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

Exploring new dimensions in longitudinal rosacea management.

Schaller M, Welsh B, Micali G, et al. Dermatol Ther (Heidelb). 2025 Dec 12. Epub ahead of print. DOI: 10.1007/s13555-025-01612-x. PMID: 41387649.

Rosacea is a common, chronic, inflammatory disease of the skin, which predominantly (but not exclusively) affects the centrofacial region. Clinical features may include transient or persistent facial erythema, recurrent flushing, telangiectasia, papules, pustules, phymatous changes, and ocular disturbances. These can lead to significant physical and psychological burden and discomfort, which adversely affects a patient's quality of life (QoL). While current guidelines provide recommendations on treatment initiation and modification, there is a lack of information for long-term management and maintenance. The Rosacea-Expert Advice on Combined and Holistic approaches (REACH) group is an international group of experienced dermatologists, brought together to address these shortcomings. This paper summarizes discussions from three REACH Global Scientific Committee (GSC) meetings, with the objective to simplify the rosacea management pathway and ensure that healthcare professionals are aware of rosacea triggers, pathogenesis, risk factors, comorbidities, chronicity, patient satisfaction, monitoring, and treatment options. The REACH GSC developed a rosacea management pathway as a backbone for this publication-to advise on each step, including pitfalls to avoid, patient discussions to conduct, tools and guidelines to employ, and clinical factors to consider. Being able to discern all the clinical features of rosacea specific to each patient is imperative, from recognizing overriding signs and symptoms to understanding potential comorbidities and assessing impact on QoL. Clear and sensitive communication regarding these elements, and what outcomes are achievable, will help to optimize therapeutic management and foster a sense of patient empowerment and disease control. For patients, being able to engage in their own long-term care of symptoms, signs, and flares is critical. Deepening the understanding of the condition as a chronic, yet eminently manageable one, will help empower patients with rosacea and their dermatologists alike. The REACH GSC project was initiated and funded by Galderma.

National Delphi consensus on laser and energy-based treatments for rosacea.

Nguyen L, Seeber N, Paasch U, et al. J Dtsch Dermatol Ges. 2025 Dec 19. Epub ahead of print. DOI: 10.1111/ddg.15976. PMID: 41414941.

Background: Various treatments are available for rosacea, including lasers and energy-based devices (EBDs). However, the specific role of lasers and EBDs in rosacea management remains insufficiently defined in Germany. The aim of the study was to develop a comprehensive expert consensus on the use of lasers and EBDs in the treatment of rosacea. Patients and methods: A three-phase study was conducted. First, a steering group performed a systematic literature review and meta-analysis. Second, a prospective, multicenter online survey gathered patient-reported experiences and treatment perspectives. Third, a structured, three-round Delphi process was implemented to discuss consensus statements based on the literature and patient input. Results: A total of 185 patients participated in the survey. Based on the systematic review and patient questionnaire consensus was performed on (1) the role of lasers and EBDs across different rosacea phenotypes, (2) the integration of laser/EBD treatments with combination therapies, and (3) best practices for pre- and post-treatment care. 16 dermatologists contributed to the Delphi process. Conclusions: This expert consensus offers practical guidance for incorporating laser and EBD therapies into rosacea treatment strategies. The Delphi process clarifies key aspects of their role in management, their integration into combination therapies and directions for future research.

Impact of oral DFD-29, a low-dose formulation of minocycline, on quality of life in patients with rosacea: results of two phase 3 randomized controlled trials.

Gold LS, Yamauchi P, Dirschka T, et al. J Clin Aesthet Dermatol. 2025 Oct;18(10):66-72. PMID: 41416027; PMCID: PMC12710994.

