Multi-point Intradermal Injection Of Botulinum Toxin A In The Treatment Of Rosacea

BackgroundRosacea is a chronic recurrent inflammatory skin disease with various clinical manifestations,including persistent erythema,recurrent flushing,telangiectasia,papules,and pustules,etc.According to the clinical manifestations,rosacea is mainly divided into four subtypes.This disease could cause cosmetic changes and bring psychological burden to the patients.At present,the treatment of rosacea is mainly aimed at symptom control rather than cure.Botulinum toxin A(BTX-A)is a neurotoxin produced by Clostridium botulinum.Recently,it has been found that BTX-A has a good efficacy in many skin diseases.Till now,many basic studies have found that BTX-A can inhibit the release of neuropeptide and degranulation of mast cells in addition to the inhibition of acetylcholine release.Considering the role of acetylcholine,neuropeptide and mast cells in pathogenesis of rosacea,BTX-A might be a new therapy for rosacea.Treatment of rosacea with intradermal botulinum toxin injection has previously been reported by a number of foreign literatures.BTX-A is reported to have efficacy in improving facial erythema and flushing,showing satisfactory safety.There is still a lack of research on the efficacy of botulinum toxin A in rosacea in China.What's more,most of the foreign literatures use subjective assessment methods such as clinician rating scales to assess the severity of rosacea and monitor the efficacy,which is easily affected by subjective factors.Therefore,more intuitive and objective assessment is still needed.Objective:The primary aim of this study is to evaluate the efficacy and safety of BTX-A in the treatment of rosacea,and to explore the role of VI SI A imaging system in evaluation and efficacy monitoring of rosacea.MethodThis study is a retrospective review of rosacea patients who received 15-25 U of BTX-A injection at the dermatology clinic of PUMCH from September 2018 to January 2019.19 patients who meet the inclusion criteria was enrolled,including 13 patients of erythematotelangiectatic rosacea and 6 patients of papulopustular rosacea.Their age,course of disease and other basic information were collected at the beginning.High-resolution pictures of patients was taken by VISIA imaging system at baseline and 8 weeks after the treatment.Assessments of disease severity was done via standard grading system for rosacea,lesion counting,VISIA red image value,and the dermatology life quality index(DLQI)questionnaire.SPSS 20.0 software was used for statistical analysis to compare whether there was significant difference in each evaluation index before and after treatment,and to compare the correlation between VISIA red image value and the subjective assessment scores.Result1.After BTX-A treatment,there is a significant decrease in the patients' flushing score(P=0.000),erythema score(P=0.001),telangiectasia score(P=0.002),total score of the standard grading system(P=0.000),VISIA red image value(P=0.000),and DLQI score(P=0.000).For the 6 patients of papulopustular phenotype,papule/pustular score(P=0.180)and lesion counts(P=0.068)showed downtrend;however,there was no significant difference.Patients did not report serious adverse effects.2.VISIA red value was positively correlated with erythema score(before treatment:r=0.653,P=0.002;after treatment:r=0.459,P=0.048),telangiectasia score(before treatment:r=0.614,P=0.005;after treatment:r=0.493,P=0.032),and total score(before treatment:r=0.873,P=0.000;after treatment:r=0.628,P=0.004).Conclusion1.Microinjection of BTX-A has a certain efficacy on rosacea patients' erythema,flushing,telangiectasia and subjective symptoms,can effectively relieve the psychological pressure of patients,improve the quality of life of patients,and has a good safety.2.VISIA imaging system can show the changes of skin lesions via objective images and data,and can be used to evaluate disease severity and monitor the efficacy.