Rosacea is a chronic skin disease characterized by facial erythema, papules, pustules and telangiectasia. Although the exact etiology of rosacea has not been fully clarified, its pathogenesis is known to involve multiple factors, such as genetics, environment, immune response, and microbial infection. Patients with rosacea usually experience persistent or recurrent facial flushing, which not only affects their appearance but also has a significant impact on their psychology and quality of life. Therefore, it is crucial to find effective treatment methods to improve the quality of life of patients. In recent years, botulinum toxin has certain advantages in the treatment of rosacea and related erythema and flushing. As a neurotoxin, this drug can block the release of acetylcholine from nerve endings, thereby inhibiting muscle contraction and continuous secretion of glands. Botulinum toxin can not only reduce the skin blood flow, erythema, and flushing of patients, but also improve the symptoms of rosacea by inhibiting neuroinflammation and reducing the continuous release of inflammatory mediators. This review aims to summarize the research progress of botulinum toxin in the treatment of erythema and flushing associated with rosacea in recent years, mainly including the mechanism of action, clinical application, efficacy evaluation and safety analysis of botulinum toxin.