Botox for Rosacea? A Novel Use of an Aesthetic Workhorse

Christopher Chu M.D.
April 3, 2024

Rosacea is a chronic skin condition characterized by facial redness, swelling, and acne-like eruptions that can cause significant discomfort and emotional distress. While the precise causes of rosacea are multifactorial, factors like neurovascular abnormalities, immune system dysregulation, and environmental triggers play crucial roles. At Pure Dermatology, we see rosacea often, and the condition can be difficult to treat. Botox for rosacea has emerged as an exciting new therapeutic option.


Before I read about the potential use of botox for rosacea, I noticed something in my wife. My wife, who has rosacea, tends to flush while running. After one particularly intense run, she noticed that while her forehead was red, there was five circles that were not. These five circles correlated perfectly to where her botox injections were previously performed. Later that year at the American Academy of Dermatology, I heard lectures about the potential use of botox for rosacea, and have since learned about its potential.

Traditionally, for papulopustular rosacea, in which patients get acne-like red bumps in rosacea-prone areas, there are many treatment options, ranging from topical creams and oral antibiotics. On the other hand, erythematotelangiectatic (ET) rosacea, which is characterized by persistent redness of the face, has been much more difficult to treat, with limited topical and oral options. Treatments for ET rosacea are usually aimed at minimizing exposure to known triggers or the use of vascular lasers. A newly studied approach however is the use of botox’s microdroplet dosing, which has shown promising results for reducing the redness of rosacea.


Understanding the Mechanism

Botox is a neuromodulator best known for its cosmetic applications in reducing wrinkles and fine lines. It has also been used for a variety of other conditions, ranging from migraines to TMJ. Recent studies have shown that botox can be used to treat persistent erythema and flushing associated with rosacea.

The action of Botox in rosacea treatment is twofold: First, it inhibits the release of acetylcholine, a neurotransmitter responsible for muscle contractions. This results in diminished facial redness by reducing the excessive dilation of facial blood vessels.

Second, botox can modulate a white blood cell called mast cells. Mast cells are involved in inflammation and allergic reactions, and studies have shown that botox reduces the degranulation of mast cells, the process by which these mast cells release their pro-inflammatory substances. The degranulation of mast cells play a significant role in rosacea symptoms, and preventing their degranulation appears to play a role in botox’s ability to provide relief from the persistent redness and discomfort or rosacea.


Clinical Evidence

In a series of studies, individuals with refractory rosacea flushing and erythema received intradermal injections of Botox, resulting in noticeable improvements in their symptoms. These treatments not only alleviated redness but also contributed to an overall reduction in the inflammation associated with rosacea. The side effects were minimal and transient, with patients experiencing only mild pain and localized bruising that resolved without further intervention. These effects lasted up to 3months.


Park, Kui Young, et al. "Botulinum toxin for the treatment of refractory erythema and flushing of rosacea." Dermatology 230.4 (2015): 299-301.APA

A Promising Alternative

For those grappling with rosacea's persistent and often debilitating symptoms, Botox presents a promising alternative. Its dual action— both vascular and immunological — provides a multifaceted approach to treatment, targeting the condition's symptoms at their roots.


While Botox for rosacea may not be suitable for everyone, and its use in rosacea is still being studied, the evidence thus far is encouraging. For patients suffering from severe redness and inflammation from rosacea, botox may be used as an adjunct therapy to laser treatment or medical therapy, or as the lone therapeutic modality. At Pure Dermatology, we are experts in rosacea. We can help you determine what type of rosacea you may have, and assist in deciding whether the use of lasers, medical therapy, or a neuromodulator like botox is the right choice for your type of rosacea.