Objective: DFD-29 is a low-dose modified formulation of minocycline 40mg that has demonstrated efficacy and safety in patients with rosacea. We report the effect of DFD-29 on patient-reported assessments of disease severity and quality of life (QoL) from two clinical trials in patients with moderate-to-severe rosacea. Methods: MVOR-1 (NCT05296629) and MVOR-2 (NCT05343455) were 16-week, randomized, double-blind, active- and placebo-controlled Phase III trials that compared the impact of oral DFD-29 (EMROSI, Journey Medical Corporation), doxycycline 40mg, and placebo in adults aged 18 years or older with moderate-to-severe rosacea. Changes in QoL were exploratory endpoints that were evaluated at baseline and Weeks 2, 4, 8, 12, and 16 using the Rosacea-Specific Quality of Life (RosaQoL) questionnaire and the Dermatology Life Quality Index (DLQI). Results: Among randomized subjects, 288 completed MVOR-1 (DFD-29, n=117; doxycycline, n=98; placebo, n=73) and 296 completed MVOR-2 (DFD-29, n=115; doxycycline, n=113; placebo, n=68). In both trials, DFD-29 significantly improved QoL versus placebo (p<0.05) as assessed by RosaQoL and DLQI over 16 weeks. In MVOR-2, DFD-29 was also significantly superior to doxycycline in improving least squares mean RosaQoL scores at Week 12 (p=0.034). In MVOR-1, patients reported superior improvements in DLQI scores with DFD-29 versus doxycycline (p<0.05) at Weeks 4, 8, and 12. Limitations: RosaQoL and DLQI were exploratory endpoints. Conclusion: These data suggest that DFD-29 may be useful in improving QoL in patients with moderate-to-severe rosacea.

Topical medications for moderate-to-severe rosacea: protocol for a living systematic review and network meta-analysis.

Amstutz AV, Fladger A, Sanchez-Feliciano A, Barbieri JS. BMJ Open. 2025 Dec 21;15(12):e109057. DOI: 10.1136/bmjopen-2025-109057. PMID: 41423296.

Introduction: Rosacea is a chronic skin condition characterised by papules, pustules, transient erythema (flushing), persistent erythema, telangiectasia and phymatous changes. Rosacea can be associated with substantial effects on quality of life. Rosacea is most commonly treated with topical therapy, but little is known about the relative efficacy of these treatment options. Since most randomised controlled trials of topical rosacea therapies do not include active comparators (ie, head-to-head comparisons), indirect comparisons must be made to understand the relative efficacy, safety and tolerability of these treatment options. The aim of this study is to conduct a living network meta-analysis evaluating topical therapies for moderate to severe rosacea. The results of this study can guide clinical decision-making and improve patient outcomes. Methods and analysis: Data search will be conducted in the Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Web of Science and Embase. Screening of titles, abstracts and full papers, as well as data extraction, will be conducted by two independent researchers in duplicate. Primary outcomes will include mean change in absolute lesion count, Investigator Global Assessment (IGA) and treatment discontinuation for adverse events or side effects. Secondary outcomes will include percentage change in lesion count, changes in quality of life, Patient Global Assessment, Clinician Erythema Assessment (CEA) and change in rosacea facial redness. For each outcome with enough qualified data, a network meta-analysis using a random-effects model will be carried out. We plan for a living review with continuous updating of the analysis as new treatments become available.

Therapeutic and formulation advances of ivermectin in veterinary and human medicine.

Gernandt N, Wentzel C, van Staden D, et al. Pharmaceutics. 2025 Oct 25;17(11):1384. DOI: 10.3390/pharmaceutics17111384. PMID: 41304722; PMCID: PMC12655129.

The treatment of parasitic infections has evolved in terms of effectiveness and the prevention of drug resistance. This is highlighted by the discovery of ivermectin (IVM), a macrocyclic lactone and broad-spectrum antiparasitic agent. IVM garnered scientific attention by presenting a therapeutic alternative in the field of veterinary medicine due to its control of multiple parasite species, including nematodes and soil-transmitted helminths. Shortly after its discovery, IVM was approved for human use by the World Health Organization (WHO) and United States Food and Drug Administration (FDA) for combating head lice, onchocerciasis, rosacea, scabies, and worm infestations within the gastrointestinal tract (GIT). In veterinary medicine, IVM is available in a range of formulations and can be administered via different routes (i.e., oral, topical, and parenteral), whereas for humans, IVM is only approved as a single oral dose and dermal cream. Establishing a comprehensive overview of IVM's applications in both human and veterinary medicine is necessary, particularly in light of its repurposing potential as a treatment for various conditions and emerging diseases. Given its primary application in veterinary medicine, there is a need to enhance the development of dosage forms suitable for human use. Therefore, this review details the discovery, mechanisms, and applications of IVM, while also examining the challenges of resistance, side-effects, and controversy surrounding its use, to ultimately emphasize the importance of targeted, optimized IVM delivery via tailored dosage form development in animals and humans as part of the One Health approach to interlink innovations across veterinary and human medicine fields.

