Rosacea Research Digest - February 28, 2025
The latest research on rosacea, including reports on comorbidities, new treatments, and case studies.
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
Early investigational agents for the treatment of rosacea: drugs in phase I and II clinical development.
Moran SK, Wong SC, Taylor SL, Feldman SR. Expert Opin Investig Drugs. 2025 Jan-Feb;34(1-2):27-36. Epub 2025 Feb 9. doi:10.1080/13543784.2025.2463093. PMID: 39918332.
Introduction: Rosacea is a multifactorial chronic dermatologic condition with a psychosocial burden for patients. There are topical, systemic, laser, and light treatments FDA-approved, but many patients remain under- or non-responsive to those available, leaving a need for more options. Areas covered: Based on a literature search using databases, PubMed, Embase, Cochrane Library, and Clinicaltrials.gov, using keywords 'rosacea clinical trials,' we discuss treatments undergoing phase I and II clinical trials for rosacea, as well as other early clinical studies. Expert opinion: The evolving understanding of rosacea's multifaceted pathophysiology, including neurovascular dysregulation and immune responses, has led to exploration of novel treatments. Mainstays of treatment are topical and systemic antibiotics, topical vasoconstrictors, pulsed dye laser, and intense pulsed light. However, even with these treatment options, some patients remain unsatisfied with results. Addressing the underlying pathophysiology of rosacea may be more effective than a siloed approach. Therapies on the horizon, such as phosphodiesterase-4 inhibitors, biologics, topical tyrosine kinase inhibitors, neurotoxin, topical probiotics, Dermaceuticals, oral tranexamic acid, oral supplements, and neuropeptide modulators are investigated as targeted interventions. Use of lasers in synergy with topical treatments offers a multipronged personalized approach. While management remains challenging, ongoing research provides promise for additional effective and individualized treatment plans.
Vascular remodeling in rosacea: a study on microcirculatory insights using oral capillaroscopy.
Demirbas A, Demirbas GU, Diremsizoglu E. J Cosmet Dermatol. 2025 Feb;24(2):e70012. doi:10.1111/jocd.70012. PMID: 39918088; PMCID: PMC11803680.
Background: Rosacea is a chronic inflammatory skin condition characterized by facial erythema, telangiectasia, and papules. Although clinical assessment is essential for diagnosis, objective criteria for evaluating severity are lacking. This study aimed to investigate the relationship between rosacea severity, disease duration, and associated microvascular changes through oral mucosal capillaroscopy. Methods: This cross-sectional case-control study included patients with rosacea and healthy controls. Oral capillaroscopy was performed to evaluate capillary morphology, analyzing parameters such as capillary arrangement (regular or irregular), presence of dot vessels, microhemorrhages, glomerular vessels, megacapillaries, tortuous vessels, areas of discoloration, and hyperkeratosis. Results: A total of 100 patients diagnosed with rosacea and 100 healthy controls were included in the study. Oral capillaroscopic findings revealed significantly higher rates of family history of rosacea and tortuous capillaries in the patient group. Patients with microhemorrhages exhibited a longer disease duration. No significant differences in tortuous capillary positivity were found between the papulopustular and erythematotelangiectatic subtypes; however, phymatous rosacea demonstrated no positive findings. Additionally, moderate-severity patients had lower rates of microhemorrhage positivity, whereas the presence of tortuous capillaries increased with severity. Conclusion: Oral mucosal capillaroscopy is a valuable tool for assessing microvascular damage in rosacea and may serve as a diagnostic and prognostic marker for effective management.
Exploring the psychodermatologic burden and associated psychiatric manifestations in rosacea: a systemic review.
Sharifi S, Katamanin O, Jafferany M. Arch Dermatol Res. 2025 Feb 15;317(1):427. doi:10.1007/s00403-025-03982-w. PMID: 39954108.
Rosacea is an inflammatory skin disorder possessing significant mental health implications, including anxiety and depression. Although the disease's link to psychiatric outcomes has been explored, recent data highlights the need for a deeper examination of underlying pathways and overall burden. This systematic review aims to synthesize and evaluate the current literature on the association between rosacea and anxiety and depression, with particular attention to establishing multidisciplinary treatment approaches. A comprehensive review of the PubMed, Embase and Web of Science databases was performed to select peer-reviewed English studies relevant to our topic. Our results reveal that anxiety and depression continue to affect a majority of rosacea patients, with certain demographic variables such as age and gender modulating psychiatric burden. The complex interaction between rosacea and its psychological outcomes is thought to rely on inflammatory mediators, lipid metabolism, and neurotropic factors. Certain treatment options, including carvedilol, paroxetine and Cortexin, may target these core processes and hence, help alleviate psychological sequalae. Bearing these insights in mind, dermatologists should focus on adopting interdisciplinary treatment plans. Future research should prioritize longitudinal designs, diverse populations, and standardized methodologies to deepen our understanding of the relationship between anxiety, depression, and rosacea.
