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.

Research

Comparative evaluation of ChatGPT-5.2, Claude Sonnet 4.5, and DeepSeek-V3.2 for rosacea-related information: accuracy, reliability, readability, and reference hallucinations.

Uçar MT, Bostan E, Ortabağ T, Dönmez E. Diagnostics (Basel). 2026 Aug 18;16(16):2620. DOI: 10.3390/diagnostics16162620. PMID: 42651021; PMCID: PMC13512755.

Background/Objectives: Rosacea is a chronic inflammatory skin disease that requires long-term management and continuous patient education regarding triggers, skincare practices, and treatment adherence. In recent years, patients have increasingly turned to online platforms and artificial intelligence (AI)-based chatbots for health-related information. Although ChatGPT has been evaluated in the context of rosacea, evidence regarding the performance of other AI chatbots remains limited. This study aimed to evaluate the accuracy, reliability, quality, readability, and diagnostic relevance of AI-generated responses to common rosacea-related patient questions and to assess their potential role as sources of health-related information. Methods: Between 21 December 2025 and 22 February 2026, rosacea-related questions were collected from the publicly accessible Quora platform using a systematic screening process. Twenty clinically relevant and representative questions covering diagnosis, triggers, treatment options, skincare practices, and disease manifestations were selected. Each question was independently submitted to three AI chatbots (Claude Sonnet 4.5, ChatGPT-5.2, and DeepSeek-V3.2). Responses were evaluated by domain experts using the modified DISCERN (mDISCERN) for reliability, the Global Quality Scale (GQS) for overall quality, the Flesch Reading Ease Score (FRES) for readability, and a 5-point Likert scale for accuracy. Reference hallucinations were assessed through manual verification of cited sources. Statistical comparisons were performed using the Friedman test with Bonferroni-adjusted post hoc analyses, and effect sizes were calculated using Kendall's coefficient of concordance (Kendall's W). Results: Significant differences were observed among the AI chatbots across all evaluation domains (p < 0.05), with moderate to large effect sizes (Kendall's W = 0.272-0.683). ChatGPT-5.2 and DeepSeek-V3.2 demonstrated significantly higher reliability and accuracy scores than Claude Sonnet 4.5. DeepSeek-V3.2 achieved the highest overall quality scores, whereas ChatGPT-5.2 produced the most readable responses. Reference analysis revealed variable hallucination rates among the evaluated models. Conclusions: Generative AI chatbots demonstrate considerable potential as sources of health-related information for rosacea-related queries. However, variability in performance and reference hallucination rates highlights the need for careful validation before their widespread use as complementary sources of patient health information.

Reddit for redness: a cross-sectional analysis of the r/Rosacea forum.

Kotlyar J, Adler R, Nwaubani U, et al. J Drugs Dermatol. 2026 Aug 1;25(8):e71-e72. DOI: 10.36849/JDD.9436. PMID: 42555071.

Patients are increasingly turning to social media for disease/treatment advice and support. This has varying benefits but involves the risk of inaccurate information. Reddit, a news/social content discussion platform site with 1.1 billion active monthly members, hosts numerous dermatology "subReddit" forums dedicated to dermatologic advice/education/treatment experience. Rosacea, an inflammatory dermatosis affecting 2% to 22% percent of fair-skinned individuals and up to 10% of individuals in regions with predominantly skin of color populations, has its own subReddit, r/Rosacea, with 74,000 active users. This study analyzes r/Rosacea and its alignment with National Rosacea Society (NRS) standard management options.

Ivermectin in the management of Demodex-associated blepharitis: a comprehensive literature review.

Buzzi M, Sponga P, Angheben A, et al. Eye Contact Lens. 2026 Jul 1. Epub ahead of print. DOI: 10.1097/ICL.0000000000001299. PMID: 42381191.

