Clinical efficacy of Nd:YAG-laser combined with hyaluronic acid and trehalose injections in patients with erythematotelangiectatic rosacea

Introduction. Erythematotelangiectatic rosacea, the most prevalent subtype, is characterized by its resistance to standard therapeutic approaches. A combination of laser treatment for vascular lesions and injectable biorevitalization for the functional dermal remodeling appears pathogenetically justified. However, its clinical efficacy and safety require further investigation.
Aim. To assess the clinical efficacy and safety of Nd:YAG-laser combined with hyaluronic acid/trehalose injections within a single procedure or with 2-week interval in patients with erythematotelangiectatic rosacea.
Materials and methods. In this study, 20 patients diagnosed with erythematotelangiectatic rosacea were allocated to four groups: Group 1 (laser treatment combined with hyaluronic acid/trehalose injections within a single procedure); Group 2 (laser treatment combined with hyaluronic acid/trehalose injections with 2-week interval); Group 3 (laser treatment); Group 4 (hyaluronic acid/trehalose injections). Treatment outcomes were monitored using Antera 3D® three-dimensional skin analysis and validated clinical assessment and patient satisfaction scales.
Results. Combination therapy (Groups 1 and 2) demonstrated the most significant reduction of erythema, telangiectasia and vascular lesions. These approaches were associated with the greatest improvements in overall skin condition and patient satisfaction. No significant difference between Groups 1 and 2 was found. Nd:YAG-laser monotherapy proved most effective for the reduction of vascular lesions, it had no significant impact on skin quality parameters. Hyaluronic acid/trehalose injections improved skin hydration and texture, however demonstrated limited efficacy against telangiectasias.
Conclusion. The high efficacy and safety of Nd:YAG-laser combined with hyaluronic acid/trehalose injections both within a single procedure and with 2-week intervals support the inclusion of these treatment protocols in clinical algorithms for erythematotelangiectatic rosacea.

1. Yakovleva AО, Verbenko DA, Kondrakhina IN, Plakhova KI, Кubanov AA. New approaches to the treatment of rosacea on the basis pathogenesis factors and clinical forms. Russian Journal of Skin and Venereal Diseases. 2023;26(3):251–262 (In Russ.) https://doi.org/10.17816/dv217260.

2. Snarskaya ES, Rusina TS. Modern concepts of erythematotelangiectatic rosacea pathogenesis and treatment. Russian Journal of Skin and Venereal Diseases. 2021;24(4):367–374. (In Russ.) https://doi.org/10.17816/dv87993.

3. Barakji Y, Rønnstad A, Christensen M, Zachariae C, Wienholtz N, Halling AS et al. Assessment of Frequency of Rosacea Subtypes in Patients With Rosacea: A Systematic Review and Meta-analysis. JAMA Dermatology. 2022;158:617–625. https://doi.org/10.1001/jamadermatol.2022.0526.

4. Micali G, Gerber PA, Lacarrubba F, Schäfer G. Improving Treatment of Erythematotelangiectatic Rosacea with Laser and/or Topical Therapy Through Enhanced Discrimination of its Clinical Features. J Clin Aesthet Dermatol. 2016;9(7):30–39. Available at: https://pubmed.ncbi.nlm.nih.gov/27672409/.

5. Chen C, Wang P, Zhang L, Liu X, Zhang H, Cao Y et al. Exploring the Pathogenesis and Mechanism-Targeted Treatments of Rosacea: Previous Understanding and Updates. Biomedicines. 2023;11(8):2153. https://doi.org/10.3390/biomedicines11082153.

6. Farshchian M, Daveluy S. Rosacea. In: StatPearls. StatPearls Publishing; 2025. Accessed January 7, 2026. Available at: https://www.ncbi.nlm.nih.gov/books/NBK557574/.

7. Chang HC, Huang YC, Lien YJ, Chang YS. Association of rosacea with depression and anxiety: A systematic review and meta-analysis. J Affect Disord. 2022;299:239–245. https://doi.org/10.1016/j.jad.2021.12.008.

