Clinical improvement in refractory erythematotelangiectatic rosacea following platelet-rich plasma monotherapy

Dear Editor,

Rosacea is a chronic inflammatory facial dermatosis characterised by vascular hyperreactivity, persistent erythema, and papulopustular flares.¹ Conventional therapies such as topical metronidazole, ivermectin, azelaic acid, and oral tetracyclines offer partial control and frequent relapses.² Platelet-rich plasma (PRP), a biologic concentrate enriched with growth factors and cytokines, has demonstrated significant tissue-regenerative and anti-inflammatory properties in multiple dermatoses.³ However, its role as monotherapy in rosacea has not been well-documented. We report a case of rosacea successfully managed with PRP alone, demonstrating significant clinical remission without adjunctive pharmacotherapy.

A 32-year-old woman presented with recurrent facial erythema and burning over the cheeks for 18 months. Symptoms were aggravated by heat and sun exposure, with no exacerbation related to cosmetics, and there was no family history of rosacea. There was no history of steroid use or acneiform lesions elsewhere. Examination revealed diffuse centrofacial erythema with scattered telangiectasias, without papules or pustules [Figures 1a and b]. Baseline dermoscopy (×10) showed linear telangiectatic vessels in a polygonal network with background erythema, consistent with erythematotelangiectatic rosacea. The patient had previously received topical metronidazole and oral doxycycline for approximately 3 months, with minimal symptomatic relief, leading to treatment discontinuation 6 months before presentation.

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Figure 1:

(a and b) Pre-treatment clinical photographs showing diffuse erythema and telangiectasias over both cheeks. (c and d) Post-treatment images after three sessions of platelet-rich plasma monotherapy demonstrating marked reduction in erythema and vascular prominence.

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The patient was initiated on autologous PRP, prepared using a double-spin method (first spin: 1,800 rpm for 10 min; second spin: 3,200 rpm for 8 min) using sodium citrate anticoagulant (blue-top tubes) without exogenous platelet activators, allowing physiological in vivo platelet activation. Each session involved intradermal microinjections (0.1 mL per site at 1-cm intervals) over the cheeks using an insulin syringe, administered at 4-week intervals for a total of three sessions. No other systemic or topical medication was given. Improvement was noted after the first session, with a marked reduction in erythema and burning after the second. At 12 weeks, the patient reported an 80% subjective improvement [Figures 1c and d], confirmed by a reduction in the investigator’s global assessment score from 3 (moderate) to 1 (minimal), a scale widely used in clinical practice to assess rosacea severity and treatment response. Follow-up dermoscopy revealed attenuation of telangiectatic vessels and reduced erythematous background. No adverse effects or rebound flares were observed over 6 months of follow-up.

PRP contains a variety of bioactive molecules, including platelet-derived growth factor, transforming growth factor-β, and vascular endothelial growth factor, which have been implicated in angiogenic regulation, dermal remodeling, and inflammatory modulation in experimental and clinical studies. Given the role of neurovascular dysregulation and endothelial hyperreactivity in rosacea, it is plausible that PRP may influence these pathways. However, the precise mechanisms by which PRP may affect rosacea remain unclear. The clinical improvement observed in our patient may reflect modulation of vascular and inflammatory responses, though this remains speculative and warrants further investigation.⁴ Previous studies have mainly explored PRP as an adjunct to fractional lasers or microneedling⁵; isolated monotherapy outcomes are rare. Botulinum toxin has been reported as an effective option for refractory erythematotelangiectatic rosacea; however, PRP was selected in this case for its autologous nature, favorable safety profile, and regenerative potential. PRP monotherapy may serve as a safe, biologically rational alternative for refractory erythematotelangiectatic rosacea. In conclusion, although sustained remission was observed over 6 months in this patient, the comparative long-term efficacy of PRP versus established rosacea therapies remains uncertain. The main limitations include the single-patient design, absence of standardised platelet quantification, and lack of objective vascular outcome measures. Well-designed controlled trials comparing PRP with standard anti-inflammatory regimens are required to validate these observations.