Background. Rosacea is a chronic inflammatory skin disease with a high prevalence among patients in the cosmetology profile. It is assumed that the actual number of cases may be higher due to the underdiagnosis of mild forms. Polyetiology and variability of pathogenesis determine the different severity and clinical manifestations of rosacea. Combined therapy methods show high efficiency of therapy due to the impact on various links of pathogenesis.
Objective. Comparative assessment of the efficacy and safety of combination therapies for rosacea: laser therapy in combination with topical and botulinum therapy for a combination of erythematotelangiectatic (ET) and papulopustular (PP) subtypes.
Methods. An open prospective randomized study included 30 patients diagnosed with ET and PP rosacea of mild-to-moderate severity, as well as their combination. Group 1 (15 patients): pulsed dye laser (PDL) 595 nm + topical therapy (azelaic acid, ivermectin). Group 2 (15 patients): PDL 595 nm + botulinum therapy (incobotulinum toxin type A) + topical therapy. Efficacy was assessed clinically, using photo documentation and the Dermatological Symptom Scale Index of (DSSI).
Results. According to the DSSI, the highest efficacy in stopping the vascular and inflammatory components was observed in group 2 (89.1%), in group 1 – 70.2%, respectively. With regard to the vascular component, the best results were recorded in group 2: reduction of erythema by 84.2%, telangiectasia (TAE) – by 71.4%.
Conclusion. In combination of ET and PP rosacea subtypes of mild-to-moderate severity, combination therapy with PDL 595 nm, botulinum therapy, ivermectin and azelaic acid showed the greatest efficiency in treating both the vascular and inflammatory components of rosacea. The technique is safe and highly effective.

Keywords: pulsed dye laser, ivermectin, rosacea, botulinum therapy, azelaic acid