Laser and energy‐based devices for treating rosacea ‐ a systematic review and network meta‐analysis

Summary Background and Objectives Rosacea is a chronic inflammatory condition affecting the central face. While laser and energy‐based devices (EBDs) are commonly used for managing vascular symptoms, comprehensive comparisons between systems are limited. This study aims to evaluate and compare the efficacy and safety of lasers and EBDs for rosacea through a systematic review and network meta‐analysis (NMA). Methods Randomized controlled trials (RCTs) were identified from MEDLINE, CENTRAL, and Web of Science, with additional searches for ongoing trials. Primary outcomes included patient satisfaction, improvements in erythema and telangiectasia, and long‐term adverse events (AEs). Risk of bias (RoB) and publication bias were also assessed. Results 25 RCTs were included for qualitative analysis, and subsets contributed to the NMAs. Most studies exhibited unclear or high risk of bias, with a slight publication bias observed. Radiofrequency microneedling was more effective than pulsed dye laser (PDL) in terms of patient satisfaction (MD –1.32; 95 % CI –1.89 to –0.76) and erythema (MD –1.44; 95 % CI –1.96 to –0.91). The combination of oxymetazoline and PDL appeared superior for telangiectasia (MD –0.58; 95 % CI –1.03 to –0.14). AEs and discontinuation rates were comparable across treatments.