Rosacea Research Digest - January 31, 2025
Studies on mast cell degranulation, ocular rosacea, light devices and more.
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.
Beginning with this issue, the full contents of Rosacea Research Digest will only be accessible to those with a paid subscription. Nonpaid subscribers will only see the first three studies in each issue. Subscribe now for $5 per month or $50 per year!
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Research
Activation of aryl hydrocarbon receptor ameliorates degranulation of LL-37 induced mast cells in rosacea through enhancing autophagy.
Chen S, Hu H, Wu J, et al. Int Immunopharmacol. 2025 Jan 27;146:113910. Epub 2024 Dec 29. doi:10.1016/j.intimp.2024.113910. PMID: 39736238.
Background: Activation of the aryl hydrocarbon receptor (AhR) ameliorates LL-37-induced rosacea-like dermatitis in mice, whereas mast cells and cytokine overexpression are prominent features in rosacea skin. Objective: To evaluate the potential mechanisms of AhR activation on autophagy and degranulation of mast cells in rosacea. Methods: LL-37 treated mast cells were used to mimic rosacea. An AhR agonist (tapinarof) was applied to LL-37 induced mast cells. Furthermore, an autophagy agonist (RAPA) and an inhibitor (CQ) was added to investigate the mechanisms of autophagy. Western blot and RT-qPCR assessed cell degranulation (Cma1, Tpsab1) and cytokines (MMP9, TNF-α, and IL-6). Changes in cell morphology were observed under a microscope. Autophagy markers (LC3 and p62) were examined using Western blot and cellular immunofluorescence. Results: LL-37 upregulated the expressions of Cma1, Tpsab1, MMP9, TNF-α, and IL-6, which were then reduced by tapinarof treatment for 24 h. LC3B-I was converted to LC3B-II and p62 was reduced gradually with increasing concentration of tapinarof, indicating that autophagy was enhanced. RAPA enhanced the expression of LC3B-II on LL-37-induced mast cells, similar to tapinarof, while CQ partially inhibited the ability of tapinarof to induce autophagy in mast cells. Moreover, CQ reversed tapinarof's suppression of Cma1, Tpsab1, MMP9, TNF-α and IL-6 on LL-37 treated mast cells. Conclusion: The present study showed that activation of AhR ameliorated degranulation of LL-37-induced mast cells in rosacea through enhancing autophagy, offering a new option for rosacea treatment.
Comparing prescription drug saving platforms for dermatology: a cost analysis of Mark Cuban Cost Plus Drugs, GoodRx, and Amazon RxPass.
Perry NJ, Barbieri JS. J Am Acad Dermatol. 2025 Jan 23:S0190-9622(25)00125-2. Epub ahead of print. doi:10.1016/j.jaad.2025.01.045. PMID: 39863169.
High medication costs and prior authorization processes often lead to non-adherence and worse clinical outcomes, disproportionately impacting vulnerable populations. To combat high retail pharmacy prices of generic drugs, prescription drug cost-saving platforms such as Mark Cuban Cost Plus Drugs (MCCPD) and Amazon RxPass have emerged, aiming to make medications more accessible and pricing more transparent, even for uninsured patients. GoodRx (website and app) provides discount coupons and price comparisons at pharmacies, while Cost Plus Drugs offers an online, direct-to-consumer model with transparent pricing and minimal markups. However, little is known about which of these platforms may be most useful for dermatologic indications.
Investigation of corneal topographic and ocular surface parameters in ocular rosacea based on skin subtypes.
Yesilirmak N, Yuzbasioglu S, Saritas O, et al. J Fr Ophtalmol. 2025 Jan 10;48(3):104403. Epub ahead of print. doi:10.1016/j.jfo.2024.104403. PMID: 39798300.