8. Davydova AV, Bakulev AL. Research of personal features of patients with rosacea. Saratov Journal of Medical Scientific Research. 2014;10(3):560–564. (In Russ.) Available at: https://ssmj.ru/2014/3/560.

9. Alinia H, Cardwell LA, Tuchayi SM, Nadkarni A, Bahrami N, Richardson IM et al. Screening for depression in rosacea patients. Cutis. 2018;102(1):36–38. Available at: https://pubmed.ncbi.nlm.nih.gov/30138493/.

10. Drozhdina MB, Bobro VA. Mechanisms of rosacea pathogenesis. A phenotypic approach to therapeutic tactics. Vestnik dermatologii i venerologii. 2022;98(5):90–97. (In Russ.) https://doi.org/10.25208/vdv1310.

11. Yoon SH, Hwang I, Lee E, Cho HJ, Ryu JH, Kim TG, Yu JW. Antimicrobial Peptide LL-37 Drives Rosacea-Like Skin Inflammation in an NLRP3-Dependent Manner. J Invest Dermatol. 2021;141(12):2885–2894.e5. https://doi.org/10.1016/j.jid.2021.02.745.

12. Micali G, Gerber PA, Lacarrubba F, Schäfer G. Improving Treatment of Erythematotelangiectatic Rosacea with Laser and/or Topical Therapy Through Enhanced Discrimination of its Clinical Features. J Clin Aesthet Dermatol. 2016;9(7):30–39. Available at: https://pubmed.ncbi.nlm.nih.gov/27672409/.

13. Chen LXY, Hao PS. The role of skin barrier and immune abnormalities in the pathogenesis of Rosacea. Clin Exp Med. 2025;25(1):324. https://doi.org/10.1007/s10238-025-01859-w.

14. Sener S, Akbas A, Kilinc F, Baran P, Erel O, Aktas A. Thiol/disulfide homeostasis as a marker of oxidative stress in rosacea: a controlled spectrophotometric study. Cutan Ocul Toxicol. 2019;38(1):55–58. https://doi.org/10.1080/15569527.2018.1517124.

15. Wang X, Shi H, Li X, Feng Y. Macrophages in rosacea: pathogenesis and therapeutic potential. Front Immunol. 2025;16:1595493. https://doi.org/10.3389/fimmu.2025.1595493.

16. Lee WJ, Lee YJ, Lee MH, Won CH, Chang SE, Choi JH, Lee MW. Prognosis of 234 rosacea patients according to clinical subtype: The significance of central facial erythema in the prognosis of rosacea. J Dermatol. 2016;43(5):526–531. https://doi.org/10.1111/1346-8138.13166.

17. Logger JGM, Olydam JI, Driessen RJB. Use of beta-blockers for rosaceaassociated facial erythema and flushing: A systematic review and update on proposed mode of action. J Am Acad Dermatol. 2020;83(4):1088–1097. https://doi.org/10.1016/j.jaad.2020.04.129.

18. Shanler SD, Ondo AL. Successful Treatment of the Erythema and Flushing of Rosacea Using a Topically Applied Selective α1-Adrenergic Receptor Agonist, Oxymetazoline. Arch Dermatol. 2007;143(11):1369–1371. https://doi.org/10.1001/archderm.143.11.1369.

19. Xiao W, Chen M, Wang B, Huang Y, Zhao Z, Deng Z et al. Efficacy and safety of antibiotic agents in the treatment of rosacea: a systemic network metaanalysis. Front Pharmacol. 2023;14:1169916. https://doi.org/10.3389/fphar.2023.1169916.

20. Del Rosso JQ, Tanghetti EA, Baldwin HE, Rodriguez DA, Ferrusi IL. The Burden of Illness of Erythematotelangiectatic Rosacea and Papulopustular Rosacea: Findings From a Web-based Survey. J Clin Aesthet Dermatol. 2017;10(6):17–31. Available at: https://pubmed.ncbi.nlm.nih.gov/28979654/.