Medicaid formularies for rosacea treatment are often restrictive and show inconsistency in transparency and coverage.
Lowry WP, Nock MR, Cohen JM, Barbieri JS. J Am Acad Dermatol. 2025 Jan 15:S0190-9622(25)00053-2. Epub ahead of print. doi:10.1016/j.jaad.2025.01.014. PMID: 39824354.
To the Editor: Rosacea is a chronic inflammatory skin condition characterized by papules, pustules, redness (ie, flushing, persistent erythema, telangiectasia), and phymatous changes that can cause patients significant psychosocial distress and disfigurement, particularly if left untreated. Although it has been suggested that treatments for papules and pustules may be better covered than treatments for redness and flushing, Medicaid formulary access and coverage for rosacea treatments has not been assessed.
Exploring the link: trichostasis spinulosa and its association with early phymatous rosacea.
Andrea S, Luca M, Arturo G. Skin Appendage Disord. 2025 Feb;11(1):9-13. Epub 2024 Aug 16. doi:10.1159/000540509. PMID: 39911977; PMCID: PMC11793881.
Introduction: Rosacea is a chronic inflammatory skin condition with several clinical subtypes, including phymatous rosacea, which is distinguished by thickened skin, enlarged pores, and irregular surface nodularities, primarily affecting the nose. This manuscript aims to explore the underrecognized connection between early to moderate phymatous rosacea and trichostasis spinulosa (TS), a follicular disorder characterized by the retention of multiple telogen hairs. Methods: A total of consecutive 13 patients with initial phymatous changes and black dilated openings were enrolled. Detailed dermatological assessments, including dermoscopy, were conducted to identify and confirm trichostasis spinulosa. Dermoscopy of the black openings confirmed the presence of hair tufts emerging from dilated follicular openings and plugs. Patients underwent minor procedures using a comedo extractor to remove the hair bundles. Results: All extracted follicular units showed typical characteristics of trichostasis spinulosa, including bundles of telogen hairs surrounded by a sebokeratinous plug. Conclusion: We postulate that the fibrotic processes characteristic of phymatous rosacea may promote the development of TS. Recognizing TS as an early indicator of phymatous rosacea could help prevent disease progression.
The role of fibroblasts in chronic inflammatory and proliferative skin diseases.
Zang R, Xu CC, Fan Z, et al. Exp Dermatol. 2025 Feb;34(2):e70066. doi:10.1111/exd.70066. PMID: 39984797.
Fibroblasts are crucial mesenchymal cells that preserve the skin's natural structure and physiological processes. They can build dense connective tissue by remodelling the extracellular matrix and control immunological activity by secreting cytokines. This indicates that the development of chronic inflammatory and proliferative skin disorders is significantly influenced by fibroblasts. In order to provide new ideas for clinical research and treatment with a clearer perspective, this study thoroughly compiles the involvement of fibroblasts in various chronic inflammatory and proliferative skin diseases such as psoriasis, hypertrophic scar, keloid, atopic dermatitis, oral lichen planus, chronic eczema, and rosacea.
Skin 101: understanding the fundamentals of skin barrier physiology — why is this important for clinicians?
Del Rosso, J. Q., & Kircik, L. (2025). J Clin Aesthet Dermatol. 2025;18(2):7–15.
This article reviews epidermal barrier dysfunctions and more thoroughly discusses the stratum corneum (SC) permeability barrier, physiologic self-repair mechanisms in healthy skin, and the clinical and structural effects of an overstressed SC permeability barrier. Discussion includes epidermal barrier impairments induced by both exogenous exposures and endogenous factors such as specific dermatologic disorders. Due the plethora of skin care products on the market and the variability of their contents and vehicle formulations, this article addresses core concepts required to optimize skin care product selection, including for specific disease states such as atopic dermatitis, psoriasis, acne vulgaris, and rosacea. To summarize, the selection of skin care products is directed at maintaining SC hydration, including assisting the SC in self-repair when conditions are adverse. This approach optimizes the ability to sustain healthy skin structure, function and appearance.
Genetic analyses reveal association between rosacea and cardiovascular diseases.
Gao Y, Xu C, Yan Q. Sci Rep. 2025 Feb 24;15(1):6657. doi:10.1038/s41598-025-91240-4. PMID: 39994418; PMCID: PMC11850808.
