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

Rosacea in patients with skin of color: diagnosis and management.

Lohani D, Marson JW, Baldwin HE. Am J Clin Dermatol. 2026 Sep 21. Epub ahead of print. DOI: 10.1007/s40257-026-01066-7. PMID: 42766280.

Rosacea is a chronic central face dermatosis caused by a combination of dysregulated innate and adaptive immunity and hyperreactive cutaneous neurovasculature. Although classically associated with lighter skin phototypes, rosacea may affect up to 2-4% of Black, Asian, Pacific Islander, and Hispanic/Latino American populations and its prevalence is likely underestimated given our current diagnostic reliance on phenotypic expression (e.g., fixed erythema with or without intermittent exacerbations, flushing, and/or telangiectasias) that may be difficult to appreciate in more heavily pigmented skin. In patients with richly pigmented skin, a careful history of symptoms to assess the minor/secondary criteria (i.e., burning or stinging, edema, dryness, flushing, low tolerance for over-the-counter products, symptoms with classic 'triggers', family history and/or ocular symptoms), along with patient participation during the physical exam to establish their baseline skin tone, may facilitate diagnosis. Rosacea treatment regimens are centered around presentation and can include over-the-counter agents, lifestyle modifications, prescription topical, systemic, and procedural therapies. Optimal regimens may be tailored to best address patient-perceived disease severity and concerns and to minimize any further irritation/inflammation which may drive pigmentary alteration.

The latest advances in rosacea treatment: a systematic review.

Andrusiewicz A, Khimuk S, Niżnik J, et al. Pharmaceuticals (Basel). 2026 Jun 24;19(7):982. DOI: 10.3390/ph19070982. PMID: 42515667.

Background: Rosacea is a chronic inflammatory dermatosis characterized by vascular dysregulation, immune dysfunction, neurovascular alterations, and microbial involvement. Recent advances in understanding its pathophysiology have led to the development of targeted therapeutic strategies addressing multiple disease mechanisms. This systematic review aimed to evaluate contemporary evidence regarding emerging and established treatment approaches for rosacea. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, and Web of Science were searched for studies published between 2016 and 2025. Original human studies evaluating therapeutic interventions for rosacea were included. Study selection, data extraction, and risk-of-bias assessment were performed independently by two reviewers. Methodological quality was assessed using Joanna Briggs Institute (JBI) critical appraisal tools appropriate for each study design. Results: Fifteen studies involving 537 patients with rosacea and 77 controls (614 participants in total) met the eligibility criteria. Evaluated interventions included vascular-targeted therapies, topical anti-inflammatory agents, systemic and immunomodulatory treatments, and microbiome-oriented approaches. Oxymetazoline, pulsed-dye laser, platelet-rich plasma, ivermectin, azelaic acid, dapsone, sulfur preparations, and metronidazole demonstrated clinical benefits in reducing erythema, inflammatory lesions, or overall disease severity. Emerging therapies, including tofacitinib and oral ivermectin, showed promising results in refractory disease. Microbiome-related interventions, particularly Demodex-targeted therapies and Helicobacter pylori eradication, were also associated with clinical improvement. Risk-of-bias assessment identified two studies with low risk of bias, twelve with moderate risk of bias, and one study with high risk of bias. Conclusions: Current evidence supports a multimodal and mechanism-based approach to rosacea management, integrating vascular, inflammatory, immunological, and microbiological targets. However, the available evidence remains limited by small sample sizes, heterogeneous methodologies, short follow-up periods, and a predominance of non-randomized study designs. Large, well-designed randomized controlled trials are needed to establish optimal evidence-based treatment strategies and define the long-term efficacy and safety of emerging therapies.

Clascoterone cream 1% is safe and effective for papulopustular rosacea: a phase 2 clinical trial.

Joerg L, Zafar K, Kabakova M, et al. J Drugs Dermatol. 2026 Aug 1;25(8):701-707. DOI: 10.36849/JDD.10040. PMID: 42555080.

Background: Papulopustular rosacea (PPR) is a chronic inflammatory facial dermatosis with a need for well-tolerated and effective topical therapies. Clascoterone cream 1% is an androgen receptor inhibitor and a promising novel treatment for PPR. Methods: In this single-center, single-arm, phase 2 pilot study, adults with PPR applied clascoterone cream 1% twice daily to the face. The primary endpoint was biopsy-proven change in mean sebaceous gland number and diameter over 12 weeks. Secondary endpoints included Dermatology Life Quality Index (DLQI), patient-reported outcomes (PROs), and prevalence of adverse events. Results: Twenty participants were enrolled, and 18 completed the study. Mean sebaceous gland count decreased significantly (4.94 ± 1.98 to 3.61 ± 2.33; P=0.012). Mean gland diameter also decreased, although not significantly (P=0.182). Mean DLQI scores significantly improved (7.5 ± 5.8 to 3.3 ± 5.6; P=0.029). PRO scores were favorable for papules/pustules (3.2 ± 1.1), facial redness (2.7 ± 1.0), general skin appearance (2.7 ± 1.1), and overall treatment satisfaction (3.1 ± 0.7). The treatment was well tolerated, with no serious adverse events. Mild, transient dryness (n=1) and eye irritation (n=1) resolved without intervention. Conclusion: Clascoterone cream 1% demonstrated favorable tolerability, safety, and efficacy in PPR, with significant improvements in sebaceous gland count and patient-centered outcomes. These findings support the therapeutic potential of clascoterone cream 1% for the treatment of PPR.

