Rosacea Research Digest - July 31, 2026
Potential rosacea biomarkers, acne and rosacea comorbidity, cinnamaldehyde 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.
Research
Cutaneous inflammatory biomarkers in rosacea and their association with disease severity.
Wienholtz NKF, Egeberg A, Kezic S, et al. Clin Exp Dermatol. 2026 Jul 8:llag281. Epub ahead of print. DOI: 10.1093/ced/llag281. PMID: 42417426.
Background and objectives: Rosacea is a common chronic disease of the facial region characterized by erythema, flushing, papules, pustules, phymatous changes, and ocular symptoms. Despite its prevalence, the inflammatory pathways underlying rosacea remain poorly understood, and reliable biomarkers for assessing disease severity have not been established. Methods: In this study, we employed a noninvasive skin tape stripping technique to evaluate levels of certain cutaneous biomarkers in patients with rosacea compared with skin-healthy individuals. Results: Levels of the following biomarkers were increased in patients with rosacea compared with skin-healthy controls: interleukin (IL)-1RA, IL-8, IL12p70, IL-17A, IL-17E, IL-17F, IL-18, IL-22, interferon-gamma inducible protein (IP)-10, vascular endothelial growth factor (VEGF)-a and interferon gamma (IFN-γ). Increasing severity of rosacea (measured by the Rosacea Area and Severity Index) was positively correlated with higher concentrations of IFN-γ, IL-18, IP-10, VEGF-α and IL-17F. Conclusions: Our data suggest that dysregulation of both innate and adaptive immune responses, particularly involving T-helper (Th)1 and Th17 pathways, plays a critical role in rosacea pathogenesis and severity.
Current and emerging pharmacotherapy for rosacea: a misunderstood and undertreated condition.
Vescovacci N, Malone L, Huang CA, Feldman SR. Expert Opin Pharmacother. 2026 Jul;27(10):941-951. Epub 2026 Jul 11. DOI: 10.1080/14656566.2026.2695088. PMID: 42431636.
Introduction: Rosacea is a chronic inflammatory skin disease characterized by heterogeneous features, including erythema, telangiectasias, papules, pustules, ocular symptoms, and phymatous changes, which can impact quality of life. Its complex pathophysiology involves dysregulated innate immune, neurovascular, and inflammatory pathways, leading to an expanding range of therapeutic options. Areas covered: A narrative review was conducted using the PubMed database to identify peer-reviewed articles published between 2014 and 2026. Keywords such as 'rosacea,' 'advances,' 'emerging,' 'management,' 'treatment,' 'off label,' 'device,' 'lasers,' and 'pathogenesis' were used to evaluate established and emerging pharmacologic and procedural therapies for rosacea. The following article summarizes the established and emerging agents for each treatment modality available for rosacea, with emphasis placed on mechanism of action, efficacy, and safety profiles. Expert opinion: Current management reflects a phenotype-driven approach to guide personalized treatment regimens. Emerging agents targeting novel inflammatory and neurovascular pathways may address limitations in tolerability and durability of response. Cost and evidence gaps continue to limit widespread clinical adoption. Further investigation is needed to define long-term safety, comparative efficacy, and cost-effectiveness to optimize individualized treatment strategies.
Therapeutic progress in rosacea: targeting the neuro-vascular-immune triad.
Yang X, Yang W, Chen N, et al. Front Immunol. 2026 Jun 22;17:1876564. DOI: 10.3389/fimmu.2026.1876564. PMID: 42440475; PMCID: PMC13333516.
Rosacea is a chronic inflammatory dermatological condition predominantly affecting the facial region. Clinically, rosacea is characterized by paroxysmal flushing, persistent erythema, telangiectasia, papules, pustules, and ocular symptoms. Severe rosacea cases are frequently complicated by anxiety, depression, and sleep disturbances, imposing a heavy psychosocial burden and markedly impairing the quality of life of the patients. Abnormal activation of the neuro-vascular-immune triad has been reported as a crucial pathological mechanism of rosacea. Moreover, dysregulation within the central nervous system might exacerbate disease progression by modulating peripheral nerve activity and neuroendocrine homeostasis. In this review, we summarize the latest advancements in rosacea treatments targeting the neuro-vascular-immune triad, including γ-aminobutyric acid derivatives, antidepressants, anti-calcitonin gene-related peptide agents, physical neuromodulation (transcutaneous auricular vagus nerve and repetitive transcranial magnetic stimulations), botulinum toxin type A, and β-blockers. We provide a comprehensive analysis of their molecular mechanisms, clinical efficacy, and current limitations. While such therapies could specifically regulate different stages of the pathway, their evidence lacks large-scale randomized controlled trials and clarity regarding optimal dosing regimens and treatment durations. Future studies should strengthen basic investigations and clinical translation, explore combined therapeutic strategies, as well as develop personalized therapeutic strategies for the long-term effective control of rosacea.