Objectives: To review the role of Demodex infestation in blepharitis and summarize available evidence on the efficacy and safety of topical and oral ivermectin. Methods: This narrative review was conducted through collaboration between expert ophthalmologists and infectious diseases specialists with clinical experience in the use of ivermectin. A literature search was performed in PubMed and Embase from inception to November 2025. Results: Evidence from clinical trials, observational studies, and case series was reviewed and synthesized. Ivermectin, administered orally or topically, has been investigated as a potential treatment option for Demodex-associated blepharitis, either as monotherapy or in combination with other therapies. Across different treatment protocols and patient populations, ivermectin use was generally associated with reductions in Demodex mite density, improvement in cylindrical dandruff, ocular surface parameters, and patient-reported symptoms. Reported adverse events were infrequent and predominantly mild. Conclusions: Current evidence suggests that ivermectin may represent an effective and overall safe therapeutic option for Demodex-associated blepharitis. Further studies are needed to establish standardized treatment regimens and to assess long-term outcomes.

Causal effects of atopic dermatitis and rosacea on ventricular structure and function: a Mendelian randomization study.

Wu W, Huang GL, Cui J. Medicine (Baltimore). 2026 Aug 21;105(34):e50298. DOI: 10.1097/MD.0000000000050298. PMID: 42629688; PMCID: PMC13502878.

Rosacea and atopic dermatitis (AD) are 2 chronic inflammatory skin diseases. Studies have revealed that patients with rosacea and AD exhibit elevated risks of cardiovascular disease. However, the impact of these conditions on the ventricular structure and function remains to be elucidated. This study employed a two-sample Mendelian randomization (MR) approach, utilizing genetic variants as instrumental variables, to explore the genetic associations between rosacea and AD with alterations in ventricular function (including stroke volume and ejection fraction) and structural ventricular variations (including end-diastolic volume and end-systolic volume). The research design adhered to 3 core assumptions. Primary analyses were performed using the inverse-variance weighted method, complemented by 4 additional MR models and sensitivity analyses to ensure robustness. Additionally, multivariate MR was further integrated to adjust for potential confounders, such as systolic blood pressure and diastolic blood pressure. Genetically predicted AD exhibited a positive association with right ventricular end-systolic volume (odds ratio = 1.3640, 95% confidence interval = 1.0002-1.8601, P = .0498). However, this association was no longer statistically significant after adjusting for systolic blood pressure and diastolic blood pressure. Furthermore, no causal association was observed between rosacea and ventricular parameters (P > .05). Multiple sensitivity analyses confirmed the stability of the findings, with no evidence of horizontal pleiotropy (P > .05). Genetic prediction suggested a potential link between AD and impaired right ventricular function. However, no significant causal associations were identified between rosacea and ventricular structural or functional parameters.

Left atrial volume index in patients with Rosacea: a retrospective case-control study.

Celik C, Yasar E, Celik MS, et al. Acta Clin Belg. 2026 Aug 21:1-8. Epub ahead of print. DOI: 10.1080/17843286.2026.2720751. PMID: 42630071.

