The Rosacea Research Digest from the National Rosacea Society keeps you up to date on recently published basic and clinical research on rosacea, as well as news, reviews, and presentations. It goes out on the last weekday of each month.

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Research

The role of biotics in rosacea: a narrative review.

Avendaño-Pérez AL, Orozco-Covarrubias L, Saez-de-Ocariz M. Cureus. 2026 Mar 24;18(3):e105799. DOI: 10.7759/cureus.105799. PMID: 42037847; PMCID: PMC13106664.

Rosacea is a chronic inflammatory dermatosis affecting the central face of adults, characterized by persistent erythema, flushing, papules, pustules, telangiectasias, and, in some cases, phymatous changes. Its pathogenesis involves a multifactorial interplay of immune dysregulation, neurovascular alterations, genetic predisposition, and disturbances of the skin and gut microbiota. Increasing interest in the gut-skin axis has prompted investigation into microbiota-targeted therapies, including probiotics, prebiotics, postbiotics, and synbiotics. This narrative review evaluates current evidence regarding the role of biotics in rosacea. A literature search was conducted in PubMed/MEDLINE, Scopus, and Web of Science using combinations of the terms "rosacea," "gut-skin axis," "probiotics," "prebiotics," "postbiotics," and "synbiotics." Clinical trials, observational studies, and relevant mechanistic investigations published in English were considered. Available data suggest that certain probiotic strains, administered orally or topically, may improve inflammatory lesions, erythema, and skin barrier function, particularly as adjuncts to standard therapy. However, findings are characterized by significant heterogeneity in strains, dosages, study design, outcome measures, and treatment duration. Evidence supporting the use of prebiotics, postbiotics, and synbiotics in rosacea remains limited and, in many cases, extrapolated from related inflammatory conditions or preclinical models. Although microbiota modulation represents a promising therapeutic avenue, current evidence is insufficient to establish standardized clinical recommendations. Larger, well-designed randomized controlled trials with standardized endpoints and long-term follow-up are required to clarify their efficacy, optimal formulations, and safety.

Postbiotics in dermatology: a literature review of emerging topical therapies for acne, rosacea, and eczema.

Flores Rodríguez JC, Morán Ortega MJ, Jimenez Ordoñez AC, et al. Cureus. 2026 Mar 18;18(3):e105440. DOI: 10.7759/cureus.105440. PMID: 42005241; PMCID: PMC13089085.

Postbiotics, defined as non-viable microbial cells and their metabolites, have emerged as topical therapies for inflammatory dermatoses and provide more clinical benefits than live postbiotics by eliminating infection risk and stability. This literature review aims to generalise existing knowledge about the effectiveness and mechanisms of action of first-line topical postbiotic treatments for acne, rosacea, and eczema. Search terms included "postbiotics" and keywords that represented the dermatological conditions of interest. Thematic synthesis was performed on the systematically extracted data. After screening, 16 studies were included in the review. Postbiotic preparations showed significant reductions in Scoring Atopic Dermatitis (SCORAD) and pruritus and improved barrier function in the skin, as well as longer remissions (p < 0.001). In acne vulgaris, postbiotics decreased inflammatory lesions by 50% to 70%, suppressed sebum secretion (42% to 72%), and stopped the growth of Cutibacterium acnes. The study concluded that topical postbiotics, reported to be effective in atopic dermatitis and acne vulgaris, have favourable safety profiles and can be integrated into treatment regimens for the aforementioned diseases. However, no interventional studies have examined rosacea, and the evidence is limited to narrative reviews in which microbiome disequilibrium remains undetermined despite a lack of clinical efficacy. Therefore, a lack of clinical trials for rosacea is a high research priority, given the substantial mechanistic rationale for this absence of high-quality pragmatic evidence.

LetibotulinumtoxinA for rosacea: a pilot study.

Bańka-Wrona A, Wrona W, Barańska-Rybak W. Toxins (Basel). 2026 Mar 28;18(4):162. DOI: 10.3390/toxins18040162. PMID: 42043026; PMCID: PMC13120600.