Therapeutic effect of an MRGPRX2/MRGPRB2 antagonist on LL-37-induced rosacea-like inflammation in mice.

Chow BKC, Choi YG, Wong TK, et al. Inflamm Res. 2025 Nov 26;74(1):174. DOI: 10.1007/s00011-025-02144-y. PMID: 41296102; PMCID: PMC12657586.

Introduction: Rosacea is a chronic inflammatory skin disorder characterized by symptoms like itching, redness, and impaired skin barrier function. Mast cell activation plays a crucial role in its pathogenesis. Recent evidence shows higher expression of mast cell receptor MRGPRX2/MRGPRB2 in rosacea patients' skin tissues and its potential as a novel drug target. We evaluated the therapeutic effect of a novel small-molecule MRGPRX2/MRGPRB2 antagonist in a mouse model of rosacea and itch. Methods: The therapeutic effects of GE1111 were evaluated in vivo on wildtype and MRGPRB2 knock-out mice with LL-37-induced rosacea. Serum MCP-1 level and histochemistry measured inflammation and mast cell degranulation in skin tissue. Functional in vitro cell culture assays were developed using MRGPRX2/MRGPRB2 agonist LL-37, mast cells, keratinocytes, and macrophage cell lines. Results: LL-37-treated mice showed redness, increased serum MCP-1, and epidermal thickness of skin tissue, while these changes were absent in LL-37-treated MRGPRB2 knock-out mice. Treatment with GE1111 reduced rosacea symptoms, epidermal thickness, and serum MCP-1 levels. GE1111 protected tight junction protein expression and reduced mast cell degranulation and inflammatory cytokine gene and protein expression in skin lesions. GE1111 treatment reduced the number and duration of itch in the compound 48/80 induced itch model. In vitro evidence showed GE1111's mechanism by inhibiting inflammatory interaction of mast cells with keratinocytes and macrophages. Conclusion: GE1111 showed promising therapeutic effects in rosacea via targeting interactions between mast cells, keratinocytes, and macrophages and inhibiting inflammatory cytokines. These findings open possibilities for developing MRGPRX2/MRGPRB2 antagonists as novel treatments for rosacea.

Quantitative infrared meibography for ocular rosacea: lower eyelid meibomian gland loss as a diagnostic marker.

Gokcinar NB, Karabulut AA. BMC Ophthalmol. 2025 Nov 29. Epub ahead of print. DOI: 10.1186/s12886-025-04545-3. PMID: 41318445.

Purpose: To quantitatively assess meibomian gland loss (MGL) using infrared meibography in patients with ocular rosacea and to evaluate its diagnostic performance and relationship with ocular surface parameters. Methods: Thirty eyes from 30 patients with ocular rosacea and 34 eyes from 34 controls were analyzed. The Ocular Surface Disease Index (OSDI), Schirmer I test (without anesthesia), Oxford staining, and non-invasive tear break-up time (NITBUT) were recorded. Infrared meibography (Sirius system) quantified MGL in both upper and lower eyelids. Receiver operating characteristic (ROC) curve and logistic regression analyses were performed. Results: Meibomian gland loss was significantly higher in both upper (31.4 ± 13.8% vs. 20.0 ± 7.3%) and lower (46.0 ± 12.5% vs. 18.4 ± 9.6%) eyelids of patients compared with controls (both p < 0.001). ROC analysis showed excellent diagnostic accuracy for lower-lid MGL (AUC = 0.97, 95% CI: 0.93–1.00; p < 0.001) with an optimal cut-off of 30.2%, yielding 100% sensitivity and 91% specificity, whereas upper-lid MGL showed moderate accuracy (AUC = 0.77, 95% CI: 0.62–0.91). Lower-lid MGL showed a strong correlation with NITBUT (r = − 0.63) and modest but significant correlations with OSDI (r = 0.32) and Oxford staining (r = 0.29; all p < 0.05). Conclusions: Ocular rosacea is associated with marked meibomian gland dropout in both eyelids, with the lower lid showing superior diagnostic performance. Quantitative infrared meibography provides an objective and practical tool for assessing gland involvement in ocular rosacea.

Efficacy and safety of tranilast combined with minocycline in the treatment of moderate-to-severe rosacea: a prospective, randomized controlled study.

