Intradermal injection of botulinum toxin for centrofacial erythema
Centrofacial erythema is a common feature of rosacea. Beyond cosmetic concerns, it can be accompanied by redness, scaling, sensitivity, and burning. Rosacea is progressive and may eventually contribute to tissue overgrowth.
A 2025 review, “Intradermal injection of botulinum toxin for erythema in rosacea: A scoping review and meta-analysis,” evaluated the evidence for this treatment and examined dosing strategies to minimize complications.
The authors included seven studies with 167 patients. Diluted neuromodulator was injected intradermally, with erythema improving in the first and subsequent months; the greatest improvement was reported at three months. Complications, including unintended facial muscle paralysis and hematoma, occurred with some injection concentrations, but none were identified when the injection volume was 0.1–0.2 mL.
An earlier review of 17 studies found marked improvement in erythema and flushing within one to two weeks after injection, with effects lasting three to six months. Some studies reported adverse events such as bruising and unintended facial muscle paralysis; the overall facial paralysis rate was 4.3%, and the effects were reversible. Patient satisfaction and quality-of-life improvements were high.
Both studies concluded that neuromodulators may improve rosacea-related erythema and flushing. Symptoms often recurred after several months, requiring repeat treatment.
