A comparative study between fractional microneedling radiofrequency with systemic isotretinoin and fractional microneedling alone in the treatment of rosacea

Introduction:
Rosacea is a chronic inflammatory disease presenting with facial flushing, non-transient erythema, papules/pustules, telangiectasia, and phymatous changes. Secondary manifestations, such as itching, burning, or stinging, are often observed in patients with rosacea. The pathogenesis of rosacea is not fully understood, but immune dysfunction, Demodex infection, neurovascular dysregulation, and exposure to ultraviolet radiation represent contributing factors.

Aim:
To evaluate and compare effectiveness of fractional micro-needling radiofrequency with systemic isotretinoin and micro-needling alone in the treatment of rosacea.

Material and methods:
A cross-sectional comparative study between fractional microneedling radiofrequency with systemic isotretinoin and micro-needling alone in the treatment of rosacea was carried out in a private outpatient clinic and Al-Yarmouk teaching hospital from January 2022 to June 2023. Group A comprised 25 patients treated with systemic isotretinoin (10 mg/day) for 6 weeks and fractional microneedling radiofrequency for 16 weeks. Patients received a session every 2 weeks during the first 2 months of treatment then one session per month. Group B comprised 25 patients treated with fractional microneedling radiofrequency for 16 weeks. The patients received a session every 2 weeks during the first 2 months of treatment then one session per month. Measurement of baseline serum lipid profile, complete blood count, and liver enzyme levels was done to all patients receiving isotretinoin. All patients in both groups were instructed to use sunscreen and emollients. Follow-up of all patients was carried out for 3 months after treatment. Patients were assessment according to the Grade system of rosacea, patient satisfaction, and relapse rate. Relapse rate: no relapse (0), relapse (1). Patient satisfaction: poor (0), fair (1), and good (2).

Results:
There was no significant difference in the mean severity score for rosacea between group A and group B, before, after 8 weeks, and after 16 weeks. Patients in group A showed higher good satisfaction (72%) than group B (32%). During the follow-up period the relapse rate was higher in group B (32%) than in group A (16%), the percentage reduction (response rate) of the mean of severity score was 41.37% after 8 weeks and 91.37% after 16 weeks in group A, and 34.48% after 8 weeks and 82.75% after 16 weeks in group B.

Conclusions:
Fractional microneedling radiofrequency is a safe and effective method in the treatment of rosacea, and so it can be used when there are contraindications to other lines of therapy, when patients are resistant to long-term oral therapy, and when patients (including pregnant women) choose not to take oral or topical drugs.