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 II and III clinical development.

Tian K, Li J, Wang B. Expert Opin Emerg Drugs. 2026 May 12. Epub ahead of print. DOI: 10.1080/14728214.2026.2655714. PMID: 42124339.

Introduction: Rosacea is a chronic inflammatory facial skin disease with an incompletely understood pathogenesis and limited efficacy of current treatments. A number of clinical trials are underway for the development of new drugs to improve patient care. Areas covered: Based on a literature search of PubMed, Embase, Cochrane Library, and Clinicaltrials.gov using the keywords 'rosacea clinical trials'，'rosacea treatment ' we discuss treatments undergoing phase II and III clinical trials for rosacea. Expert opinion: As the pathogenesis of rosacea is better understood and researched, many clinical trials are being conducted to develop new drugs for the treatment of rosacea based on new mechanisms and targets. Currently under investigation are biologics, antidepressants, PDE4 inhibitors, and neuropeptide modulation. Current treatments often focus on monotherapy targeting specific phenotypes, such as inflammatory papules or persistent erythema. However, single-agent therapy is often insufficient to address the multiple clinical manifestations of rosacea simultaneously. Therefore, we need to explore how combination or sequential treatments can be tailored to a patient's specific symptoms to minimize the patient's psychological burden.

The role of emotional distress in disfiguring skin diseases: a view from brain-skin axis.

Wen Z, Chen XS, Zeng H, et al. Front Neuroendocrinol. 2026 May 8:101253. Epub ahead of print. DOI: 10.1016/j.yfrne.2026.101253. PMID: 42107661.

Disfiguring skin diseases refer to skin diseases that significantly affect one's appearance. The development of disfiguring skin diseases is multifactorial, such as genetic, immune, and endocrine factors. However, recent research suggests that emotional distress (such as anxiety, depression, and sleep disorders) has been implicated as a key contributing factor to the onset and progression of disfiguring skin diseases, including acne, rosacea, and vitiligo; in turn, the psychosocial burden imposed by these conditions exacerbates emotional disturbances, thereby creating a self-perpetuating vicious cycle. Therefore, understanding the relationship between emotional distress and disfiguring skin diseases is essential. In recent years, the proposed concept of the "brain-skin axis" has framed the nervous, endocrine, and immune systems as an intricate regulatory network, highlighting the multilayered connections between the brain and the skin. Within the mechanistic framework of the brain-skin axis, emotional distress may alter neural and endocrine signaling, potentially disrupt normal skin homeostasis, exacerbate inflammatory responses and immune dysregulation, and impair skin barrier function; based on experimental and observational evidence, these changes may elevate susceptibility to disfiguring skin diseases. In this review, we examined the complex relationship between emotional distress and three disfiguring skin diseases (acne, rosacea, and vitiligo) from the perspective of the brain-skin axis. We also discussed the potential value of various psychosomatic interventions, including psychotherapy, pharmacotherapy and integrated therapy in improving both dermatological symptoms and psychiatric comorbidities. Understanding the interactions and mechanisms linking emotional distress and disfiguring skin diseases through the lens of the brain-skin axis can provide new insights into the diagnosis and treatment of these skin conditions.

Beyond efficacy: pulse duration is crucial for adverse events in pulsed dye laser therapy for rosacea.

Liu T, Liu Y, Meng X, et al. J Dermatolog Treat. 2026 Dec;37(1):2665064. Epub 2026 May 11. DOI: 10.1080/09546634.2026.2665064. PMID: 42112600.

Background: Pulsed dye laser (PDL) is widely used for erythematotelangiectatic rosacea (ETR); however, the influence of pulse duration remains unclear. Objective: To compare the efficacy and tolerability of 6 and 10 ms PDL pulse durations for ETR. Methods: In this single-center, prospective, randomized controlled study, 80 patients with ETR received single PDL treatment using either a 6 or 10 ms pulse duration (9-11 J/cm2, 7 mm spot size). Erythema was assessed by blinded dermatologists using the Clinical Erythema Assessment (CEA) and telangiectasia scores, and Rosacea Area and Severity Index (RASI). ImageJ analysis measured the Relative Intensity of Redness (RIR) and Percentage of Erythema Area (PEA). Adverse events were recorded on days 3 and 7, and patient global assessment (PGA) and symptom improvement were evaluated at week 4. Results: Both groups showed significant improvements in CEA, RASI, RIR, and PEA (p < 0.001), with no significant between group differences. However, edema (p < 0.05) and purpura (p < 0.001) were more frequent with the 6 ms setting. No significant differences were observed between the groups on the PGA, erythema improvement scale, or symptom improvement scale. Conclusion: Both pulse durations effectively reduced erythema, but 10 ms demonstrated more favorable tolerability.