Liang J, Chen Y, Yang M, et al. J Dermatolog Treat. 2026 Dec;37(1):2597711. Epub 2025 Dec 22. DOI: 10.1080/09546634.2025.2597711. PMID: 41424372.

Background: Rosacea is a common chronic inflammatory skin disease. Mast cells are implicated in the pathogenesis of rosacea. However, the therapeutic potential of tranilast, a mast cell membrane stabilizer, remains unexplored. This study aims to evaluate the efficacy and safety of tranilast monotherapy and in combination with minocycline in patients with moderate-to-severe rosacea. Methods: This study has been registered on ClinicalTrials.gov (Registration No. NCT06307223). All enrolled patients with rosacea were randomly assigned to receive tranilast, minocycline, or a combination of both. Tranilast (0.1 g, three times daily) and minocycline (50 mg, once daily) were administered for 12 weeks, with follow-up every two weeks. Results: Forty-five patients completed the study. At week 12, the combination group showed a significantly higher IGA success rate (93.33%) compared to the tranilast (53.33%) and minocycline (46.67%) groups (p < 0.05). The secondary endpoints, such as CEA success rate, erythema index, and erythema score, also favored the combination group over minocycline group (p = 0.021, 0.030, and 0.024, respectively). Conclusion: In our study, patients with moderate to severe rosacea treated with tranilast showed a favorable clinical response and experienced no serious adverse events. The combination therapy yielded better outcomes than minocycline monotherapy, especially in improving facial erythema.

Clinical manifestations and treatment outcomes of pediatric rosacea patients: a retrospective study.

Kim YJ, Park JM, Lee HM,et al. J Clin Med. 2025 Dec 11;14(24):8783. DOI: 10.3390/jcm14248783. PMID: 41464684.

Background: Rosacea is a chronic inflammatory skin disorder with limited research in pediatric populations. The study aims to characterize the clinical features and evaluate treatment outcomes in Korean pediatric patients with rosacea. Method: We retrospectively reviewed the medical records of 22 pediatric patients with rosacea who visited a tertiary hospital in Korea (2013-2023). Results: A total of 22 patients (F:M = 1.75:1) were included. The mean age at presentation was 14 ± 3.3 years. Papulopustular rosacea (PPR) was the most common subtype (72.7%), followed by ocular (45.5%) and erythrotelangiectatic rosacea (ETR) (27.3%). PPR was more frequently associated with nose involvement, while ETR predominantly affected the cheek. The mean duration of systemic treatment was 16.8 weeks, with 63.6% achieving favorable responses; however, 54.5% experienced recurrence, particularly females and those with PPR. The average symptom-free duration after discontinuing systemic treatment was 16.8 months. Conclusions: In Korean pediatric patients with rosacea, clinical features and treatment outcomes were similar to the results of previous studies conducted in Western populations. However, in terms of epidemiology, a female predominance and adolescent onset were notable, which differ from previous studies. Additionally, the study presented the clinical differences between ETR and PPR and suggested potential predictors of recurrence in pediatric rosacea.

Clinical updates of JAK inhibitors in cutaneous granulomatous diseases.

Gu J, He X, Lu B, et al. Front Immunol. 2025 Dec 12;16:1698816. DOI: 10.3389/fimmu.2025.1698816. PMID: 41459541; PMCID: PMC12740879.

Cutaneous granulomatous diseases, characterized by persistent granuloma formation, often exhibit chronic and relapsing courses that are challenging to manage with conventional therapies. The Janus kinase (JAK)-signal transducer and activator of transcription (STAT) pathway plays a central role in mediating key cytokines involved in granuloma initiation and maintenance, such as IFN-γ, IL-6, IL-12, and IL-23. JAK inhibitors, by targeting this pathway, offer a promising therapeutic strategy for refractory cases. This review synthesizes current evidence supporting the efficacy of JAK inhibitors-including tofacitinib, ruxolitinib, baricitinib, upadacitinib, and abrocitinib-in conditions such as sarcoidosis, granuloma annulare, granulomatous rosacea, and adverse reactions to cosmetic injectables. Clinical studies and case reports have demonstrated that JAK inhibitors significantly improve lesion outcomes and effectively control symptoms in these conditions, highlighting their potential as targeted treatments. However, further large-scale trials are needed to establish optimal dosing, long-term safety, and predictive biomarkers for personalized therapy.