Objective: Rosacea is a chronic inflammatory skin disease that may have systemic and cardiovascular effects. The left atrial volume index (LAVI) reflects left atrial remodeling and diastolic function. This study evaluated LAVI and diastolic echocardiographic parameters in patients with rosacea. Materials and methods: This cross-sectional case-control study included patients with rosacea and age- and sex-matched healthy controls. All participants underwent transthoracic echocardiography. Left atrial diameter, left ventricular dimensions, ejection fraction (EF), transmitral Doppler parameters (E, A), tissue Doppler-derived early diastolic velocity (E'), E/E' ratio, and LAVI were recorded. Data distribution was assessed using the Shapiro-Wilk test. Intergroup comparisons were performed using appropriate statistical tests, and correlations between LAVI and echocardiographic parameters were assessed using Spearman correlation analysis. Results: A total of 150 participants were included, comprising 75 patients with rosacea (56 females and 19 males; mean age, 33.2 ± 10.7 years) and 75 age- and sex-matched healthy controls (53 females and 22 males; mean age, 33.5 ± 11.4 years). Compared with controls, patients with rosacea had significantly higher LAVI values (p < 0.001). In addition, significant differences were observed in E' velocity, E/E' ratio, and left atrial diameter (all p < 0.001), whereas ejection fraction was similar between the groups (p = 0.062). Correlation analysis demonstrated a moderate positive correlation between LAVI and E/E' (ρ = 0.489, p < 0.001), a weak negative correlation between LAVI and age (ρ = -0.219, p = 0.007), and a weak positive correlation between LAVI and EF (ρ = 0.175, p = 0.032). Conclusion: Patients with rosacea had higher LAVI values and altered diastolic echocardiographic parameters than healthy controls, suggesting subclinical alterations in cardiac filling dynamics. However, causality cannot be established from these observational findings. Larger prospective studies are needed for confirmation.

From the TPR pathway and the neuroimmune unit to the cutaneous HPA axis: a neuro-endo-immune cross-talk in rosacea.

He Z, Feng YY, Ning T, et al. Front Med (Lausanne). 2026 Jul 27;13:1800590. DOI: 10.3389/fmed.2026.1800590. PMID: 42577786; PMCID: PMC13455111.

The pathogenesis of rosacea is complex, and most of the pathogenesis is not completely clear, but the nervous system, the internal system and the immune system dysregulation is an important factor mediating the pathogenesis of rosacea, yet the three are not a single system's role, it is the mutual influence, the interaction together mediate the pathogenesis of rosacea. The skin is essentially a whole of neural, internal and immune functions. From the neurological aspect, the skin realizes information transmission by means of neural pathways and receptors, and releases neurotrophins and neuropeptides to influence the organism; from the internal level, the skin not only receives multiple signals, but also has an active part, and possesses a local regulatory function similar to that of the hypothalamus-pituitary-adrenal axis; with regard to the immune function, the skin not only relies on physical barriers, but also on immune cells and related molecules to play a defense function, and also participates in the inflammatory response. In terms of immunity, the skin not only relies on the physical barrier, but also on immune cells and related molecules for defense, and also participates in inflammatory reactions. As a multifunctional organ, the skin maintains homeostasis by regulating peripheral neurologic-endoimmune activities, and at the same time receives bi-directional regulation from the central nervous system, the integumentary system and the immune system. This article describes the three systems that work together in the pathogenesis of rosacea, detailing them in three perspectives: the TPR pathway, the neuroimmune cellular unit, and the cutaneous HPA axis. This article provides a certain summary of the pathogenesis of rosacea, as well as reflections on the underlying mechanisms.

Neuro-immune-vascular interactions in rosacea and hypertension: a mechanistic review.

Xie Y, Cai M. Front Immunol. 2026 Aug 3;17:1883039. DOI: 10.3389/fimmu.2026.1883039. PMID: 42609850; PMCID: PMC13478957.

Rosacea is a chronic inflammatory skin disorder characterized by recurrent flare-ups and significant variability in therapeutic responses. Its pathophysiology is complex and involves multilevel processes, including neurogenic dysregulation, immune activation, and alterations in vascular reactivity. Recent epidemiological studies suggest that rosacea may be associated with an increased risk of hypertension and other cardiometabolic diseases. However, it remains unclear whether this association merely reflects a comorbidity or indicates the presence of shared underlying pathophysiological mechanisms. Therefore, from an integrated neuro-immune-vascular perspective, this review summarizes current evidence regarding potential shared neuro-immune-vascular mechanisms that may be associated with rosacea and hypertension. Emerging evidence suggests that aberrant activation of sensory nerves, neuropeptide release, and subsequent innate and adaptive immune responses may collectively participate in a putative regulatory network. Locally, this network may be associated with neurogenic inflammation and aberrant vasodilation in the skin; at the systemic level, it may potentially be associated with dysregulated blood pressure control through mechanisms such as chronic low-grade inflammation, endothelial dysfunction, and vascular remodeling. By synthesizing evidence from dermatology, immunology, and vascular biology, this review summarizes potential neuro-immune-vascular interactions associated with rosacea and hypertension and discusses their possible implications for comorbidity management.