The combination of 1064nm pulsed Nd:YAG laser and ALA-PDT for phymatous rosacea.

Ping D, Chenglong H, Xian J. Photodiagnosis Photodyn Ther. 2026 Jul 4:105562. Epub ahead of print. DOI: 10.1016/j.pdpdt.2026.105562. PMID: 42401359.

Rosacea is a common chronic inflammatory disease. Among its four subtypes, phymatous rosacea predominantly affects middle-aged and elderly men and is characterized by hyperplasia and hypertrophy of both fibrous tissue and sebaceous glands of the nose. The visible manifestation is often considered a disfigurement and the accompanying social stigma often cause serious emotional and physical impact. In this article, we describe a combination therapy of a 1064nm Nd:YAG laser (Sichuan Aerospace World Guidance Co., Ltd.; fiber core diameter: 0.6 mm; laser energy: 100-200 mJ) and ALA-PDT (20% 5-aminolevulinic acid: Fudan Zhangjiang Co., Ltd., Shanghai, China and red light: Sigma, 635 nm wavelength, 60-80 mW/cm² irradiation energy for 15-20 minutes). This combined regimen achieved satisfactory clinical outcomes with minimal adverse effects, including little bleeding and a low risk of postoperative infection. Furthermore, it facilitated convenient postoperative home care for the patient.

Immunomodulatory effects of poly-D,L-lactic acid on LL-37-driven rosacea-like inflammation via suppression of mTORC1 signaling.

Byun KA, Park JY, Oh S, et al. Int J Mol Sci. 2026 Jul 19;27(14):6425. DOI: 10.3390/ijms27146425. PMID: 42511767; PMCID: PMC13410482.

Rosacea is a chronic inflammatory skin disorder driven by dysregulated cathelicidin processing and excessive LL-37, which triggers a circuit involving Toll-like receptor 2 (TLR2)/kallikrein-5 (KLK5)-dependent amplification and downstream mechanistic target of rapamycin complex 1 (mTORC1), NF-κB, and NLR family pyrin domain containing 3 (NLRP3) inflammasome pathways. We hypothesized that poly-D,L-lactic acid (PDLLA) could attenuate this inflammatory cascade by inducing macrophage-derived interleukin (IL)-10. PDLLA increased IL-10 secretion from THP-1-derived macrophages in a dose-dependent manner. In LL-37-stimulated HaCaT keratinocytes, LL-37 decreased phosphorylated signal transducer and activator of transcription (pSTAT3)/STAT3, DNA damage-inducible transcript 4 (DDIT4), and phosphorylated AMP-activated protein kinase (pAMPK)/AMPK while increasing phosphorylated protein kinase B (pAKT)/AKT and mTORC1 activation; conditioned media from PDLLA-treated macrophages (CMPDLLA) restored pSTAT3/STAT3, DDIT4, and pAMPK/AMPK, reduced pAKT/AKT, and suppressed pmTOR/mTOR. CMPDLLA attenuated downstream inflammatory responses, including NF-κB nuclear translocation, VEGF production, and NLRP3-inflammasome-mediated IL-18 secretion. These findings were validated using an intradermal LL-37-injected mouse model. Compared with the normal control/saline group, LL-37/saline decreased IL-10, pSTAT3/STAT3, DDIT4, and pAMPK/AMPK while increasing pAKT/AKT, pmTOR/mTOR, pS6K/S6K, TLR2/KLK5/LL-37, NF-κB, VEGF, and NLRP3 inflammasome/IL-18 signaling; PDLLA partially restored the STAT3/DDIT4-AMPK regulatory pattern and suppressed these disease-associated signals. Consequently, PDLLA treatment led to a pronounced reduction in clinical lesion area. Overall, PDLLA may attenuate LL-37-driven cutaneous inflammation by promoting an IL-10-linked STAT3/DDIT4-AKT/AMPK program that suppresses mTORC1 and disrupts cathelicidin amplification, supporting its potential as an injectable immunomodulatory approach for rosacea-like skin inflammation.