Rosacea-associated erythema and flushing often remain inadequately controlled by standard therapies. Intradermal botulinum toxin A has emerged as a potential treatment targeting the neurovascular component of rosacea. This pilot study aimed to evaluate the safety and preliminary efficacy of intradermal letibotulinumtoxinA for persistent erythema and flushing in rosacea. Eleven patients with refractory erythematotelangiectatic rosacea received a single session of intradermal letibotulinumtoxinA (20 U total dose). Outcomes at 2 weeks included clinician- and patient-rated erythema severity, patient-reported flushing, skin hydration, sebum, elasticity, and Dermatology Life Quality Index (DLQI). Safety assessments included adverse events and pain. Two weeks post-treatment, 73% of patients showed improvement in Clinician's Erythema Assessment score and 100% reported reduced flushing. Median hydration and elasticity increased, while the level of sebum decreased. Median DLQI improved from 9 to 2. No serious adverse effects occurred; mild, transient cheek heaviness and dryness were noted in three cases. Intradermal letibotulinumtoxinA was well tolerated, with few reported side effects/complications. The treatment demonstrated preliminary efficacy in reducing rosacea erythema and flushing, and improving skin physiology and quality of life; however, these require confirmation in a larger, controlled study.

T cell immunosenescence in inflammatory skin diseases: pathogenesis and therapeutic targets.

Liu C, Yang M, Xiao F, Zeng J. Aging Cell. 2026 May;25(5):e70527. DOI: 10.1111/acel.70527. PMID: 42050386.

T cell immunosenescence refers to the progressive functional decline of T lymphocytes with aging, characterized by the phenotypic markers, mitochondrial dysfunction, and the senescence-associated secretory phenotype (SASP), representing a pivotal aspect of overall immune aging. This review systematically elucidates the critical role of T cell immunosenescence in the pathogenesis of common inflammatory skin diseases, including psoriasis, atopic dermatitis, rosacea, and seborrheic dermatitis. Senescent T cells drive the production of a disease-specific SASP via internally dysregulated signaling networks such as NF-κB, JAK-STAT, p38 MAPK, and PI3K-Akt-mTOR pathways, thereby shaping and sustaining a chronic cutaneous inflammatory microenvironment that promotes disease chronicity and recurrence. Furthermore, this review summarizes current therapeutic strategies targeting these senescence-associated pathways and SASP components, discussing both biological agents and small molecule inhibitors. Finally, we propose future research directions focusing on the direct targeting of senescent T cells or their upstream regulatory hubs to achieve deep disease remission and overcome therapeutic resistance.

A Multicenter Trial Evaluating the Safety and Efficacy of a Serum containing plant adaptogens in patients with mild-to-moderate, persistent centrofacial erythema associated with rosacea.

Draelos ZD, Watchmaker J, Nelson DB. J Clin Aesthet Dermatol. 2026 Mar;19(3):32-37. PMID: 42027414; PMCID: PMC13102154.

