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

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 two‐point 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. © 2019 Wiley Periodicals, Inc.