Oral dapsone in refractory rosacea: a prospective exploratory study defining a "high inflammatory burden" subtype and a testable precision treatment hypothesis.

Xu B, Liu H, Yang Y, et al. J Am Acad Dermatol. 2026 May 8:S0190-9622(26)00557-8. Epub ahead of print. DOI: 10.1016/j.jaad.2026.04.020. PMID: 42104980.

Background: Refractory rosacea lacks evidence-based management. Objective: To preliminarily assess oral dapsone outcomes in strictly defined refractory rosacea, explore mechanisms via proteomics, and generate a testable subtyping hypothesis. Methods: This prospective, single-center, single-arm exploratory trial enrolled 124 refractory rosacea patients. Patients received dapsone 100 mg daily for 8 weeks. A nested substudy (N = 28) collected stratum corneum for proteomics. Using proteomic and clinical data, we defined a "high inflammatory burden" subtype and explored its association with treatment response. Results: Patients failed a mean of 3.2 prior treatments. At week 8, 59.68% achieved Investigator Global Assessment 0/1. 82.26% achieved "deep remission" (both Investigator Global Assessment and Clinician Erythema Assessment improved)-a finding requiring interpretation within potential placebo effects (20% to 45%). Proteomics revealed 33 downregulated inflammation-related proteins. The "high inflammatory burden" subtype (54.03%) showed higher deep remission (88.06% vs 75.44%), absolute difference 12.62% (OR = 2.40, 95% CI: 0.925-6.23; P = .110), not reaching significance. Limitations: Single-center, single-arm design. Conclusion: This exploratory study observed clinical improvements with oral dapsone in refractory rosacea and generated a testable hypothesis: the "high inflammatory burden" subtype may identify patients more likely to benefit. Providing a clear subtype definition, effect size estimates, and enrichment trial design, this study offers an actionable framework for future validation trials.

Exploring immune-related gene and mechanisms in rosacea through transcriptome analysis and Mendelian randomization.

Wang Y, Zhang J. Biomed Res Int. 2026;2026(1):e7294117. DOI: 10.1155/bmri/7294117. PMID: 42112773.

Background: Dysregulation of the innate and adaptive immune system is thought to be central to the pathogenesis of rosacea. However, the molecular mechanism of immune-related genes has not been extensively studied in rosacea. Methods: The GSE65914 and GSE155141 datasets were included in this study. Firstly, intersection genes were screened by overlapping key module genes obtained from weighted gene coexpression network analysis (WGCNA) and DEGs (rosacea vs. control). Then, functional enrichment analysis was performed to explore the functions of intersection genes. Subsequently, exposure factors (key genes) for rosacea were identified through Mendelian randomization (MR), and machine learning and expression analysis were conducted based on intersection genes. Single-gene gene set enrichment analysis (GSEA) was utilized to investigate the molecular mechanisms of key genes. Additionally, a regulatory network was constructed. Finally, the mRNA-drug interaction network was established. Results: A total of 624 intersection genes were screened, with functional enrichment results indicating involvement in positive regulation of protein kinase activity and the Hippo signaling pathway. Four key genes (ALDH1A1, COL17A1, RELL1, and ZNF404) were identified, with ALDH1A1 as a risk factor and the others as protective factors for rosacea. Single-gene GSEA results showed enrichment in the IL-17 and chemokine signaling pathways. The regulatory network included four mRNAs, two transcription factors (TFs), and 61 miRNAs. Lastly, 73 drugs targeting key genes were predicted. Conclusions: This study identified four immune-related key genes (ALDH1A1, COL17A1, RELL1, and ZNF404) through MR analysis and machine learning, suggesting potential diagnostic or therapeutic candidates for further validation.

Therapeutic efficacy and safety of botulinum toxin type A in erythematotelangiectatic rosacea: a systematic review.

Marrar K, Althiyabi R, Alsannaa M, et al. Cureus. 2026 Apr 11;18(4):e106841. DOI: 10.7759/cureus.106841. PMID: 42124752; PMCID: PMC13159499.