Case Reports

Unilateral presentation of Morbihan's disease: a comprehensive case report and review.

Alvarez IJ, Nguyen K, Samala S, et al. Orbit. 2025 Nov 12:1-11. Epub ahead of print. DOI: 10.1080/01676830.2025.2581628. PMID: 41222206.

We report a case of unilateral Morbihan's disease (MD) in a 55-year-old male presenting to a private oculofacial practice in San Francisco. Successful treatment with a series of triamcinolone injections to the upper and lower eyelids was achieved after several unsuccessful therapies. The authors provide a comprehensive review of the literature from 2022 to 2025 on MD.

Granulomatous rosacea of the scalp.

Rezende HD, Fukuma LO, Delgado JC, et al. Int J Trichology. 2025 May-Jun;17(3):273-274. Epub 2025 Nov 19. DOI: 10.4103/ijt.ijt_98_23. PMID: 41346560; PMCID: PMC12674469.

Granulomatous conditions of the scalp are rare and challenging in clinical practice. Patients with granulomatous rosacea (GrR) often tell a long history of unsuccessful treatments; this is possibly related to the lack of a correct diagnosis owing to the unspecific cutaneous appearance of granulomatous diseases. Moreover, signs on physical examination are generally inconspicuous which adds little value to diagnosis regarding its etiology.

A novel presentation of minocycline-induced nail discoloration: a case report.

Li K, Zha W, Qian Y, Shi L. Exp Ther Med. 2025 Dec 1;31(2):41. DOI: 10.3892/etm.2025.13036. PMID: 41383251; PMCID: PMC12690544.

Minocycline, a tetracycline antibiotic used to treat acne and rosacea, is known to cause nail discoloration, typically as blue-gray pigmentation. However, other unique manifestations are less frequently reported. A 19-year-old male with acne developed a unique 'snow mountain nail' after one month of minocycline treatment. The patient's nails showed blue-gray pigmentation near the nail bed, along with bright white changes at the free edge and parallel white stripes on the nail bed, forming a distinctive dual-color pattern. After the discontinuation of minocycline, the treatment plan was also adjusted. After 2 months, the pigmentation was significantly reduced. After 2 years the nails had returned to normal and there were no residual pigmented spots. The 'snow mountain nail' phenomenon introduces a novel clinical presentation of minocycline-induced pigmentation. It may be proposed that minocycline forms chelates with iron, which accumulate in the nail cuticle, causing discoloration. The bright white stripes may result from changes in the blood supply or inflammation in the nail bed. This case expands the understanding of minocycline-induced nail discoloration, emphasizing the importance of early recognition and management of this side effect to minimize its cosmetic and psychological impact. The present findings offer new insights into its pathogenesis and diagnostic significance.

News

Rosacea Treatment: Filling In the Gaps

Medscape

Despite recent advances in rosacea therapy and an ongoing shift toward phenotype-driven treatment, experts told Medscape Medical News that addressing the multifaceted mechanisms of rosacea remains challenging. With research into novel therapeutic approaches largely in early stages, dermatologists must optimize an existing armamentarium that leaves room for improvement, particularly regarding symptoms beyond inflammation.

Persistent Facial Redness in a Patient Treated for Rosacea

The Dermatologist

Editor's Note: In this new On the Case series, we ask a dermatologist to share how they would treat the presented case. A 29-year-old woman with a 9-year history of rosacea and acne was referred to dermatology. Three months prior, the patient reported to the office with papules and pustules coalescing in an irregular plaque on the right cheek and diffuse background erythema with superficial telangiectasias of the central face. She was prescribed azithromycin 250 mg daily for 1 week then twice weekly and metronidazole gel 0.75% to the face nightly. The patient reported that she was trying to get pregnant and was told to stop oral antibiotics if she became pregnant.

Dermatology Times 2025 Year in Review: Rosacea

Dermatology Times

Throughout 2025, rosacea remained a key area of focus in dermatology, reflecting both its high prevalence and the ongoing challenges associated with managing a chronic, heterogeneous inflammatory condition. Over the past year, Dermatology Times reported on a range of developments shaping rosacea care, from FDA approvals and late-stage clinical trial results to emerging research on microbiome involvement, barrier dysfunction, and energy-based therapies.

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