Objective: To compare the corneal topographic parameters and ocular surface parameters of ocular rosacea (OR) patients across skin subtypes of the disease and healthy controls. Methods: This prospective study included 180 eyes of 90 OR patients and 60 eyes of 30 healthy controls. Among the OR patients, 30 had phymatous (60 eyes), 30 had erythematotelangiectatic (60 eyes) and 30 had papulopustular skin types (60 eyes). We measured the mean keratometry (Kmean), maximum keratometry (Kmax), thinnest corneal thickness (TCT), central corneal thickness (CCT) and corneal volume (CV) with a topography device (Sirius, Italy). Additionally, we measured tear-film breakup time (TBUT), Meiboscore and Schirmer's test from all participants. We compared parameters across OR skin groups as well as with controls. Results: Kmean and Kmax were significantly steeper in the OR group compared to controls (p<0.05). We found significant correlations between "Kmean-Kmax", "CV-TCT", "CV-CCT", and "TCT-CCT" in both groups, while significant correlations between "age-Kmean", "age-Kmax", and "Meiboscore-Kmax" were present only in OR patients. When patients were divided into subgroups according to their skin subtypes, the papulopustular and phymatous subgroups had steeper Kmean and Kmax compared to the erythematotelangiectatic and control groups (P<0.05). The papulopustular subgroup had lower CCT, lower TBUT and higher Meiboscore compared to the phymatous, erythematotelangiectatic and control groups but lower TCT compared to controls (P<0.05). In addition, there were significant correlations between "Kmax-CV", "Kmax-TCT", and "Kmax-meiboscore" only in the papulopustular subgroup (P<0.05). Conclusion: It appears that the corneas of OR patients are steeper than those of healthy controls; corneal thinning and abnormalities of ocular surface parameters are more pronounced in papulopustular skin types.
Ocular rosacea: an updated review.
Mohamed-Noriega K, Loya-Garcia D, Vera-Duarte GR, et al. Cornea. 2025 Jan 14. Epub ahead of print. doi:10.1097/ICO.0000000000003785. PMID: 39808113.
Purpose: Ocular rosacea is a chronic inflammatory disorder affecting the ocular surface, often associated with cutaneous rosacea. This review aims to explore its pathogenesis, treatment approaches, and future directions for management. Methods: A review of current literature on the pathophysiology, clinical features, and treatment strategies of ocular rosacea in adults and children (pediatric blepharokeratoconjunctivitis) was conducted. Emerging research on immune dysregulation, microbiome alterations, and potential therapeutic targets was analyzed. Results: Ocular rosacea involves dysregulation of the immune and neurovascular systems, with toll-like receptor activation and complement system involvement leading to chronic ocular surface inflammation. Alterations in the ocular microbiome have been implicated in disease progression. Treatment strategies emphasize a stepwise approach, incorporating ocular and skin hygiene, lifestyle modifications, and pharmacological interventions. Recent advancements in understanding the disease mechanisms have led to the exploration of targeted therapies, including biologics and small-molecule inhibitors. Conclusions: Ocular rosacea remains challenging to diagnose and treat, particularly in children (pediatric blepharokeratoconjunctivitis), often leading to delayed intervention and poor outcomes. A multidisciplinary approach, including new therapeutic options, holds promise for improving patient care. Further research into the genetic and molecular basis of ocular rosacea may enable more personalized treatments.
Low-energy delicate pulsed light therapy for sensitive skin: a retrospective study.
Fu Y, Quan Y, Zhao W, et al. J Cosmet Dermatol. 2025 Jan;24(1):e16781. doi:10.1111/jocd.16781. PMID: 39780466; PMCID: PMC11711946.