Background: Persistent facial erythema is one of the most common subtypes of rosacea, often prompting patients to seek treatment. Characterized by multiple factors including adaptive immune and vascular dysregulation, genetics, and environmental influences, skincare measures aimed at reducing erythema and strengthening the skin barrier are fundamental to treatment. Plant adaptogens are rich phytochemicals that promote homeostasis, helping to increase resistance to stress, mitigate inflammation, support the skin barrier, and prevent premature aging. A serum containing plant adaptogens demonstrated significant improvements from baseline in global skin quality in subjects with mild-to-severe facial photodamage over 12 weeks. Objective: We sought to evaluate the safety and efficacy of a serum containing plant adaptogens (MYS) in subjects with mild-to-moderate persistent centrofacial erythema. Methods: A multicenter, open-label trial enrolled male or female subjects 30 to 65 years of age with mild (2) to moderate (3) persistent centrofacial erythema based on a Modified Clinical Erythema grading scale (M-CEA; 0=clear to 4=severe). A subset of subjects enrolled was taking oral or topical medications for rosacea (≥6 months) with breakthrough erythema. Subjects with >5 papules or pustules were excluded from participation. The investigators assessed erythema based on the M-CEA scale and global inflammatory lesions utilizing a 5-point grading scale (0=none to 4=severe) at baseline, 2, 4, 8, and 12 weeks. Subjects assessed erythema, dryness/flaking, itching, stinging, and burning using a 5-point grading scale (0=none to 4=severe) at baseline, 2, 4, 8, and 12 weeks. Subjects also completed self-assessment questionnaires. Digital photography and adverse events (AEs) were captured throughout the study. In addition to the study product (MYS [AM/PM]), subjects used a standardized skincare regimen that included a gentle cleanser, moisturizer, and sunscreen. Results: Fifty-five subjects were enrolled and 51 subjects completed the study: 38 in the Non-Medication Treatment Group (N-MTG) and 13 in the Medication Treatment Group (MTG). Significant mean reductions in the appearance of erythema of -17%, -25%, -32%, and -33% were demonstrated from baseline at Weeks 2, 4, 8, and 12 (all P<0.001), respectively, with each group demonstrating significant reductions over 12 weeks. Subject-assessed erythema demonstrated comparable results for both groups combined, with -22%, -30%, -34%, and -35% significant mean reductions occurring from baseline at Weeks 2, 4, 8, and 12 (all P<0.001). Significant mean reductions also occurred in papules/pustules at Weeks 4 (-29%), 8 (-43%), and 12 (-58%) (n=34; P<0.05). Subjects reported improvements in dryness/flaking, itching, stinging, and burning over the study period. After 12 weeks, subjects (94%) reported that flare-ups were not as intense and their skin looked less blotchy and looked healthier. Subjects (88%) reported feeling less self-conscious about their skin's appearance. One mild, possibly related hypersensitivity reaction on the neck was reported and resolved without sequela. No subject discontinued the study due to an AE. Conclusion: Twice-daily use of a serum comprised of plant adaptogens in subjects with mild-to-moderate persistent centrofacial erythema demonstrated significant reductions in the appearance of erythema from baseline as assessed by investigators and subjects over 12 weeks. Significant reductions from baseline also occurred in papules/pustules. Subjects reported decreases in skin sensitivity and healthier-looking skin.

TRPV4-mast cell interactions in neurogenic inflammation and chronic diseases: a narrative review.

Fouani M, Kumari S, Charles A, et al. Int J Mol Sci. 2026 Mar 21;27(6):2865. DOI: 10.3390/ijms27062865. PMID: 41898724; PMCID: PMC13026590.

Transient receptor potential vanilloid 4 (TRPV4) is a polymodal cation channel that is widely expressed in sensory neurons, immune cells, and structural tissues, where it integrates mechanical, osmotic, and chemical stimuli to regulate both physiological responses and disease-associated signaling. Mast cells (MCs), key immune effector cells capable of rapid mediator release through degranulation, also express TRPV4. Increasing evidence supports TRPV4-MC signaling as an important neuroimmune interface, linking mechanical and inflammatory stimuli to tissue hypersensitivity and pain. In this review, we synthesize current evidence supporting a role for TRPV4 in MC-associated neuroimmune signaling across multiple disease contexts while distinguishing settings in which TRPV4 directly regulates MC activation from those in which MC responses arise through multicellular tissue interactions. Direct TRPV4-dependent MC activation has been described in conditions such as LL-37-driven rosacea and mechanically induced inflammation, whereas in disorders including asthma, visceral hypersensitivity, bladder pain syndromes, and osteoarthritis, TRPV4 activity in epithelial, neuronal, or stromal compartments more often influences MC function indirectly through ATP-purinergic signaling, cytokine release, and neuropeptide-mediated crosstalk. Across systems, TRPV4 emerges not as a single pathogenic switch but as part of a context-dependent signaling network whose functional consequences depend on cell type, tissue microenvironment, and disease stage. Altogether, these findings identify TRPV4 as a therapeutically actionable node within neuroimmune signaling pathways and support the development of tissue-specific and combination strategies targeting both TRPV4 activity and MC-mediated signaling in chronic inflammatory and pain disorders.

Sphenopalatine ganglion radiofrequency ablation for severe facial rosacea manifestations.

Kapural L, Esebua LG, Poddar N, et al. Pain Pract. 2026 Apr;26(4):e70151. DOI: 10.1111/papr.70151. PMID: 41918220.