Pulsed dye laser and intense pulsed light therapy for cutaneous and ocular rosacea: a systematic review.

Finney OS, Soliman J, Choi M, et al. Lasers Surg Med. 2026 Aug 6. DOI: 10.1002/lsm.70185. Epub ahead of print. PMID: 42561123.

Objectives: This manuscript reviews studies on the use of pulsed dye laser (PDL) and intense pulsed light (IPL) for the treatment of cutaneous rosacea, with a focus on their emerging role in managing ocular rosacea. Methods: A literature search was conducted using the PubMed database with the terms "rosacea and intense pulsed light", "ocular rosacea and intense pulsed light", "rosacea and pulsed dye laser", and "ocular rosacea and pulsed dye laser." Of the 81 initially identified articles, studies not in English and those published before 1999 were excluded to ensure relevance to modern laser technologies. Additionally, review articles and case reports with three or fewer patients were excluded due to limited generalizability and statistical robustness. Results: After applying exclusion criteria, 20 articles remained. Studies consistently demonstrated significant improvement in erythema and telangiectasia following multiple sessions of PDL or IPL, with minimal differences between the two modalities. However, one study reported that IPL treatment was faster to administer. While IPL has been widely studied in ophthalmology for treating dry eye syndrome and meibomian gland dysfunction, it has also been shown to effectively alleviate ocular rosacea symptoms, reducing lid margin telangiectasia and improving meibum expressibility. Conclusions: PDL and IPL have demonstrated efficacy and safety in managing cutaneous rosacea, and IPL has also proven beneficial for ocular rosacea. These findings support the expanding role of laser and light-based therapies as effective treatment options for patients suffering from rosacea-related symptoms.

Recognizing paediatric ocular rosacea: clinical spectrum, diagnostic clues, and treatment outcomes.

Akgun Z, Bulut Tarlabolen O, Barut Selver O, Palamar M. Ocul Immunol Inflamm. 2026 Sep 18:1-7. Epub ahead of print. DOI: 10.1080/09273948.2026.2735405. PMID: 42757848.

Purpose: To evaluate demographic and clinical characteristics, diagnostic clues, and treatment outcomes among paediatric patients with ocular rosacea. Methods: Medical records of patients aged ≤ 16 years diagnosed with ocular rosacea between 2020 and 2026 were retrospectively reviewed. Demographic characteristics, presenting symptoms, eyelid and corneal findings, dermatological involvement, diagnostic delay, treatment response, recurrence, and follow-up outcomes were recorded. Disease severity at the initial examination and after treatment was evaluated using the clinical severity score described by Audelan et al. graded on a 0-4 scale. Results: Thirty-one patients with 62 eyes were included. The female-to-male ratio was 22/9, and the mean age was 7.7 ± 4.6 (1-16) years. The most common presenting symptom was burning and/or stinging (58.1%). Blepharitis was the most common eyelid manifestation (98.4%). Corneal and dermatologic involvement were observed in 71.0% of eyes and 54.8% of patients, respectively. The mean interval between symptom onset and diagnosis was 13.2 ± 12.1(20 days-36 months) months. Three patients (9.7%) had previously been treated as having herpetic keratitis. Mean follow-up duration was 10.2 ± 10.7 (1-36) months. The mean clinical severity score decreased significantly from 2.52 ± 1.16 to 1.34 ± 1.39 after treatment (p < 0.001), with improvement in 47 eyes (75.8%). No recurrence was documented during follow-up period. Conclusion: Paediatric ocular rosacea is an underrecognized ocular surface disease with a broad clinical spectrum and often a delayed diagnosis. A standardized clinical severity score may provide a common language for grading and monitoring. Early recognition and appropriate long-term management may help reduce morbidity.

The left middle frontal gyrus: A potential central hub for rosacea in the brain-skin axis.

Chen N, Yang W, Xu Y. J Invest Dermatol. 2026 Sep 22:S0022-202X(26)02626-6. Epub ahead of print. DOI: 10.1016/j.jid.2026.06.1276. PMID: 42770928.

For decades, rosacea has been conceptualized as a peripheral inflammatory dermatosis driven by aberrant crosstalk within the neurovascular–immune triad. The hallmark symptoms of persistent erythema, flushing, and burning sensations have been attributed to the aberrant release of neuropeptides, such as calcitonin gene-related peptide (CGRP) and substance P, which orchestrate local vasodilation and inflammatory cascades. However, mounting clinical and epidemiological evidence has long hinted at a deeper central involvement. Patients with rosacea frequently experience comorbid neurological and psychiatric conditions, including migraine, anxiety, and depression. Furthermore, emotional stress is a well-documented precipitant of rosacea flare-ups, suggesting a profound yet mechanistically elusive connection between the brain and the skin.