Background: Sensitive skin (SS) is a multifactorial syndrome that affects about half of the world's population. However, there is no standardized treatment protocol. Photovoltaic technology has been widely used in recent years for the treatment of sensitive skin, but the efficacy of low-energy delicate pulsed light (DPL) in the treatment of sensitive skin is unknown. Objective: To explore the efficacy and safety of low-energy DPL treatment for sensitive skin. Methods: This study included 181 patients with SS who attended the Department of Dermatology from January 2019 to January 2022. All patients were treated with DPL (5.0-6.8 J/cm2). Patients received varying durations of DPL, with 4-week intervals based on the severity of their condition. Sensitivity scores at baseline and final treatment were collected using a 10-item sensitivity scale (SS-10). Facial erythema was assessed through the Clinician Erythema Assessment Scale (CEA) based on facial photographs taken at each visit. VISIA-CR was used to visualize and analyze facial redness at baseline and after the final treatment, and erythema values were recorded. Adverse reactions were documented during each treatment session. Results: Among 181 patients, 86 were SS alone, 32 were rosacea with SS, 32 were acne with SS, and 31 were dermatitis with SS. A significant difference was observed between patients' baseline and final SS-10 scores (p < 0.001). Statistically significant differences were found between the patients' CEA scores at different visits (p < 0.001). Clinical photographs demonstrated significant improvements in facial redness and skin color. VISIA-CR analysis showed a considerable reduction in erythema values at the final treatment visit compared to baseline (p < 0.001). No obvious adverse effects were observed in any of the patients. Conclusion: Low-energy DPL is an effective and safe treatment for sensitive skin.
Unveiling the molecular mechanisms of rosacea: insights from transcriptomics and in vitro experiments.
Chen L, Wang J. J Cosmet Dermatol. 2025 Jan;24(1):e16753. doi:10.1111/jocd.16753. PMID: 39823143; PMCID: PMC11739675.
Background: Rosacea is a prevalent inflammatory skin condition, but its molecular mechanisms and treatment responses remain poorly understood. Aims: This study aims to investigate the molecular mechanisms underlying rosacea and explore drug response through transcriptomic analysis and in vitro experiments. Patients/methods: We performed high-throughput RNA sequencing to analyze gene expression patterns in rosacea patients. In vitro experiments, including RT-qPCR, Western blot, ELISA, scratch, and Transwell assays, were used to evaluate gene and protein expression and cell behavior in HaCaT cells under simulated rosacea conditions. Results: Transcriptomic analysis revealed significantly elevated expression of inflammatory-related genes in rosacea patients. In vitro, HaCaT cells exhibited enhanced proliferation and migration abilities, accompanied by increased expression of pro-inflammatory genes and proteins. Specifically, Toll-like receptor 2 (TLR2) and S100A9 proteins were upregulated, potentially promoting these processes. Conclusions: Our study elucidates the molecular mechanisms of rosacea, highlighting the role of inflammatory pathways and altered cell behavior in the disease. TLR2 and S100A9 may contribute to disease progression, offering potential targets for future therapeutic strategies.
Gabapentin is an efficacy treatment for facial flushing and erythema of erythematotelangiectatic rosacea: A randomized clinical noninferiority trial.
Wei J, Wan M, Chen Q, et al. J Am Acad Dermatol. 2024 Dec 20:S0190-9622(24)03378-4. Epub ahead of print. doi:10.1016/j.jaad.2024.12.011. PMID: 39710117.
To the Editor: Patients with erythematotelangiectatic rosacea (ETR) have limited treatment options. Carvedilol, a multifaceted antagonist of α1-, β1-, and β2-adrenergic receptors, is globally endorsed for managing erythema and flushing in ETR according to clinical guidelines and consensus. Gabapentin, approved for seizures and postherpetic neuralgia, is also utilized off-label for pain and psychiatric conditions, notably hot flashes, neuropathic pain, migraine, anxiety, and insomnia. However, the efficacy of gabapentin in the context of rosacea remains to be elucidated. This randomized, controlled noninferiority trial was designed to assess the efficacy of gabapentin (300 mg, three times a day) versus carvedilol (5 mg, twice a day) in ETR treatment.
Vessel-targeting therapies for the management of rosacea: a review of current evidence.
Vidal SI, Menta N, Friedman A. J Drugs Dermatol. 2025 Jan 1;24(1):105-106. PMID:39761138
Rosacea, a condition defined by persistent erythema, may also present with flushing, telangiectasias, edema, enlarged facial blood vessels, and/or vascular nets. The pathophysiology of rosacea is believed to be a culmination of neurovascular dysregulation, altered immune detection and response, and long-term changes to the skin's superficial vasculature. Alterations in the vasculature result from increased angiogenesis, disruptions in cutaneous vascular homeostasis, and endothelial cell damage from inflammatory byproducts. These aberrant processes culminate in progressive vascular changes, beginning with increased blood flow to affected skin, followed by persistent vasodilation and proliferation, and ultimately permanent vascular changes.