Background: Rosacea is an inflammatory, persistent erythema that can present under several clinical subtypes. Recently, a neurogenic type of rosacea has been suggested that can be associated with chronic pain and headaches. Aims: Here we describe a successful interventional treatment for severe, likely neurogenic rosacea associated with severe migraines previously treated using various conservative approaches. Materials and methods: Radiofrequency ablation of the sphenopalatine ganglion (SPG) was completed for the patient's primary chronic pain problem, severe migraine headaches. Results: Completion of the left-sided ganglion denervation resulted in resolution of left facial rosacea symptoms/signs. After the right radiofrequency denervation (about 2 weeks later), rosacea signs/symptoms disappeared from the right side of the patient's face as well. Twelve months following the sphenopalatine radiofrequency ablation, the patient is still rosacea-free. Conclusion: A larger case series is needed to assess the efficacy of sphenopalatine radiofrequency ablation in long-term management of the facial subtype of rosacea.

Cross-species transcriptomics identify mineralocorticoid receptor pathway overactivation as a central driver of ocular rosacea.

Zhu L, Yesilirmak N, Rodrigues-Braz D, et al. Nat Commun. 2026 Apr 16. Epub ahead of print. DOI: 10.1038/s41467-026-71945-4. PMID: 41991541.

Ocular rosacea (OR) is a chronic inflammatory disease of the ocular surface frequently associated with meibomian gland dysfunction (MGD), with limited therapeutic options and an underexplored pathophysiology. Here, we uncover the pivotal role of mineralocorticoid receptor (MR) pathway overactivation in driving MGD and OR. Analysis of eyelid tissues from OR patients revealed increased MR expression and altered local corticosteroid metabolism, associated with inflammation, fibrosis, and impaired meibocyte renewal. Using a transgenic rat model overexpressing human MR, we demonstrate that MR overactivation initiates subclinical MGD and, with aging or ultraviolet-B exposure, drives a full OR-like phenotype characterized by gland dropout, oxidative and mitochondrial stress, immune infiltration, epithelial barrier disruption, and secondary corneal damage. Cross-species transcriptomic integration of rat, human MGD, and rosacea datasets identified a conserved MR-dependent gene signature, highlighting S100A9 as a specific downstream target and biomarker of MR activation. Local pharmacological MR antagonism suppressed S100A9 expression. These findings establish MR overactivation as a unifying pathogenic driver of MGD and OR and identify MR blockade as a promising therapeutic strategy, with S100A9 as a candidate biomarker for patient stratification and treatment monitoring.

Efficacy of AOPT combined with collagen dressings on facial flushing and skin barrier function in patients with rosacea.

Mao J, Yang M. Int Wound J. 2026 Apr;23(4):e70902. DOI: 10.1111/iwj.70902. PMID: 41967902; PMCID: PMC13070664.

This study aimed to evaluate the efficacy of advanced optimal pulse technology (AOPT) combined with collagen dressings on facial flushing and skin barrier function in patients with rosacea. A total of 150 patients with rosacea were prospectively enrolled and randomised into the control group (n = 75, received AOPT treatment alone) and observation group (n = 75, additionally used recombinant human type III collagen dressing). Clinical improvement, erythema and lesion features were recorded before and 12 weeks after therapy. Patient quality of life was measured using the Acne-QOL scale. Skin barrier function was evaluated by transepidermal water loss (TEWL), sebum output and epidermal hydration. Serum inflammatory markers were analysed, and adverse reactions and recurrence were also tracked. Following 12 weeks of treatment, compared to the control group, the observation group showed higher overall effectiveness, greater reduction in erythema, lesion severity and pain scores, higher Acne-QOL scores across all dimensions (self-perception, emotional well-being, symptom burden and social function), lower TEWL and sebum secretion, higher hydration and lower levels of TNF-α, hs-CRP and PCT (all p < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (2.67% vs. 6.67%, p = 0.246), but the observation group had a lower recurrence rate (2.67% vs. 14.67%, p = 0.009). The combination of AOPT with collagen dressing offers superior benefits over AOPT alone, alleviating facial flushing, strengthening the skin barrier, decreasing systemic inflammation and reducing relapse, highlighting its clinical value in rosacea management.

Case Reports

CO2 laser resection of giant rhinophyma under local anesthesia: a case report.

Zhao QK. Clin Cosmet Investig Dermatol. 2026 Mar 26;19:597723. DOI: 10.2147/CCID.S597723. PMID: 41918801; PMCID: PMC13034776.

