Non-Invasive Imaging of Facial Erythema Treated with a Transdermal Delivery System

(1) Background: Facial erythema is spatially heterogeneous and may fluctuate considerably, making objective assessment of treatment-related changes challenging. This study aimed to evaluate changes in facial erythema following a hydroporation-based transdermal delivery protocol using complementary instrumental and image-based methods. (2) Methods: Twenty-eight women with persistent facial erythema underwent six treatment sessions performed at weekly intervals. Erythema was assessed at baseline, after three treatments, and after completion of the treatment series using a Mexameter and standardized cross-polarized photography followed by Gray-Level Co-occurrence Matrix (GLCM) texture analysis of the green image channel at 45° and 135° orientations. Representative high-frequency ultrasound images were acquired to illustrate fluid deposition within the dermis immediately after the infusion step. (3) Results: The median Mexameter erythema index decreased from 383.0 (IQR 362.5–418.5) at baseline to 297.0 (268.5–337.5) after three treatments and 270.0 (247.3–311.3) after six treatments, with significant differences between all time points (Holm-adjusted p < 0.001; r = 0.74–0.86). GLCM analysis demonstrated a significant decrease in contrast and an increase in homogeneity at both 45° and 135° orientations compared with baseline (Holm-adjusted p < 0.001; r = 0.74–0.83). No significant differences in either GLCM parameter were observed between the third and sixth treatments (p > 0.05). (4) Conclusions: The hydroporation-based transdermal delivery protocol was associated with a significant reduction in facial erythema. Mexameter and GLCM analysis provided complementary quantitative information on treatment response.