Don't let beauty blind you: unveiling clinical diagnoses during cosmetic dermatology practice.
Aristizabal MA, Soto T, Tolaymat L, Bruce AJ. J Clin Aesthet Dermatol. 2024 Nov-Dec;17(11-12 Suppl 1):S30-S33. PMID:39759903
There has been a notable rise in the prevalence of cosmetic dermatology services worldwide, involving a diverse range of providers. Patients presenting with cosmetic concerns should be thoroughly assessed and require meticulous attention because subtle, unexpected clinical cues might necessitate the application of dermatologic expertise. In this study, we present a case series involving patients who sought cosmetic care at an academic cosmetic dermatology center, revealing subsequent diagnoses of significant medical conditions. This underscores the critical importance of comprehensive training and substantial clinical exposure for practitioners in the highly nuanced field of dermatology.
Case Reports
Successful treatment of tosacea by trephination combined with photodynamic therapy: a case report.
Qiu Y, Yang P, Zhao X, et al. Photodiagnosis Photodyn Ther. 2025 Jan 1:104470. Epub ahead of print. doi:10.1016/j.pdpdt.2024.104470
Rosacea is a chronic, inflammatory dermatological condition primarily affecting the central face, including the cheeks, nose, chin, and forehead. It presents with erythema, phymatous changes, papules, pustules, and telangiectasia. The pathogenesis of rosacea is still unknown. Patients often suffer from multiple symptoms of rosacea, requiring more precise assessments and individualized therapies. 5-Aminolevulinic acid photodynamic therapy (ALA-PDT) has shown promise as a safe and effective treatment for rosacea, especially in patients with multiple subtypes. To our knowledge, this is the first case of successful treatment involving a 46-year-old male patient with erythematotelangiectatic rosacea and phymatous changes using trephination combined with photodynamic therapy (PDT), improving quality of life without recurrence during the 9-month follow-up period.
A case series of a novel approach in the treatment of rosacea: use of boulinum toxin and intense pulsed light for the treatment of erythematotelangiectatic rosacea.
Ardila CG, Colorado Franco LA, Franco M, et al. J Cosmet Dermatol. 2025 Jan;24(1):e16774. doi:10.1111/jocd.16774
Rosacea is a chronic inflammatory skin disorder, prevalent in individuals with light skin, most of the times difficult to treat with conventional treatments. Although both Botulinum neurotoxin Type A (BoNT/A) and Intense Pulsed Light (IPL) separately have proven to be safe and effective alternatives, studies have shown that the combination of therapies may lead to better treatment outcomes. In our study, we found an improvement in erythematotelangiectatic rosacea using the combination of BoNT/A and IPL.
News
What to Make of the Comorbidities Linked to Rosacea
Medscape
As a steady stream of studies suggests associations between rosacea and comorbidities, ranging from cardiovascular disease to depression and gastrointestinal (GI) issues, patients may look to their dermatologists for guidance on how to interpret these findings.
Topical Ivermectin May Improve Rosacea Indirectly
Rosacea.org
In addition to improving the clinical signs of rosacea, topical ivermectin, an FDA-approved antiparasitic agent for papulopustular rosacea, also may be effective because it alters the bacterial composition of the skin, according to a recent National Rosacea Society-funded study in the Journal of Investigative Dermatology.
The Important Link Between Rosacea and Sun Exposure
MedicalNewsToday
Sun exposure is a common trigger for rosacea symptoms. Ultraviolet (UV) rays can cause inflammation, damage the skin barrier, and dilate blood vessels, increasing redness or the deepening of skin color, sensitivity, and flushing.
IPL and BoNT/A Synergy for Rosacea
Dermatology Times
“To our knowledge, we present the first approach to the use of BoNT/A and IPL in the Latin American population with erythematotelangiectatic rosacea with Fitzpatrick skin type III, opening up a range of therapeutic options that could be useful and available for our patients,” researchers behind the study wrote.
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