Inflammatory memory as a potential driver of rosacea pathogenesis: integrating mechanisms of chronic relapse and perspectives on disease modification.

Zhang M, Zhou Z, Zhan D, et al. Front Immunol. 2026 Sep 29;17:1962766. DOI: 10.3389/fimmu.2026.1962766.

Inflammatory memory refers to functional changes retained by a tissue after an inflammatory episode that allow faster or stronger responses to subsequent challenges. It encompasses epigenetic memory in epithelial and stem cells, trained immunity, and tissue-resident memory T cells. Rosacea is a chronic inflammatory skin disease characterized by recurrent flushing, persistent erythema, and papulopustular lesions, and relapse after treatment cessation is common; the mechanisms that drive recurrence remain unclear. In this hypothesis-generating critical review, we use inflammatory memory as an integrative framework and examine evidence consistent with inflammatory memory in rosacea, including the Toll-like receptor 2/kallikrein-related peptidase 5/cathelicidin antimicrobial peptide (LL-37) positive feedback axis, mast-cell-mediated amplification, neuroimmune amplification, and an interleukin-1β-centered persistent inflammatory program. We draw on mechanistic evidence from psoriasis and atopic dermatitis related to tissue-resident memory T cells, epithelial memory, and trained immunity, while explicitly separating established rosacea-specific observations from indirect cross-disease parallels and speculative claims. A multilayer memory network model is proposed in which repeated triggers write memory and lower the relapse threshold; disease modification is then discussed as a candidate therapeutic goal, together with potential strategies and testable hypotheses. Direct molecular evidence for inflammatory memory in rosacea is still lacking, alternative mechanisms remain plausible, and disease modification should be viewed as a perspective rather than an established endpoint.

Case Reports

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.

Beyond lifting: superficial-targeted monopolar radiofrequency for erythematotelangiectatic rosacea.

Kim WS. Clin Cosmet Investig Dermatol. 2026 Sep 21;19:639027. DOI: 10.2147/CCID.S639027. PMID: 42799195; PMCID: PMC13614337.

Noninvasive monopolar radiofrequency (NMRF) is an established modality for skin tightening, but its role in inflammatory dermatoses such as rosacea remains poorly defined. We report a man in his forties with an erythematotelangiectatic rosacea (ETR) phenotype, characterized by persistent centrofacial erythema, flushing, and xerosis, who underwent two sessions of multifrequency NMRF (XERF; Cynosure Lutronic, Goyang, Korea) at 4-week intervals using an off-label, superficial-targeted protocol (shallow setting, intensity level 5; 6.78 MHz; approximately 250 pulses; approximately 23,000 J cumulative energy per session; fragmented-pulse mode with controlled off-time). One month after the second session, facial erythema was visibly reduced and skin tone appeared more uniform. Antera 3D (Miravex, Dublin, Ireland) multispectral imaging showed a 24.3% decrease in average hemoglobin level (2.016 to 1.525) and a 36.9% decrease in hemoglobin variation (0.255 to 0.161). Surface scaling and xerosis also improved clinically. This single case suggests that superficial-targeted NMRF may reduce erythema and improve barrier-related symptoms in ETR through combined vascular, anti-inflammatory, and epidermal barrier mechanisms, beyond its established tissue-tightening effect, although these findings are exploratory and controlled studies incorporating standardized imaging, transepidermal water loss, histology, and inflammatory mediator assessment are needed to test this hypothesis.

News

Perimenopause May Mark Rosacea’s Onset or Worsening

Rosacea.org

Menopause is the stage of life when menstruation stops, and is defined as the moment when a person has not menstruated for 12 consecutive months. But the four to 10 years leading up to menopause commonly involve a wide variety of physical, mental and emotional symptoms caused by decreasing estrogen and progesterone. This tumultuous stage of life is called perimenopause. In perimenopause, symptoms such as irregular periods, hot flashes, mood disorders, joint issues, brain fog and insomnia are quite common.

Social Media Mythbusters: Skin Flooding

Dermatology Times

Does "flooding" with 5 to 7 products every night really hydrate the skin or is it just a myth? Read more about the latest social media trend and learn how to counsel your patients in the clinic.

There’s an Azelaic Acid Shortage Happening Right Now—Here’s Everything to Know About the Buzzy Ingredient

New Beauty

The ingredient is popping up everywhere, from TikTok to your derm’s office—though, as New York dermatologist Dr. Kiran Mian notes, experts have been using it in practice for decades. The renewed demand has even led to a shortage of Finacea, the prescription-strength version of azelaic acid: Dr. Mian says suppliers are reporting that it’s backordered, leading to delays for patients waiting on it. (Not to worry: the over-the-counter versions remain easy to find.)

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