Risk factors for acne vulgaris among rosacea patients: a cross-sectional study.
He S, Cen X, Zhong J, et al. Front Public Health. 2026 Jun 24;14:1859962. DOI: 10.3389/fpubh.2026.1859962. PMID: 42422699; PMCID: PMC13341721.
Background: The prevalence of acne vulgaris among rosacea patients is significantly higher than that of the general population, but the risk factors for acne vulgaris among rosacea patients remain unclear. Objective: Explore the potential risk factors for the occurrence of acne vulgaris among rosacea patients, focusing on lifestyle, skincare habits, and dietary habits. Methods: A total of 300 rosacea patients were included. Lifestyle, skincare habits, and dietary habits were collected using a validated questionnaire survey. A Multivariate logistic regression model was employed to analyze risk factors associated with acne vulgaris. Further subgroup analysis and restricted cubic spline function was used to analyze the related risk factors. Results: The prevalence of acne vulgaris was 30.33% in 300 rosacea patients, which is significantly higher than the 14.83% observed in the general population. Multivariate logistic regression analysis revealed that sufficient sleep duration was a protective factor against acne vulgaris in rosacea patients [OR = 0.738 (0.589-0.926)] (p < 0.05), while the use of sunscreen products was identified as a risk factor [OR = 2.602 (1.083-6.249)], (p < 0.05). Additionally, restricted cubic spline analysis indicated a significant linear dose-response relationship between longer sleep duration and a lower risk of acne vulgaris (Poverall < 0.05, Pnonlinear = 0.86). Conclusion: Adequate sleep appears to be a protective factor, while frequent sunscreen use may increase the risk of acne vulgaris among rosacea patients. Tailored lifestyle recommendations may contribute to improved comorbidity management.
Clinical outcomes associated with a digital standardized skin care regimen in acne-rosacea comorbidity: a real-world longitudinal study with cross-lagged and mediation analyses.
Qing Y, Zhang K, Xu B, et al. J Am Acad Dermatol. 2026 Jul 14:S0190-9622(26)02984-1. Epub ahead of print. DOI: 10.1016/j.jaad.2026.06.090. PMID: 42455099.
Background: Co-occurring acne and rosacea is challenging. A digital standardized skin care regimen (SSCG) may be associated with better real-world outcomes, but the clinical-barrier temporal sequence remains unclear. Objective: To evaluate associations between SSCG participation and outcomes, the clinical-barrier temporal sequence, transepidermal water loss (TEWL) mediation, and communication frequency. Methods: Single-center retrospective cohort with verified dual diagnosis. All patients received doxycycline plus azelaic acid; propensity score matching yielded 282 pairs. Primary outcome was IGA 0/1 at week 12. Cross-lagged, mediation, and E-value analyses were used. Results: SSCG participation was associated with higher IGA 0/1 (54.6% vs 34.4%; RR = 1.59, 95%CI:1.31-1.92), lower relapse (18.8% vs 34.0%), and greater DLQI MCID attainment (91.1% vs 71.3%). Week-6 IGA predicted week-12 TEWL reduction; the reverse path was nonsignificant. TEWL mediated 12.4% of the estimated association. Communication frequency showed no dose-response. Limitations: Retrospective design, bundled intervention, possible self-selection and cost-related bias, chart-based adherence assessment, and unrecorded exposome and contraceptive changes. Conclusions: In this cohort, SSCG participation was associated with higher clearance and lower relapse. Findings are associative and hypothesis-generating.
Assessing the rosacea potential pathogenic risks of cinnamaldehyde in daily skin care products and cosmetics using network toxicology and molecular docking with experimental validation.
Huang H, Wen J, Feng J, et al. Medicine (Baltimore). 2026 Jul 24;105(30):e49854. DOI: 10.1097/MD.0000000000049854. PMID: 42499056; PMCID: PMC13406124.