Previous studies have shown that patients with rosacea tend to have a higher risk of developing cardiovascular diseases (CVDs). However, the potential causal relationship between genetic susceptibility to rosacea and the risk of CVDs remains unclear. Based on summary statistics from publicly available genome-wide association studies, we detected the genetic association between rosacea and CVDs by a bidirectional two-sample Mendelian randomization (MR) analysis. The inverse-variance weighted method was used as the primary analysis, while weighted median and MR-Egger were applied as complementary methods. For sensitivity analyses, we applied Cochran's Q test, the intercept of MR-Egger, MR-Pleiotropy Residual Sum and Outlier (MR-PRESSO), funnel plot, and leave-one-out analysis. The MR analysis revealed that rosacea was associated with an elevated risk of hypertension (HTN) (OR = 1.0032, 95% CI [1.0001-1.0063], P = 0.04). However, no casual relationship was found between rosacea and risk of atrial fibrillation (OR = 1.0099, 95% CI [0.9823-1.0382], P = 0.49), coronary artery disease (CAD) (OR = 1.0138, 95% CI [0.9824-1.0462], P = 0.39), heart failure (HF) (OR = 0.9965, 95% CI [0.9671-1.0268], P = 0.82), ischemic stroke (OR = 0.9933, 95% CI [0.9545-1.0337], P = 0.74), or myocardial infarction (MI) (OR = 1.0001, 95% CI [0.9988-1.0013], P = 0.92). In the sensitivity analysis, significant heterogeneity was revealed in the MI subgroup according to the Cochran's Q test. Other sensitivity analyses indicated the stability of our results. Reverse MR analysis showed no significant genetic effect of cardiovascular disease on rosacea risk. We are the first to use MR analysis to explore the casual relationship between rosacea and the risk of various CVDs, revealing an increased risk of HTN in patients with rosacea.
Intradermal injection of botulinum toxin for erythema in rosacea: A scoping review and meta-analysis.
Yeh MC, Shih YC, Huang YC. Indian J Dermatol Venereol Leprol. 2025 Jan 8:1-7. Epub ahead of print. doi:10.25259/IJDVL_274_2024. PMID: 39912154.
Background: Rosacea is a skin condition characterised by persistent facial erythema, flushing, papules, pustules, and telangiectasia. Botulinum toxin A (BoNT-A) has been used to treat a variety of conditions, but its effectiveness in improving facial erythema in rosacea patients is uncertain. Objectives: The aim of the study is to evaluate the effectiveness and determine the optimal dose of BoNT-A treatment for rosacea. Methods: An online database search (Pubmed, Cochrane Library and Embase) was conducted on 30th June 2023 to identify studies that used intradermal injection of BoNT-A to treat facial erythema in rosacea patients and excluded studies in which BoNT-A was used for facial erythema due to other known medical condition such as menopause, drug or pregnancy. The primary outcome measure for this study was the improvement in erythema score as objectively assessed. A random effect model was used in the meta-analysis. Results: Seven studies involving a total of 167 rosacea patients were included in the meta-analysis. Meta-analysis of two randomised controlled trials showed improvement of erythema on the third month after treatment standardized mean difference (SMD): 1.676, 95% confidence interval (CI): 2.278-1.074, I2: 35.76%). A separate analysis of seven single-armed treatment studies found significant improvement in erythema with intradermal injection of BoNT-A at one, two and three months after treatment (first month: SMD: 2.712, 95% CI: 4.1182-1.243; second month: SMD:2.213, 95% CI: 3.702-0.725; third month: SMD: 1.912, 95% CI: 2.882-0.941). Adverse events, including mild facial paralysis and injectional purpura, were reported in some studies. Limitation: The limitations of this study include heterogeneity in study design and a small sample size. Conclusion: Intradermal injection of BoNT-A may be an effective treatment for facial erythema in rosacea. Unwanted facial muscle paralysis was seen in different BoNT-A concentration but not noted when the dose was less than 0.02ml per site. Future studies particularly randomised trials are required to identify the volume of injection required to reduce the erythema.
Case Reports
Rosacea-like skin reaction under treatment with dupilumab for atopic dermatitis.
Grote C, Zirkenbach F, Wagner JN, Augustin M. J Dermatolog Treat. 2025 Dec;36(1):2452987. Epub 2025 Jan 27. doi:10.1080/09546634.2025.2452987. PMID: 39870387.
Purpose: Dupilumab is a widely recommended treatment for moderate-to-severe atopic dermatitis (AD), with known ocular side effects but less frequent cutaneous reactions. Material and methods: This case report details a 52-year-old female patient with atopic dermatitis treated with dupilumab. After an initially successful treatment, the patient developed a rosacea-like dermatitis. At first, dupilumab was continued alongside doxycycline, metronidazole gel and ivermectin cream. Results: Following a worsening of her skin condition, dupilumab was discontinued. Lebrikizumab was introduced, leading to significant regression of the lesions. Conclusions: This case highlights a rare paradoxical skin reaction to dupilumab, potentially linked to the blockade of IL-4Rα, which may shift the immune response towards a Th1/Th17 phenotype. The findings suggest that alternative therapies, such as IL-13 inhibitors, should be considered when cutaneous side effects arise during dupilumab treatment.
