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

Mechanisms and recent advances of small-molecule therapeutics in rosacea treatment.

Ye M, Hao P, Luo N, Li T. Clin Cosmet Investig Dermatol. 2025 Jun 12;18:1459-1470. doi:10.2147/CCID.S525787. PMID: 40529547; PMCID: PMC12170860.

Rosacea is a common dermatological disease, and the complexity of its etiology and pathogenesis makes conventional treatment of rosacea difficult. Small-molecule drugs are a new option for the treatment of rosacea. Based on its good efficacy, convenience of use, affordable price and other advantages, more and more small-molecule drugs are used in the treatment and management of rosacea, involving a variety of molecular pathways, including JAK/STAT signaling pathway, TRPV, TLR2-KLK5-LL37 and mTOR pathways, Th1/Th17-IL17, PED-4, AhR and MRGPRX2. However, the specific treatment mechanism and research progress have not been systematically elucidated. This review summarizes the latest advances in small molecules targeting key inflammatory pathways in rosacea, provides new ideas for the treatment of rosacea and new directions for the clinical management of rosacea. In addition, we need to pay attention to individual differences in patients, the side effects of drugs and formulations. Therefore, further research on small-molecule drugs for the treatment of rosacea is very necessary.

Rosacea and treatment with retinoids: a systematic review and meta-analysis.

Sticchi A, Fiorito F, Kaleci S, et al. Ther Adv Chronic Dis. 2025 May 31;16:20406223251339964. doi:10.1177/20406223251339964. PMID: 40453533; PMCID: PMC12126652.

Background: Rosacea is a common inflammatory disease. Four clinical rosacea subtypes have been described, with the papulo-pustular being the most common. At present, the only FDA-approved treatment for papulo-pustular rosacea is low-dose doxycycline. Retinoids, in particular isotretinoin, have shown for decades positive outcomes in the treatment of rosacea, but due to the lack of robust evidence, they are still considered an off-label treatment for this condition. Objectives: Summarize the current evidence in the literature regarding the role of topical and systemic retinoids in the treatment of papulo-pustular rosacea. Design: Systematic review and meta-analysis. Data source and methods: A systematic MEDLINE, EMBASE, and Cochrane search of relevant publications on this topic was carried out. Randomized and non-randomized studies regarding topical and systemic retinoid treatment for rosacea were included. We excluded not relevant studies, case reports, reviews, and non-English language studies. We have used RoB2 and ROBINS-1 tool for assessing risk of bias in randomized and non-randomized trials, respectively. Results: Due to the heterogeneity in study design and outcomes reporting, the standardization of our results is limited, but the findings from this systematic review with meta-analysis indicate that retinoids, particularly isotretinoin, are a promising treatment option for papulopustular rosacea, with a favorable tolerability and safety profile. On the other hand, available data for topical retinoid therapy are less definitive and more contradictory, with only two randomized studies reporting opposite outcomes. Conclusion: Retinoids may be a valid treatment option for rosacea, but larger, randomized controlled trials are needed to establish standardized dosing regimens and long-term safety profiles.

Therapeutic modulation of Demodex density via isotretinoin: insights from a prospective dermatological investigation.

Chakmakchi AMJ, Alatas ET, Yurekli A, et al. J Cosmet Dermatol. 2025 Jun;24(6):e70249. doi:10.1111/jocd.70249. PMID: 40433708; PMCID: PMC12117431.

Aim: Demodex spp. are ectoparasites that reside in pilosebaceous units, particularly on the face where sebum secretion is prominent. The sebum-reducing effects of isotretinoin play a crucial role in the management of acne vulgaris and rosacea. This study aims to assess the effect of isotretinoin on Demodex density in patients with acne vulgaris and rosacea accompanied by demodicosis. The evaluation includes Demodex mite density, before, during, and after 6 months of isotretinoin treatment. Materials & methods: The study included patients diagnosed with acne vulgaris and rosacea accompanied by demodicosis who were prescribed isotretinoin treatment. Demographic data were collected, and Demodex spp. mites were detected using superficial skin biopsy before treatment initiation. Follow-up samples were obtained at 2 and 6 months. Statistical analysis was performed using SPSS version 23, with a significance level set at p < 0.05. Results: A total of 36 patients, 25 with acne and 11 with rosacea, were included in our study. Demodex density was assessed before treatment, at 2 months, and at 6 months. Our findings showed a significant decrease in Demodex density with isotretinoin treatment, especially in relation to the decrease in sebum secretion (p < 0.001). Conclusion: This study makes a notable contribution to the existing literature by being the first to assess the impact of isotretinoin treatment on Demodex density. Our results indicate that isotretinoin effectively reduces Demodex density, likely due to a reduction in sebum production. To further explore isotretinoin's effects, future research should involve larger sample sizes and extended follow-up periods. These findings enhance our understanding of isotretinoin's role in managing Demodex-related dermatological conditions.