Rosacea can be such a debilitating skin disorder. It really affects my patient’s self-esteem and self-confidence. So, when multiple treatment modalities don't completely treat their refractory rosacea it can be really frustrating. 

There are other options that can help manage rosacea symptoms other than prescription medications, skincare, avoidance of triggers, etc. 

That treatment?! Botulinum toxin! It's just the most magical drug, isn't it?!

How does it work in treating rosacea symptoms?
Let's walk through it! 

There are SO many factors that play into rosacea exacerbations. Botulinum toxin will not treat every pathway that is dysregulated with rosacea but it has been shown to suppress mast cells that play into skin inflammation! 

Most commonly, Botulinum toxin inhibits the release of acetylcholine but it can also inhibit other peptides that can lead to vasodilation and flushing in the skin including vasoactive intestinal peptides (VIP) and SNARE’s. If we can block the neuropeptides that play into rosacea flares, there will be much improvement in redness and skin inflammation! 

So what does the treatment look like?

Consulting with your provider and maximizing other treatment modalities is key. Botulinum toxin is not a great option for the treatment of rosacea on its own, it is best in combination therapy. When you and your provider have exhausted all other treatment modalities and you are still dealing with some flushing and inflammation, then this may be a good treatment option. 

The actual treatment is very individualized and provider dependent but you can expect around 15-50units of botulinum toxin to be injected in the affected areas. The side effects are minimal across multiple research studies and include mostly procedural discomfort (I mean we are injecting your face), and bruising and redness after the procedure. 

Most follow-ups take place around 3-4 months and each treatment will be administered upon reassessment with your provider. When the botulinum toxin is in effect, this is when you can be more aggressive with other treatment modalities such as prescription medications and/or lasers! 

As always, consult with your provider to come up with an individualized plan to manage your rosacea! I hope this was helpful and can open the conversation up between you and your provider! 

References 

Abokwidir, M., & Feldman, S. R. (2016). Rosacea Management. Skin appendage disorders, 2(1-2), 26–34. https://doi.org/10.1159/000446215

Choi, J. E., Werbel, T., Wang, Z., Wu, C. C., Yaksh, T. L., & Di Nardo, A. (2019). Botulinum toxin blocks mast cells and prevents rosacea like inflammation. Journal of dermatological science, 93(1), 58–64. https://doi.org/10.1016/j.jdermsci.2018.12.004

Marson, J. W., & Baldwin, H. E. (2020). Rosacea: a wholistic review and update from pathogenesis to diagnosis and therapy. International journal of dermatology, 59(6), e175–e182. https://doi.org/10.1111/ijd.14757

van Zuuren, E. J. (2017). Rosacea. New England Journal of Medicine, 377(18), 1754–1764. https://doi.org/10.1056/nejmcp1506630 

Zhang, H., Tang, K., Wang, Y., Fang, R., & Sun, Q. (2021). Use of botulinum toxin in treating rosacea: A systematic review. Clinical, Cosmetic and Investigational Dermatology, Volume 14, 407–417. https://doi.org/10.2147/ccid.s307013