Acneiform eruption secondary to deucravacitinib: a case series and review of the literature.
Tran V, Wong C, Lee S, Rodrigues M. Australas J Dermatol. 2025 Feb 1. Epub ahead of print. doi:10.1111/ajd.14425. PMID: 39891469.
Acneiform eruptions have been observed and reported in clinical trials for tyrosine kinase 2 (TYK2) inhibitors. However, data on their occurrence in real-world settings remain limited. This case series describes six patients, who developed acneiform eruptions following the initiation of deucravacitinib for chronic plaque psoriasis. Through this case series, we aim to shed further light into the clinical characteristics and potential risk factors for this side effect. Contrary to clinical trial data, we demonstrate high cessation rates of deucravacitinib following the development of acneiform eruption, due to the significant burden on quality of life. We highlight the need to identify risk factors to improve patient selection and allow adequate counselling or prophylactic treatments for these acneiform eruptions.
A case of hybrid cellular neurothekeoma and perineurioma with a folliculin gene mutation.
Prechtel TJ, Brashear E, Dehner CA, Alomari AK. J Cutan Pathol. 2025 Feb 27. Epub ahead of print. doi:10.1111/cup.14799. PMID: 40015928.
Hybrid peripheral nerve sheath tumors (PNSTs) are benign tumors that show features of more than one type of PNST. Benign cutaneous plexiform hybrid tumor of perineurioma and cellular neurothekeoma (BCPHTPCN) is a rare, recently described entity that shows various combinations of histomorphologic and immunophenotypic features of the PNSTs perineurioma and cellular neurothekeoma. Our case describes a middle-aged man initially presenting with an acute papulopustular rosacea flare. Rosacea treatment unmasked a prominent erythematous papule on the forehead. A biopsy was taken, and histopathological examination showed a proliferation of epithelioid, ovoid, and spindled cells arranged in a compact nested and intersecting fascicular growth. Immunohistochemical stains were positive for NKI/C3, CD10, PGP9.5, MITF, and GLUT-1. There was weak reactivity with EMA and minimal reactivity with Claudin-1. Tumor cells were negative for SOX10, CD163, CD68, CD34, ALK, and Pan-TRK. The patient was diagnosed with BCPHTPCN. DNA and RNA sequencing showed a folliculin (FLCN) gene mutation, which is most commonly associated with Birt-Hogg-Dubé syndrome. The patient underwent excision and has remained without recurrence or complications several months post-diagnosis. We hope to expand the clinical and histopathologic characteristics of this peculiar neoplasm, as well as provide additional insight that might improve our understanding of BCPHTPCN tumorigenesis.
News
National Rosacea Society Celebrates 25 Years of Awarding Research Grants
Rosacea.org
The National Rosacea Society announced that it is accepting applications for funding from its research grants program, which is celebrating its 25th anniversary in 2025. Supported exclusively by individual donations from rosacea sufferers, the NRS research grants program has awarded more than $1.7 million to support 78 studies since 2000, with the goal of increasing knowledge and understanding of the potential causes and other key aspects of rosacea that may lead to improvements in its treatment, prevention and potential cure.
Modern Approaches to Treating Rosacea in 2025
Next Steps in Dermatology
At the 2025 ODAC Dermatology Conference, renowned dermatologist and conference co-chair Adam Friedman, MD, delivered an insightful lecture, How I Treat Rosacea in 2025. He explored the latest advancements in managing one of dermatology’s most prevalent conditions, highlighting key triggers, associated comorbidities, and evolving treatment strategies. With global rosacea prevalence reported as high as 10%, his presentation underscored the importance of a tailored, evidence-based approach to care.
Integrated Approaches to Treating Rosacea With Lasers (video)
Dermatology Times
Cheri Frey, MD, discusses how combining different laser treatments with traditional therapies can effectively target both the vascular and inflammatory components of rosacea while minimizing adverse effects and recovery time.
Rosacea Awareness Month to Spotlight Holistic Approach to Rosacea Treatment
Rosacea.org
The key to controlling rosacea is a holistic approach that addresses not only the signs and symptoms of the disease but also the personal and environmental factors that can exacerbate the condition, according to leading dermatologists. The National Rosacea Society has designated April as Rosacea Awareness Month to educate the public on this chronic facial skin disorder estimated to affect more than 16 million Americans, and to urge those who suspect they may have it to see a dermatologist for diagnosis, treatment and guidance on gentle skin care.
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