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 skin microbiome in rosacea: mechanisms, gut-skin interactions, and therapeutic implications.

Asees A, Sadur A, Choudhary S. Cutis. 2025 Jul;116(1):20-23. DOI: 10.12788/cutis.1240. PMID: 40875939.

Rosacea is a chronic inflammatory skin condition of the central face driven by immune dysregulation, genetic predisposition, epidermal barrier dysfunction, and microbial dysbiosis. Recent evidence implicates both the gut and skin microbiomes-through direct immune interactions and the gut-skin axis-in driving cutaneous inflammation and disease severity, with an increase in proinflammatory species such as Demodex folliculorum, Staphylococcus epidermidis, and Bacillus oleronius alongside a decline in protective species such as Cutibacterium acnes. Therapeutic strategies now aim to restore microbial balance using narrow-spectrum antibiotics, anthelmintics, topical and oral probiotics, and microbiome-friendly skin care to reduce inflammation, reinforce skin barrier function, and improve clinical outcomes. Future research to refine precision treatments that target specific microbial and immune pathways would be beneficial to modulate dysbiosis and improve outcomes in rosacea.

Impact of microencapsulated benzoyl peroxide on the skin microbiome and clinical outcomes in rosacea: an update on a randomized, double-blind, crossover, vehicle-controlled clinical trial.

Nong Y, Sugarman J, York JP, et al. J Clin Aesthet Dermatol. 2025 Aug;18(8):34-40. PMID: 40843233; PMCID: PMC12367243.

Objective: We sought to evaluate changes in skin microbiome biodiversity and correlation with rosacea improvement of microencapsulated benzoyl peroxide (E-BPO) versus vehicle cream in rosacea patients in a 12-week crossover study with a no-treatment period of four weeks (Week 16). Methods: This was a randomized, double-blind, single-center, crossover, vehicle-controlled evaluation of E-BPO on the skin microbiome in rosacea. Thirty-one participants had facial rosacea with global severity of 3 or 4 on the Investigator's Global Assessment (IGA) scale. Participants were randomly assigned to two groups. The E-BPO/vehicle group applied E-BPO for eight weeks, then vehicle for four weeks. The vehicle/E-BPO group applied vehicle for eight weeks, then E-BPO for four weeks. Clinical assessments were performed using IGA, inflammatory rosacea scale, and erythema scale. Determination of change in skin microbiome was based on facial swab sampling. Results: Shifts in the microbiome correlated with improvements in IGA, inflammatory rosacea, and erythema. At Week 8, similar bacterial species diversity profiles were observed among all participants. After crossover of the vehicle/E-BPO group at eight weeks to E-BPO, the relative abundance of Staphylococcus epidermidis was markedly lowered, and the relative abundance of Cutibacterium acnes was slightly increased. In the E-BPO/vehicle group, the relative abundance of S. epidermidis and C. acnes at Weeks 12 and 16 remained at the level observed at Week 8. Limitations: The study had a short duration, which may not fully capture the long-term effects and durability of E-BPO in real-world clinical practice. Conclusion: Even after withdrawal at 16 weeks, efficacy and shifts in the skin microbiome were maintained over the duration of the study period with demonstrated clinical improvement and a well-tolerated safety profile.

Effective treatment of rosacea and telangiectasias Using IPL.

Menashe S, Bermejo IG, Lois M, et al. J Cosmet Dermatol. 2025 Aug;24(8):e70357. DOI: 10.1111/jocd.70357. PMID: 40735961.

Background: To date, no definitive treatment exists for rosacea. Phototherapies, including intense pulsed light (IPL), have been reported to reduce its characteristic features of erythema and telangiectasias. Methods: This multicenter, retrospective study reviewed the charts of 82 patients with vascular and pigmented rosacea who underwent treatment with the Harmony XL Pro VL/PL Cooled Applicator. Lesion coverage was assessed from photographs taken before and 3-4 months after the last treatment session. Physicians assessed aesthetic improvement using the 5-point Global Aesthetic Improvement Scale. Patients rated pain experienced during the session and satisfaction with outcomes. Treatment safety was monitored throughout. Results: A total of 82 patients with rosacea underwent up to four IPL treatment sessions. Mean patient age was 41.9 ± 15.2 years, and most were female (84.1%), with skin type II or III (96.1%) and with facial rosacea (93.9%). Clearance of > 75% was achieved in 69.5% of the patients, and the remaining 30.5% achieved 51%-75% clearance. Physician-rated aesthetic improvement was optimal (64.6%) or good (34.1%); minimal change was reported for one lesion. Skin type III was associated with 3.59 times higher odds of achieving high clearance compared to skin type I or II (95% CI: 1.2-11.3). Patients were mostly very highly (95.1%) or highly satisfied (3.7%) with treatment outcomes. Most patients reported low (39.0%) to medium (46.3%) pain during treatment. Apart from a blister reported by one patient, no adverse events were reported. Conclusion: IPL is a safe, effective, and versatile light-based modality for the treatment of vascular rosacea lesions in individuals of skin types I-III.