Introduction and importance: Phymatous rosacea (PhR), also known as "rhinophyma", refers to a benign condition characterized by the excessive proliferation of sebaceous glands and fibrosis in the facial skin due to rosacea, leading to thickening and hardening of the nasal skin, ultimately developing into rhinophyma. This disease's pathophysiology remains unclear but is seen as an advanced stage of rosacea. Presentation of case: The patient is a 67-year-old male and has hypertrophy of nasal tip and an enlarged nodule measuring approximately 7 cm × 6.1 cm × 4.5 cm in size of dark red color, uneven surface, clear dilation of follicular orifices, presence of white pustules and yellowish-white comedone-like secretions on light touch. Compression causes deformity of the nostrils that influences the quality of life and breathing. A total excision of the rhinophyma under local anesthesia by means of the CO2 laser surgery was agreed upon. The dressing changes were used to treat the wound after surgery and full healing took place after 30 days. The patient had satisfactory results, both in a functional and aesthetic sense, with the result having no recurrence in 1 year after surgery. Clinical discussion: The CO2 laser therapy with local anesthesia is an extension of traditional general anesthesia surgery when it comes to the removal of rhinophyma because it is easy to perform the surgery, with minimal trauma, bleeding, and no follow-up surgical operation, which leads to the development of a personal approach to the treatment. In our case, reconstructing the nasal area is complicated by the decision on anesthesia and management of nasal wound, which does not interfere with its functionality and beauty. Conclusion: In this report, we emphasize the surgical value of local anesthesia with CO2 laser for rhinophyma, reducing blood loss, operation time, and the need for secondary surgery. Follow-up for 1 year.

Pustular rosacea in an 8-year-old patient: a rare presentation of pediatric rosacea.

Sharaf R, Assaf T, Ghanem UI, et al. Case Rep Dermatol Med. 2026 Apr 27;2026:6001322. DOI: 10.1155/crdm/6001322. PMID: 42051591; PMCID: PMC13111910.

Pustular rosacea is a rare chronic inflammatory disease whose prevalence increases with age. We report a case of an 8-year-old patient who presented with a 3-year history of recurrent papulopustular facial eruptions associated with severe burning sensation, primarily affecting the cheeks, nose, and chin, exacerbated by hot weather and swimming. His condition was misdiagnosed as psoriasis, eczema, food allergy, or acne with limited benefit from treatment other than temporary relief from glucocorticoids. Skin biopsy showed hyperkeratosis and vascular ectasia with neutrophilic microabscesses consistent with papulopustular rosacea. He was successfully managed with lifestyle modifications and medications including azelaic acid, metronidazole, and ambroxol hydrochloride resulting in significant improvement. Diagnosing rosacea can be challenging due to its overlap with other conditions. Early diagnosis and treatment are crucial to prevent complications like scarring, persistent erythema, and psychological distress while ensuring a better quality of life and sustained remission.

News

Take Advantage of Modern Management Options During Rosacea Awareness Month

Rosacea.org

When the National Rosacea Society was founded in 1992, rosacea was considered a rare disease and there was only one FDA-approved treatment. Thanks to more than three decades of celebrating Rosacea Awareness Month every April, rosacea is now a frequent topic in health and beauty publications, and the estimated 16 million Americans who suffer from this chronic facial skin disorder have access to a broad range of medications, procedures and sensitive skin care products to address their unique set of signs and symptoms.

Rosacea Uncovered: Current Practices and Therapies on the Horizon

Dermatology Times

Each April, Rosacea Awareness Month offers a moment to revisit a condition that is both common and surprisingly complex. Although rosacea is a familiar diagnosis in dermatology clinics, our understanding of the disease continues to evolve. Ongoing research is shedding new light on its underlying mechanisms while also expanding the range of treatment options available to patients.

Wrapping Up Rosacea Awareness Month With Dr. Julie C. Harper

Dermatology Digest

April is Rosacea Awareness Month, designated by the National Rosacea Society (NRS), and as the month draws to a close, Julie Harper, MD, a Dermatologist in Birmingham, AL, updates viewers on the latest shifts in how this condition is diagnosed and treated.

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