Effectiveness of 577-nm yellow laser in the management of steroid-induced rosacea: a prospective study.

Radhi Y, Alhamami H. Cureus. 2026 Jul 13;18(7):e112557. DOI: 10.7759/cureus.112557. PMID: 42445865; PMCID: PMC13358503.

Background: Steroid-induced rosacea (SIR) is a challenging condition resulting from prolonged topical corticosteroid use and is characterized by persistent erythema, telangiectasia, papules, and pustules. Although the 577-nm yellow laser has demonstrated efficacy in rosacea and other vascular dermatoses, its role in the treatment of SIR has not previously been investigated. Objective: To evaluate the safety and short-term clinical outcomes of 577-nm yellow laser therapy in patients with steroid-induced rosacea and to assess treatment outcomes according to clinical and telangiectatic subtypes. Methods: In this prospective study, 50 consecutive patients with steroid-induced rosacea were enrolled. Exclusion criteria included age <20 years, pregnancy, autoimmune disorders, and Fitzpatrick skin phototypes V-VI. Baseline assessment included eight symptoms and eleven clinical signs evaluated using standardized grading scales. Patients were treated with a 577-nm yellow laser (FlexSys®, GME GmbH, Germany) using a power of 20-23 W, pulse duration of 16-20 ms, and 50% coverage density. Clinical evaluations were performed before each treatment session and one month after the final session. Results: The mean duration of topical corticosteroid use was 43.2 ± 36.95 months (range: 4-240 months). The erythematotelangiectatic subtype was the most common clinical presentation (38/50, 76%), followed by the erythematous subtype (8/50, 16%) and papulopustular subtype (4/50, 8%). Among patients with a classifiable telangiectatic morphology (n = 42), network-like vessels were the predominant telangiectatic pattern (28/42, 66.7%), followed by arborizing superficial capillaries (10/42, 23.8%) and blue deep venules (4/42, 9.5%). After a median of two treatment sessions (range: 1-7), significant clinical improvement was observed. The greatest improvement among symptoms was seen in stinging sensation (13/50, 26%; 85.8%), diffuse redness (43/50, 86%; 84.1%), and papulopustular nodules (8/50, 16%; 79.7%). Among clinical signs, erythema (47/50, 94%; 87.0%) and flushing (33/50, 66%; 79.3%) demonstrated the highest response rates. In contrast, dryness (32/50, 64%; 17.7%), xerosis (17/50, 34%; 23.5%), wrinkles (2/50, 4%; 27.8%), and comedones (9/50, 18%; 35.1%) showed more limited improvement. Among telangiectatic morphologies, network-like vessels exhibited the most favorable therapeutic response. Conclusion: The findings of this prospective study suggest that a 577-nm yellow laser may represent a safe and promising adjunctive treatment for steroid-induced rosacea, particularly for improving erythema and superficial telangiectatic lesions when used as part of a standardized treatment protocol. To our knowledge, this is the first prospective study evaluating 577-nm yellow laser therapy in steroid-induced rosacea. Treatment outcomes appeared to vary according to telangiectatic morphology, with network-like vessels demonstrating more favorable responses than deeper vascular patterns. Larger controlled studies with longer follow-up are warranted to validate these findings.

Scalp rosacea: current evidence.

Olvera-Rodríguez V, Pampaloni F, Sechi A, Starace MVR. Dermatol Ther (Heidelb). 2026 Aug 1. Epub ahead of print. DOI: 10.1007/s13555-026-01871-2. PMID: 42541637.