Rosacea, a chronic inflammatory skin disorder, severely impairs patients' quality of life and imposes substantial medical burdens. Existing treatments are hampered by unsatisfactory therapeutic effects and high recurrence rates, driving urgent research into novel pathogenic mechanisms. As a common spice and cosmetic preservative, cinnamaldehyde's safety risks in rosacea patients remain poorly characterized. This study aimed to integrate network toxicology with in vitro cellular assays to clarify its pathogenic roles and molecular pathways, providing novel theoretical support for its adverse impacts on rosacea sufferers. First, we predicted the target genes of cinnamaldehyde using the PubChem, SwissTargetPrediction, SuperPred, and ChEMBL databases. Second, we obtained relevant targets for rosacea using the GeneCards and CTD databases and identified the intersection targets with toxic substances. Then, we constructed a protein-protein interaction network of the core toxic substance combination using the STRING database and performed Gene Ontology functional enrichment analysis and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis to predict possible mechanisms. Subsequently, molecular docking validation of the active ingredients with the main targets was performed using AutoDock Vina software. Finally, cinnamaldehyde was added to the rosacea-like cellular model in HaCaT cells to assess its effects and molecular mechanisms by Cell Counting Kit-8, reverse transcription quantitative polymerase chain reaction, and enzyme-linked immunosorbent assay. Database screening revealed 43 overlapping targets between the 195 predicted targets of cinnamaldehyde and the 1889 disease-related targets for rosacea, which included notable proteins such as prostaglandin‑endoperoxide synthase 2 (cyclooxygenase‑2; PTGS2), matrix metallopeptidase 9 (MMP9), and epidermal growth factor receptor (EGFR). Protein-protein interaction analysis identified PTGS2 as a pivotal hub protein, while Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis indicated that interleukin-17 signaling and lipid metabolism are vital mechanisms involved in rosacea. Molecular docking studies demonstrated strong binding affinities between cinnamaldehyde and the identified core targets. Furthermore, cell culture experiments confirmed that cinnamaldehyde exacerbates rosacea by upregulating the expression of PTGS2, MMP9, and EGFR, along with increasing the production of inflammatory cytokines such as interleukin-8 and interleukin-1 beta. In summary, our findings elucidate the potential pathogenic mechanisms by which cinnamaldehyde may induce rosacea, highlighting the roles of the core targets PTGS2, MMP9, and EGFR in mediating inflammation. This research provides new scientific insights that could inform preventive strategies and therapeutic interventions aimed at managing the toxicity associated with rosacea.
Evaluation of the interrelationship between inflammatory markers, rosacea, ocular symptoms, and migraine comorbidity.
Etgü F, Gürpınar AB, Erol D, et al. Cutan Ocul Toxicol. 2026 Jul 2:1-9. Epub ahead of print. DOI: 10.1080/15569527.2026.2694510. PMID: 42390920.
Purpose: Rosacea is a chronic dermatological condition frequently associated with ocular symptoms and neurological comorbidities such as migraine. This study aimed to compare inflammatory and hematological markers between rosacea patients and healthy controls, and to assess differences in these markers among rosacea patients based on the presence or absence of ocular symptoms and migraine. Materials and methods: A total of 150 rosacea patients and age- and gender-matched healthy controls were enrolled. Demographic data and routine hematological parameters were collected for all participants. Neurological evaluations were performed to assess the prevalence of headaches and migraines. Ophthalmological examinations were conducted in the rosacea group to determine ocular involvement. Results: Compared with healthy controls, rosacea patients had higher white blood cell counts (7.22 ± 1.60 vs 6.83 ± 1.38, p = 0.03) and neutrophil counts (p = 0.02), and lower eosinophil counts (p = 0.036), mean corpuscular volume (p < 0.001), and red cell distribution width-standard deviation (p = 0.015). Mean corpuscular hemoglobin concentration was higher in rosacea patients (p = 0.001). Headaches and migraine were more prevalent in rosacea patients than in controls (p < 0.0001 and p = 0.0006, respectively). Ocular symptoms were present in 51.3% of patients and were more frequent in females (p = 0.03) and in those with migraine (p = 0.03). Conclusion: Rosacea was associated with changes in hematological and inflammatory markers, as well as a higher prevalence of migraine and ocular symptoms. These findings support the need for comprehensive evaluation of patients with rosacea.
