retrospective Study

Abstract

Background and Objectives: Pulsed-dye laser (PDL) and oxymetazoline 1.0% cream are each used for the treatment of erythematotelangiectatic (ET) rosacea. PDL targets oxyhemoglobin and can reduce facial erythema and telangiectasias. Oxymetazoline 1.0% cream is an α adrenergic agonist, which has shown to reduce facial erythema. The aim of this study was to determine the degree of erythema improvement and telangiectasia clearance after combination treatment with PDL plus oxymetazoline 1.0% cream. Study Design/Materials and Methods: This retrospective study was conducted at two sites. Pre-and post-treatment cross-polarized images from subjects on combination treatment with PDL and oxymetazoline 1.0% cream were graded by a board-certified dermatologist at each practice. Blinded images were analyzed using the Clinical Erythema Assessment (CEA) Scale (0 = clear and 4 = severe). Unblinded images were analyzed using the five-point Telangiectasia Scale to determine the degree of improvement post-treatment compared with baseline (1 = <5% clearance and 5 = 75-100% clearance).Results: Thirty-one subjects (20 females, 11 males) of age 51 ± 13 years (mean ± standard deviation) were included in the study after an average of 4 months (range: 1-13) of daily oxymetazoline 1.0% cream and two (range: 1-4) PDL treatments. At baseline, 87% of subjects had CEA Grade 2 (mild erythema) or higher. For erythema, 55% of subjects improved by at least one CEA grade and 13% achieved two grades of improvement post-treatment. For telangiectasias, 90% of subjects achieved at least a twopoint clearance (5-25%), 62% at least a three-point clearance (25-50%), and 41% at least a four-point clearance (50-75%) post-treatment. Compared with subjects with baseline CEA Grade 1-2 (almost clear to mild erythema), significantly more subjects with baseline CEA Grade 3-4 (moderate to severe erythema) achieved at least one CEA grade of improvement (P = 0.021) and two grades of CEA improvement (P = 0.041). A higher percentage of baseline CEA Grade 3-4 subjects achieved at least a two-point clearance in telangiectasias (P = 0.055). Conclusions: Combination treatment with PDL and daily oxymetazoline 1.0% cream can safely and effectively reduce erythema and telangiectasias. Limitations include the retrospective design of the study, small sample size, and lack of a control group. Lasers Surg. Med.

Rosacea Treatment: Review and Update

“…The findings of a phase 4, multicenter, interventional, open-label study with 46 patients suggest the benefit of oxymetazoline as adjunctive therapy with energy-based therapy for the treatment of moderate to severe persistent facial erythema associated with rosacea [54]. A retrospective study including 31 subjects revealed that the combination of pulsed dye laser and 1.0% oxymetazoline cream reduced erythema and telangiectasias both safely and effectively [55]. An open-label study including 21 subjects assessed the efficacy and tolerability of topical skin care and sun protection combined with IPL therapy [56].…”

Oxymetazoline and Energy‐Based Therapy in Patients with Rosacea: Evaluation of the Safety and Tolerability in an Open‐Label, Interventional Study

“…However, retrospective and preclinical studies have investigated the efficacy of combining oxymetazoline treatment with PDL therapy. A retrospective study analyzed pretreatment and posttreatment images from 31 patients with rosacea treated with oxymetazoline and PDL at two dermatologic surgery practices [16]. After an average of 4 months of daily oxymetazoline treatment and two PDL treatments, 55% (17/31) of patients demonstrated at least a one‐grade improvement in CEA, and 41% of patients (12/29) demonstrated 50–75% clearance of telangiectasias among patients with telangiectasias at baseline.…”

Updates and Best Practices in the Management of Facial Erythema

“…3 Use of oxymetazoline as adjunctive therapy with potassium-titanyl-phosphate (KTP) lasers, 595nm pulse dye laser (PDL), and IPL has been demonstrated to be well tolerated and efficacious in further helping to reduce facial erythema. 12 , 13 …”