Evaluating the clinical outcomes of intradermal botulinum toxin A in Iraqi patients with erythematotelangiectatic rosacea: a prospective uncontrolled cohort study

Background. Erythematotelangiectatic rosacea (ETR) is one of the most common chronic dermatoses of the face, characterized by persistent erythema, flushing, and telangiectasia, mainly associated with neurovascular dysregulation. Botulinum toxin type A (BoNT-A) has been proposed as a possible treatment for ETR. However, data on its efficacy and safety in Iraqi patients are lacking. This prospective uncontrolled cohort study aimed to evaluate clinical outcomes following intradermal BoNT-A injection in Iraqi patients with facial ETR. Methods. This prospective, single-arm, uncontrolled interventional study enrolled 40 patients with ETR. Demographic data, clinical presentation, and treatment-related information were collected. BoNT-A was administered intradermally, and patients were followed for 5 months. Clinical response was assessed using ETR severity scores at baseline and during follow-up visits at 2 weeks, 1 month, 3 months, and 5 months. Improvement in severity category was considered a treatment response. Results. The mean age of the patients was 36.7 ± 4.15 years. Most patients were female (75%) and had Fitzpatrick skin type III (65%). At baseline, 52.5% of patients had moderate ETR and 22.5% had severe ETR. At the end of 5 months, 72.5% of patients were classified as having mild ETR, and no patient remained in the severe category. Overall, 25 patients (62.5%) showed improvement in severity category. Longer symptom duration (≥2 years; OR = 3.19, p = 0.040), more pronounced dryness (OR = 3.12, p = 0.032), and higher baseline ETR severity (moderate: OR = 5.4, p = 0.004; severe: OR = 6.82, p = 0.005) were associated with poorer response in multivariate analysis. Conclusion. In this prospective uncontrolled cohort, intradermal BoNT-A injection was associated with improvement in ETR severity scores over 5 months and was generally well tolerated. However, because the study lacked a control group, definitive conclusions regarding efficacy cannot be drawn. Treatment outcomes appeared to be influenced by baseline disease severity, symptom duration, and skin dryness.