Botulinum toxin type A (BoNT-A) injections have a well-known cosmetic outcome and safety profile in a variety of medical conditions. Recent studies have shown promising results for possible use in treating erythematotelangiectatic rosacea (ETR). This systematic review aimed to evaluate the efficacy and safety of BoNT-A injections in patients with ETR. A systematic search was conducted across multiple databases to identify relevant studies. Eligible articles were randomized controlled trials (RCTs) that investigated BoNT-A injections in adults diagnosed with ETR. Studies involving other rosacea subtypes, lacking a comparative group, or combining BoNT-A with other interventions without isolating its effects were excluded. Three RCTs met the inclusion criteria. Both parallel-group and split-face analyses demonstrated that BoNT-A injections significantly reduced facial erythema and flushing, resulting in improved patient satisfaction. Across all studies, BoNT-A was well-tolerated, with adverse events being mild, transient, and self-limited. However, the evidence remains limited by the small sample sizes, suboptimal study designs, and short follow-up durations. BoNT-A injections show promising efficacy and safety in the treatment of ETR. However, larger, well-designed randomized trials with longer follow-up durations are required to confirm its therapeutic role and establish standardized treatment protocols.

Role of microbiome in ocular surface disease: interpreting biology in a low-biomass environment.

Yashar M, Thigale UY, Karakus S. Curr Opin Ophthalmol. 2026 May 8. Epub ahead of print. DOI: 10.1097/ICU.0000000000001228. PMID: 42101202.

Purpose of review: Growing use of sequencing technologies has accelerated investigation of the ocular surface microbiome, yet this environment is characterized by extremely low microbial biomass, complicating data interpretation. This review assesses current evidence linking microbial communities to ocular surface disease, discusses methodological and biological factors influencing interpretation of microbiome-disease associations, and proposes a framework in which microbial roles may be considered as drivers, modifiers, or markers. Recent findings: Studies across multiple ocular surface diseases report alterations in microbial composition, including reduced α-diversity and shifts in dominant taxa. Genera such as Staphylococcus, Corynebacterium, and Cutibacterium are frequently reported as resident members of the ocular surface microbiome, although their abundance varies across individuals and sampling sites. Across diseases, microbial patterns often overlap and remain inconsistent between studies. Emerging mechanistic evidence has identified specific microbial products, such as lipoteichoic acid, that promote ocular surface inflammation through defined signaling pathways, providing initial support for a potential driver or modifier role. In low-biomass environments such as the ocular surface, contamination, host DNA predominance, and methodological variability can strongly influence detected microbial signals. Summary: Interpretation of ocular surface microbiome data remains inherently challenging in this low-biomass context. However, the emergence of mechanistic studies suggests a transition from purely associative observations toward functional and translational investigation. Future studies should be designed to better define microbial roles by integrating standardized methodologies with multiomics approaches and detailed clinical phenotyping. Until such evidence emerges, microbiome research is best viewed as advancing biological insight rather than informing clinical decision-making.

Rosacea and Hippophae rhamnoides: a phytonutrient approach to skin repair (the systematic review).

Hincu MA, Nicoara DA, Niculet E, et al. Medicina (Kaunas). 2026 Apr 1;62(4):676. DOI: 10.3390/medicina62040676. PMID: 42075548; PMCID: PMC13118053.

Background and Objectives: Rosacea is a chronic inflammatory dermatosis with a complex pathophysiology that continues to challenge effective long-term disease management. Rosacea is characterized by immune dysregulation, oxidative stress, neurovascular dysfunction, and impaired epidermal barrier integrity, while current therapeutic options remain limited. Hippophae rhamnoides (sea buckthorn) is a phytochemically rich medicinal plant with reported anti-inflammatory and dermo-reparative properties. Materials and Methods: A systematic literature review was conducted following PRISMA guidelines using the PubMed database. Studies published from 2020 onward evaluating sea buckthorn extracts, oils, or isolate bioactive compounds in the in vitro, in vivo, and limited clinical contexts were included, with emphasis on rosacea relevant mechanisms. Results: Twenty-six studies show that sea buckthorn compounds modulate inflammation, oxidative stress, vascular and immune responses, and barrier function in preclinical models. They consistently reduce pro-inflammatory mediators, improve barrier integrity, and attenuate immune or vascular activation, suggesting potential benefits for inflammatory skin disorders such as rosacea. Conclusions: Hippophae rhamnoides shows promising anti-inflammatory and skin-repairing effects that may benefit patients with rosacea. However, most evidence comes from preclinical studies, and clinical data specifically for rosacea are limited. Well-designed clinical trials are needed to confirm its effectiveness in treating this condition.

An updated systematic review of topical corticosteroid withdrawal (TCSW): steroid addiction or adverse drug effect?

Choi H, Orbe M, Esam S, Parker J. Cureus. 2026 Apr 19;18(4):e107365. DOI: 10.7759/cureus.107365. PMID: 42170112; PMCID: PMC13186782.