21. Li Y, Wang R. Efficacy Comparison of Pulsed Dye Laser vs. Microsecond 1064-nm Neodymium:Yttrium-Aluminum-Garnet Laser in the Treatment of Rosacea: A Meta-Analysis. Front Med. 2022;8:798294. https://doi.org/10.3389/fmed.2021.798294.

22. Salem SAM, Abdel Fattah NSA, Tantawy SMA, El-Badawy NMA, Abd El-Aziz YA. Neodymium-yttrium aluminum garnet laser versus pulsed dye laser in erythemato-telangiectatic rosacea: comparison of clinical efficacy and effect on cutaneous substance (P) expression. J Cosmet Dermatol. 2013;12(3):187–194. https://doi.org/10.1111/jocd.12048.

23. Kwon WJ, Park BW, Cho EB, Park EJ, Kim KH, Kim KJ. Comparison of efficacy between long-pulsed Nd:YAG laser and pulsed dye laser to treat rosaceaassociated nasal telangiectasia. J Cosmet Laser Ther. 2018;20(5):260–264. https://doi.org/10.1080/14764172.2017.1418510.

24. Volodkina TA, Murakov SV, Seraya IV, Suleyman LM. Hardware technologies in rosacea treatment. Klinicheskaya Dermatologiya i Venerologiya. 2025;24(6):814–821. (In Russ.) https://doi.org/10.17116/klinderma202524061814.

25. Rose AE, Goldberg DJ. Successful treatment of facial telangiectasias using a micropulse 1,064-nm neodymium-doped yttrium aluminum garnet laser. Dermatol Surg. 2013;39(7):1062–1066. https://doi.org/10.1111/dsu.12185.

26. Kim M, Kim J, Jeong SW, Jo H, Park HJ. Long-pulsed 1064-nm Nd: YAG laser ameliorates LL-37-induced rosacea-like skin lesions through promoting collagen remodeling in BALB/c mice. Lasers Med Sci. 2018;33(2):393–397. https://doi.org/10.1007/s10103-017-2410-8.

27. Proietti I, Svara F, Battilotti C, Innocenzi C, Potenza C. Integrated management with topical and injectable 200 kDa hyaluronic acid for erythematous rosacea. J Cosmet Dermatol. 2024;23(9):3049–3051. https://doi.org/10.1111/jocd.16342.

28. Sudha PN, Rose MH. Beneficial effects of hyaluronic acid. Adv Food Nutr Res. 2014;72:137–176. https://doi.org/10.1016/B978-0-12-800269-8.00009-9.

29. Mizunoe Y, Kobayashi M, Sudo Y, Watanabe S, Yasukawa H, Natori D et al Trehalose protects against oxidative stress by regulating the Keap1-Nrf2 and autophagy pathways. Redox Biol. 2018;15:115–124. https://doi.org/10.1016/j.redox.2017.09.007.

30. Chebotareva YuYu, Tonakanyan BM, Privalova EG. Combined rosacea treatment protocol using a pulsed dye laser and a dermal bioreparant with trehalose. Klinicheskaya Dermatologiya i Venerologiya. 2023;22(5):616–624. (In Russ.) https://doi.org/10.17116/klinderma202322051616.

31. Kozarev J. Use of Long Pulse Nd:YAG 1064nm Laser for Treatment of Rosacea Telangiectatica. J Laser Health Acad. 2011;2011(1):33–36. Available at: https://www.academia.edu/94167506/Use_of_Long_Pulse_Nd_YAG_1064nm_Laser_for_Treatment_of_Rosacea_Telangiectatica.

32. Mustafa SA, Qurtas DS. Long pulse 1064 nm Nd: YAG laser in the treatment of erythematotelangiectatic rosacea and other erythematotelan-giectatic facial conditions. Gomal J Med Sci. 2025;23(4):366–371. https://doi.org/10.46903/gjms/23.4.1934.