Scalp rosacea, also known as red scalp disease (RSD), is an inflammatory dermatosis that remains underrecognized and frequently misdiagnosed because of its clinical overlap with other inflammatory scalp disorders and the relative nonspecificity of its findings. It is characterized by diffuse scalp erythema, dry scaling, vascular alterations, and inflammatory papules or pustules, often accompanied by pruritus or burning sensations. Despite being described several decades ago, scalp rosacea has only recently gained attention, and no standardized diagnostic criteria or therapeutic guidelines have yet been established. The prevalence of scalp rosacea is unknown; however, it appears to predominantly affect middle-aged men and has been associated with androgenetic alopecia, suggesting a potential role for increased ultraviolet exposure. Current evidence supports a multifactorial pathogenesis involving genetic susceptibility, dysregulation of the innate immune response, neurovascular alterations, and environmental triggers. Keratinocyte activation by exogenous stimuli induces cathelicidin/LL-37-driven inflammation, promoting macrophage activation, vasodilation, and angiogenic signaling. In addition, Demodex folliculorum infestation may contribute to disease persistence, with the scalp acting as a potential reservoir. Clinically, scalp rosacea presents with diffuse erythema and scaling, with sparse, non-follicular papules or pustules surrounded by dilated capillaries. Trichoscopy has emerged as a valuable diagnostic tool, revealing characteristic vascular and perifollicular patterns that aid in distinguishing scalp rosacea from other inflammatory scalp conditions. Histopathology, when required, demonstrates vascular ectasia and perifollicular inflammation without follicular destruction, confirming its non-scarring nature. Management relies on topical and systemic therapies extrapolated from facial rosacea, with oral tetracyclines as first-line treatment. Overall, prognosis is favorable, as progression to cicatricial alopecia does not occur. The aim of this review is to synthesize current evidence on the pathogenesis, clinical presentation, trichoscopic and histopathologic features, differential diagnosis, and therapeutic approaches to scalp rosacea, in order to improve its recognition and clinical management.

Webinar on Persistent Erythema in Rosacea

Please join us on Facebook Live on Tuesday, September 1, 2026 at 7 pm Eastern / 6 pm Central for a webinar on treatment of persistent erythema in rosacea, presented by Dr. Zoe Diana Draelos, president and founder of Dermatology Consulting Services in High Point, North Carolina, and a member of the NRS board of directors.

Dr. Draelos will provide an overview of rosacea diagnosis, and discuss the findings of her study, “Efficacy, Tolerance, and Safety of a Novel Botanical Anti-Inflammatory Moisturizer in Rosacea: Results from a Double-Blinded, Randomized Controlled Trial,” recently published in the Journal of Cosmetic Dermatology.

If you're a healthcare provider who sees rosacea patients, please join us for this informative session.

This webinar was made possible by an unrestricted educational grant from Crescel.

Case Reports

Improvement of rosacea with tirzepatide: a case report.

Mirza MN, Khan-Walton M, Esguerra D. J Drugs Dermatol. 2026 Aug 1;25(8):749-750. DOI: 10.36849/JDD.10058. PMID: 42555072.

We present a case of papulopustular rosacea that resulted in significant improvement following the initiation of tirzepatide, highlighting its potential as an adjunctive therapeutic option in obesity and metabolic dysfunction to achieve and maintain disease control.

Rhinophyma: a report of two patients managed with electrosurgery.

El Abbade H, Baybay H, Alheyasat R, et al. Cureus. 2026 Jul 11;18(7):e112465. DOI: 10.7759/cureus.112465. PMID: 42577983; PMCID: PMC13456070.

