Therapeutic Efficacy and Safety of Botulinum Toxin Type A in Erythematotelangiectatic Rosacea: A Systematic Review

Botulinum toxin type A (BoNT-A) injections have a well-known cosmetic outcome and safety profile in a variety of medical conditions. Recent studies have shown promising results for possible use in treating erythematotelangiectatic rosacea (ETR). This systematic review aimed to evaluate the efficacy and safety of BoNT-A injections in patients with ETR. A systematic search was conducted across multiple databases to identify relevant studies. Eligible articles were randomized controlled trials (RCTs) that investigated BoNT-A injections in adults diagnosed with ETR. Studies involving other rosacea subtypes, lacking a comparative group, or combining BoNT-A with other interventions without isolating its effects were excluded. Three RCTs met the inclusion criteria. Both parallel-group and split-face analyses demonstrated that BoNT-A injections significantly reduced facial erythema and flushing, resulting in improved patient satisfaction. Across all studies, BoNT-A was well-tolerated, with adverse events being mild, transient, and self-limited. However, the evidence remains limited by the small sample sizes, suboptimal study designs, and short follow-up durations. BoNT-A injections show promising efficacy and safety in the treatment of ETR. However, larger, well-designed randomized trials with longer follow-up durations are required to confirm its therapeutic role and establish standardized treatment protocols.