33. Schlesinger TE, Powell CR. Efficacy and tolerability of low molecular weight hyaluronic acid sodium salt 0.2% cream in rosacea. J Drugs Dermatol. 2013;12(6):664–667. Available at: https://pubmed.ncbi.nlm.nih.gov/23839183/.

34. Proietti I, Kus S, Amore E, Svara F, Battilotti C, Potenza C, Ogilvie P. Integrative Rosacea Treatment: Combination of a Low Crosslinked Injectable Hyaluronic Acid Filler With Standard Therapeutical Interventions–An International Real World Case Series. J Cosmet Dermatol. 2025;24(4):e70199. https://doi.org/10.1111/jocd.70199.

35. Kislitsyna AI, Naumchik GA. Intradermal injections of trehalose products to improve skin quality: clinical findings. Klinicheskaya Dermatologiya i Venerologiya. 2022;21(3):361–367. (In Russ.) https://doi.org/10.17116/klinderma202221031361.

36. Kaplon RE, Hill SD, Bispham NZ, Santos-Parker JR, Nowlan MJ, Snyder LL et al. Oral trehalose supplementation improves resistance artery endothelial function in healthy middle-aged and older adults. Aging. 2016;8(6):1167–1183. https://doi.org/10.18632/aging.100962.

37. Dai X, Mizukami Y, Watanabe K, Tsuda T, Shidahara M, Yoshida S et al. Trehalose Prevents IL-4/IL-13-Induced Skin Barrier Impairment by Suppressing IL-33 Expression and Increasing NRF2 Activation in Human Keratinocytes In Vitro. J Invest Dermatol. 2025;145(6):1422–1432.e10. https://doi.org/10.1016/j.jid.2024.08.038.

38. Jin J, Zhu KS, Tang SM, Xiang Y, Mao MY, Hong XD et al. Trehalose promotes functional recovery of keratinocytes under oxidative stress and wound healing via ATG5/ATG7. Burns. 2023;49(6):1382–1391. https://doi.org/10.1016/j.burns.2022.11.014.

39. Chmielewski R, Lebiedowska A, Barańska-Rybak W. Evaluation of the AntiGlycation Protective Effect of an Injectable Product Based on a Combination of Two Different Ranges of Molecular Weights of Hyaluronic Acid and Trehalose on Human Skin Explants. Int J Mol Sci. 2025;26(7):3217. https://doi.org/10.3390/ijms26073217.

40. Chmielewski R, Lebiedowska A, Barańska-Rybak W. Assessment of the Curative Anti-Glycation Properties of a Novel Injectable Formulation Combining Dual-Weight Hyaluronic Acid (Low- and Mid/High-Molecular Weight) with Trehalose on Human Skin Ex Vivo. Int J Mol Sci. 2025;26(10):4747. https://doi.org/10.3390/ijms26104747.

41. Chmielewski R, Lesiak A. Mitigating Glycation and Oxidative Stress in Aesthetic Medicine: Hyaluronic Acid and Trehalose Synergy for AntiAGEs Action in Skin Aging Treatment. Clin Cosmet Investig Dermatol. 2024;17:2701–2712. https://doi.org/10.2147/CCID.S476362

42. Zubareva TS, Krylova YuS, Panfilova AS, Kvetnoy IM, Gracheva SG, Belova YuI et al. Molecular mechanisms of skin biorevitalization: expression of signaling molecules under the action of trehalose-containing gel. Molecular Medicine. 2025;23(3):48–55. (In Russ.) https://doi.org/10.29296/24999490-2025-03-06.

43. Maeda K, Zhou Z, Guo M, Zhang J, Chen L, Yang F. Functional properties and skin care effects of sodium trehalose sulfate. Skin Res Technol. 2024;30(4):e13666. https://doi.org/10.1111/srt.13666.