Topical preparations for moderate to severe rosacea treatment: a systematic review and network meta-analysis.
Amstutz AV, Sánchez-Feliciano A, Dewey E, et al. JAMA Dermatol. 2026 Jul 1:e262062. Epub ahead of print. DOI: 10.1001/jamadermatol.2026.2062. PMID: 42384418; PMCID: PMC13324944.
Importance: Comparative efficacy and tolerability of topical therapies for rosacea remain incompletely characterized, particularly for novel agents such as encapsulated benzoyl peroxide. Objective: To compare the efficacy and tolerability of topical treatments for moderate to severe rosacea through a systematic review and network meta-analysis of randomized clinical trials (RCTs). Data sources: CENTRAL (Cochrane Central Register of Controlled Trials), MEDLINE via Ovid, Web of Science, and Embase databases were searched from inception through August 6, 2025, and supplemented by manual screening of references. Study selection: RCTs published in English that included adults with moderate to severe rosacea and assessed topical therapies for rosacea were included. Data extraction and synthesis: Two reviewers independently extracted data and assessed risk of bias using the Cochrane Risk of Bias tool, version 2.0. Data were synthesized using random-effects network meta-analyses. Treatment rankings were estimated using SUCRA (surface under the cumulative ranking) values. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. Main outcomes and measures: Prespecified primary outcomes were mean change in absolute lesion count, Investigator Global Assessment (IGA) success, and discontinuation due to adverse events or effects. Secondary outcomes included patient-reported measures and clinician-assessed erythema. Results: Of 2858 records screened, 32 RCTs met inclusion criteria, comprising a total of 11 399 adults treated with 10 topical interventions. Most studies had a 8- to 16-week follow-up period. Compared with metronidazole, ivermectin and encapsulated benzoyl peroxide demonstrated greater reductions in lesion count (mean difference [MD], 4.17; 95% CI, 1.85-6.48; and MD, 4.14; 95% CI, 0.62-7.66, respectively) and higher likelihood of IGA success (MD, 10.31; 95% CI, 2.85 to 17.77; and MD, 15.51; 95% CI, 2.35-28.68, respectively). Frequency of discontinuation due to adverse events were similar between treatments, although discontinuation was more frequent with encapsulated benzoyl peroxide than metronidazole (MD, 8.33; 95% CI, 0.45-16.22). Limited data precluded robust quantitative synthesis of patient-reported outcomes and erythema outcomes. Conclusions and relevance: In this systematic review and network meta-analysis, topical ivermectin and encapsulated benzoyl peroxide were more efficacious than metronidazole for rosacea, although encapsulated benzoyl peroxide was also associated with higher discontinuation due to adverse events. Future trials should evaluate long-term efficacy, tolerability, and standardized patient-reported outcomes.
Combined therapy of 532-nm KTP and microsecond 1064-nm Nd:YAG laser for rosacea.
Sun Y, Lou Y, Lao L, Cai S. Lasers Med Sci. 2026 Jul 18;41(1):155. DOI: 10.1007/s10103-026-04941-1. PMID: 42470571; PMCID: PMC13380596.
The management of rosacea continues to pose a significant clinical challenge, underscoring the necessity for alternative therapeutic strategies to address this chronic dermatological condition. The primary objective of this study was to assess the efficacy and safety of combined therapy using a 532-nm potassium titanyl phosphate (KTP) laser and a microsecond-pulsed 1064-nm neodymium-doped yttrium aluminum garnet (Nd: YAG) laser for the treatment of rosacea. A total of 15 participants underwent 3 sessions of combined laser therapy, with each session administered at 3-week intervals. Clinical evaluations were performed both before the initiation of treatment and after the completion of all 3 treatment sessions using the Clinician's Erythema Assessment (CEA) and the Dermatology Life Quality Index (DLQI). Additionally, the Global Assessment of Improvement Scale (GAIS) was utilized to quantify overall clinical improvement, while patient-reported satisfaction levels and adverse events were documented throughout the study period. Statistical analysis revealed a significant reduction in the CEA score, which decreased from a baseline mean of 3.33 ± 0.47 to 1.47 ± 0.62 following treatment (P < 0.001). Concurrently, the DLQI score exhibited a significant improvement, declining from 18.20 ± 2.14 at baseline to 13.80 ± 2.40 post-treatment (P < 0.001). With regard to the GAIS, 14 out of 15 patients (93.3%) demonstrated clinical improvement; among these, 10 patients (66.7%) achieved either much or very much improvement. Notably, no severe adverse events were reported during the study. In conclusion, the findings of this study suggest that combined therapy with a 532-nm KTP laser and a microsecond-pulsed 1064-nm Nd: YAG laser represents an effective and well-tolerated treatment option for facial erythema associated with rosacea. Trial registration number was NCT07250165 (ClinicalTrials.gov) and date of registration was 18th, November, 2025, retrospectively registered.
