Won-Serk Kim
Noninvasive monopolar radiofrequency (NMRF) is an established modality for skin tightening, but its role in inflammatory dermatoses such as rosacea remains poorly defined. We report a man in his forties with an erythematotelangiectatic rosacea (ETR) phenotype, characterized by persistent centrofacial erythema, flushing, and xerosis, who underwent two sessions of multifrequency NMRF (XERF; Cynosure Lutronic, Goyang, Korea) at 4-week intervals using an off-label, superficial-targeted protocol (shallow setting, intensity level 5; 6.78 MHz; approximately 250 pulses; approximately 23,000 J cumulative energy per session; fragmented-pulse mode with controlled off-time). One month after the second session, facial erythema was visibly reduced and skin tone appeared more uniform. Antera 3D (Miravex, Dublin, Ireland) multispectral imaging showed a 24.3% decrease in average hemoglobin level (2.016 to 1.525) and a 36.9% decrease in hemoglobin variation (0.255 to 0.161). Surface scaling and xerosis also improved clinically. This single case suggests that superficial-targeted NMRF may reduce erythema and improve barrier-related symptoms in ETR through combined vascular, anti-inflammatory, and epidermal barrier mechanisms, beyond its established tissue-tightening effect, although these findings are exploratory and controlled studies incorporating standardized imaging, transepidermal water loss, histology, and inflammatory mediator assessment are needed to test this hypothesis.