Clinical Outcomes and Predictive Factors of Combination Treatment With Oral Doxycycline, Topical Calcineurin Inhibitor, and Pulsed Dye Laser in Erythematotelangiectatic Rosacea

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Abstract
Objective: Given that the therapeutic evidence for doxycycline in rosacea has predominantly been derived from studies on papulopustular rosacea (PPR), this study aimed to evaluate the efficacy and safety of combined oral doxycycline, topical calcineurin inhibitor (TCI), and pulsed dye laser (PDL) therapy in erythematotelangiectatic rosacea (ETR) and to identify clinical predictors of treatment response. Materials and Methods: Medical photographs of patients with ETR treated with oral doxycycline, TCI, and two subsequent PDL sessions were retrospectively reviewed. Erythema on the right cheek was quantitatively measured using computer‐aided image analysis. Results: Of the 79 included patients, 47 had the ETR subtype and 32 had the mixed ETR/PPR subtype. Erythema significantly improved after oral doxycycline and TCI treatment ( p < 0.001) and further PDL treatment ( p < 0.001). Particularly, in patients with moderate‐to‐severe ETR, background erythema improved to a level comparable to that observed in patients with mild ETR after treatment ( p = 0.307). Post‐treatment erythema did not differ by age ( p = 0.963) or Fitzpatrick skin type ( p = 0.277); however, it was significantly lower among males ( p = 0.008) and in patients without prior steroid treatment ( p = 0.046). No serious adverse events, including photosensitivity, were observed. Conclusion: Combined oral doxycycline, TCI, and PDL therapy is effective and safe for ETR, especially in patients with higher severity. Prompt diagnosis and avoidance of steroid misuse may improve treatment responses.

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