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Case Reports
Hyperbaric oxygen therapy in the reconstruction of giant rhinophyma: a case series.
Oley MH, Oley MC, Sukarno V, et al. Dermatol Reports. 2026 Jun 29. Epub ahead of print. DOI: 10.4081/dr.2026.10365. PMID: 42370426.
Rhinophyma is a progressive, disfiguring form of rosacea that affects the nasal soft tissues and leads to functional and cosmetic challenges. Surgical excision is the primary treatment, but healing can be complicated by scarring, infection, and graft failure, especially in extensive lesions. Hyperbaric oxygen therapy (HBOT) has been suggested as an adjunctive treatment to enhance healing, reduce inflammation, and improve skin-graft survival. This case series presents three patients with giant rhinophyma who underwent surgical excision, with one requiring a split-thickness skin graft (STSG). Postoperatively, HBOT sessions (90 minutes at 2.4 atmospheres absolute [ATA]) were administered for 5-10 days, depending on the lesion severity. All patients demonstrated excellent healing with complete epithelialization and no evidence of hypertrophic scarring or short-term recurrence. HBOT contributed to faster recovery, improved skin-graft survival, and enhanced cosmetic outcomes. These findings suggest that HBOT is a promising adjunct in the surgical management of rhinophyma, although larger studies are required to validate its efficacy.
Pulsed-dye laser therapy for successful management of refractory neurogenic rosacea.
Hwang HW, Lee JW, Jeong JH, et al. J Cosmet Laser Ther. 2026 Aug;28(1-5):44-47. Epub 2026 Jun 25. DOI: 10.1080/14764172.2026.2687491. PMID: 42350357.
Neurogenic rosacea (NR) poses a therapeutic challenge due to its resistance to conventional treatments. This study explores the efficacy of pulsed-dye laser (PDL) therapy in managing NR. We present two cases of NR with severe facial discomfort and photoaging, treated with PDL alongside oral medications. Remarkably, PDL significantly alleviated pain and improved skin appearance in both cases, with sustained relief for over 2 years. Mechanistically, PDL may modulate neuropeptides and nerve fiber density implicated in NR pathogenesis. Our findings suggest PDL as a promising therapeutic avenue for NR, warranting further investigation and consideration in clinical practice.
News
Gabapentin May Help Neurogenic Rosacea Patients
Rosacea.org
Neurogenic rosacea is a less common form of the disease that may be mistaken for erythematotelangiectatic rosacea (ETR), formerly referred to as subtype 1. The two subtypes share persistent facial redness and flushing as their primary signs. However, ETR sufferers are more likely to have dry, itchy skin, while those with neurogenic rosacea experience intense burning and stinging sensations that won’t go away.
Rosacea: We Still Haven’t Found What We’re Looking For
Cutis
In May 1987, U2 released “I Still Haven’t Found What I’m Looking For” as a single from their legendary fifth album, The Joshua Tree. The song became their second consecutive #1 hit in the United States to chart on the Billboard Hot 100. Here I am, almost 4 decades later, composing an editorial focused on where we are now in dermatology with rosacea. The first thought that came to mind is that U2 was right—and still is—because with rosacea, we still haven’t found what we’re looking for.
New Review Confirms How Nonmedicated Skin Care Vehicles Drive Clinical Improvement
Dermatology Times
A new narrative review suggests that foundational skin care practices, including gentle cleansing, moisturization, and photoprotection, may provide clinically meaningful benefits across several common dermatologic conditions, even in the absence of active prescription medications. By examining the vehicle arms of randomized controlled trials (RCTs), investigators found that nonmedicated skin care regimens frequently produced substantial improvements in disease severity, supporting their integration into routine patient management alongside pharmacologic therapies.
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