Rhinophyma is a chronic cutaneous condition secondary to rosacea that primarily affects the nose, leading to a bulbous and enlarged appearance. We report two cases of rhinophyma in 65- and 76-year-old men with long-standing rosacea evolving for more than 10 years. Both patients presented with progressive nasal enlargement, erythema, and nodular hypertrophy that had worsened over the previous five to seven years, leading to significant cosmetic and psychosocial impairment. The diagnosis was clinical. Surgical treatment was performed in both cases, including electrosurgical excision in one patient, allowing effective removal of hypertrophic tissue with good hemostasis and nasal remodeling. Postoperative care combined light-emitting diode photobiomodulation with adapted wound dressings and topical healing agents according to the stages of wound healing. Outcomes were favorable, with marked aesthetic improvement, reduction of nasal hypertrophy, and improved quality of life in both patients. Rhinophyma may significantly impair quality of life because of its progressive and disfiguring nature. Early management of rosacea with appropriate medical treatment is essential to limit progression; however, advanced hypertrophic forms may require therapeutic escalation to surgical approaches such as electrosurgery. In such cases, electrosurgical remodeling associated with appropriate postoperative wound care can provide favorable functional and aesthetic outcomes.

Vitiligo masked by steroid-induced rosacea-like dermatitis and revealed by VISIA ultraviolet imaging: a longitudinal case report.

Radhi Y, Almamoori A. Cureus. 2026 Jul 19;18(7):e112942. DOI: 10.7759/cureus.112942. PMID: 42614722; PMCID: PMC13483146.

Facial depigmentation may remain clinically unrecognized when obscured by persistent erythema associated with steroid-induced rosacea-like dermatitis (SIRD). We report a 42-year-old woman with Fitzpatrick skin phototype IV and a history of prolonged facial topical corticosteroid use who presented with persistent centrofacial erythema. Clinical examination was consistent with SIRD. Multimodal VISIA imaging revealed findings that were not appreciable under standard visible light: red-channel (RBX®) imaging demonstrated increased vascularity and telangiectasia, while ultraviolet imaging identified patchy depigmentation with a speckled pattern and perifollicular pigment preservation. Linear depigmentation corresponding to prior eyebrow tattooing suggested a Koebner phenomenon. Although advised to discontinue corticosteroids, the patient was lost to follow-up and returned three years later with persistent erythema and progression of depigmentation. Repeat ultraviolet imaging demonstrated an increased extent and partial coalescence of the depigmented areas. The longitudinal evolution, imaging features, perifollicular pigment preservation, and trauma-induced depigmentation were most consistent with evolving vitiligo coexisting with SIRD. Following corticosteroid withdrawal, topical tacrolimus 0.1% ointment was initiated. This case highlights how persistent facial erythema can mask progressive depigmentation and demonstrates the value of multimodal VISIA imaging, particularly red-channel and ultraviolet modalities, in detecting subclinical pigmentary changes, differentiating overlapping disease processes, and documenting disease progression.

News

Minoxidil Use May Increase Risk of Ocular Rosacea

Rosacea.org

A recent study investigated the medication minoxidil as a potential trigger for rosacea symptoms. Minoxidil is a vasodilator, often prescribed to treat hypertension and hair loss disorders. Vasodilation describes a physical process in which blood vessels widen, allowing more blood to flow through them. In treating hypertension, this helps reduce blood pressure. Exactly why minoxidil aids in regrowing hair is unknown, but vasodilation may help deliver more oxygen, blood and nutrients to hair follicles.

Low-Energy Dye Pulse Light Improves Rosacea Outcomes, Reduces Recurrence

Dermatology Advisor

Low-energy dye pulse light (DPL) therapy provides greater improvement in erythematotelangiectatic rosacea (ETR) and is associated with a lower 1-year recurrence rate than higher-energy treatment while maintaining a favorable safety profile, according to results of a study published in the Journal of Cosmetic Dermatology.

Ivermectin and Encapsulated Benzoyl Peroxide May Be More Effective Than Metronidazole for Rosacea

DocWireNews

According to a network meta-analysis, topical ivermectin and encapsulated benzoyl peroxide were each more effective for patients with rosacea than metronidazole.

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