Topical corticosteroid withdrawal (TCSW) can occur after prolonged topical corticosteroid (TCS) use. Despite the effectiveness of TCS in treating dermatological conditions, the phenomenon of steroid phobia has been gaining attention on social media platforms. This has contributed to increased anxiety among patients and potentially influenced their treatment adherence. This review aims to update the findings of two studies by investigating the latest research on TCSW. A systematic search was conducted in Ovid MEDLINE, PubMed, and the Cochrane Library from October 2020 to June 2024. Seven studies were included in the analysis, including five case reports, one case series, and one qualitative cross-sectional survey, reflecting the limited and descriptive nature of the currently available evidence on TCSW. TCSW appears to predominantly occur in adult women (90%) using TCS for atopic dermatitis (99.5%), mostly on the face (90%). Common symptoms include burning (89.8%), itching (85.6%), and skin hypersensitivity (82.3%), with erythema (89.6%) and desquamation (88.7%). TCSW appears to occur more commonly in women using high-potency TCS on the face long-term. Inconsistent diagnostic criteria, variable definitions, and the primarily descriptive nature of the currently available evidence complicate accurate diagnosis and treatment of TCSW. Increased awareness, education, and research on standardized criteria and management strategies are essential.

Case Reports

Minocycline-induced hyperpigmentation.

Maharaj A, Omar M. N Engl J Med. 2026 Apr 2;394(13):e24. DOI: 10.1056/NEJMicm2513782. PMID: 41931051.

A 68-year-old woman with rosacea presented with a 6-week history of dark patches on the skin of her arms and legs. Two weeks before the onset of the skin changes, she had started taking minocycline daily.

When antibiotics leave a mark: minocycline-induced hyperpigmentation.

Ting C, Daniel BS, O'Brien T, Robinson AJ. Clin Case Rep. 2026 Feb 28;14(3):e72187. DOI: 10.1002/ccr3.72187. PMID: 41767080; PMCID: PMC12949421.

This article presents two patients with significant minocycline-induced hyperpigmentation, illustrating the diverse clinical manifestations across various body sites. Judicious use of minocycline and early recognition of its adverse effects are crucial to reduce the risk of irreversible hyperpigmentation in patients receiving this antibiotic.

Eosinophilic folliculitis presenting as persistent pruritic facial papules: a diagnostic challenge.

Bai JQA, Mahmood MN, Chow EY. Cureus. 2026 Apr 8;18(4):e106653. DOI: 10.7759/cureus.106653. PMID: 42109950; PMCID: PMC13155252.

Eosinophilic folliculitis is a rare inflammatory dermatosis characterized by recurrent pruritic follicular papules or pustules with eosinophil-predominant inflammation. Although classically associated with immunosuppression, it demonstrates a broad clinical spectrum and may present diagnostic challenges. We report a 50-year-old woman with a several-year history of recurrent, severely pruritic facial papules initially attributed to chronic spontaneous urticaria, mastocytosis, or an atypical presentation of papulopustular rosacea. Histopathologic interpretation was initially reported as being consistent with an arthropod bite reaction. However, the failure to respond to all directed therapies prompted clinical suspicion of eosinophilic folliculitis. Targeted dermatopathologic re-review revealed a folliculocentric eosinophilic infiltrate diagnostic of eosinophilic folliculitis. The patient demonstrated a complete and reproducible response to oral indomethacin. Over longitudinal follow-up, she was subsequently diagnosed with systemic lupus erythematosus more than five years after the onset of the cutaneous symptoms. This case highlights the variable clinical and histopathologic presentation of eosinophilic folliculitis, the importance of clinicopathologic correlation in refractory facial eruptions, and the potential association with underlying immune dysregulation.

News

Track Triggers With National Rosacea Society’s Updated Rosacea Diary

Rosacea.org

The National Rosacea Society announced it has introduced an updated version of the “Rosacea Diary,” a booklet containing diary pages to help patients identify and avoid their personal rosacea triggers – such as certain foods, weather, physical activity and skincare products. The updated diary streamlines and modernizes the design for ease of use and incorporates a new and more robust checklist.

Adding Salicylic Acid to IPL Improves Rosacea Outcomes

Medscape

Supramolecular salicylic acid (SSA) plus intense pulsed light (IPL) was both safe and effective for treating rosacea, a prospective, split-face trial suggested.

Lasers and Light for Acne and Rosacea

Practical Dermatology

As lasers and light-based devices continue to gain traction in dermatology, their role in managing acne and rosacea is evolving beyond adjunctive use. In this Q&A, Emmy Graber, MD, MBA, FAAD, discusses how emerging technologies (particularly the 1726-nm laser) are reshaping treatment algorithms, patient selection, and combination strategies in clinical practice.

Please email us at digest@rosacea.org with your comments and suggestions.