What You’re Missing in Rosacea: A Deeper Dive Into Diagnosis and Treatment
At Dermatology Week 2025, Julie C. Harper, MD, took the stage with a fast-paced and eye-opening session titled “What You’re Missing in Rosacea”—a deep dive into the clinical blind spots that keep patients in the red. From skin care missteps to underrecognized subtypes, Dr Harper made the case for more nuanced, layered care and reminded the audience that rosacea is never “just bumps and redness.”
“We want to really today focus in on what it is that we might be missing in rosacea,” she began, setting the tone for a session built around practical pearls, fresh data, and a few sharp reminders of what clinicians may be overlooking.
Dr Harper started with the most basic, but often skipped, step: skin care. Emphasizing barrier dysfunction as a key trigger of symptoms like burning, stinging, and sensitivity, she urged attendees not to assume patients know how to cleanse and moisturize properly. “I don’t want you to miss the opportunity to talk about this with your patients,” she said.
She then turned to persistent background erythema, showing striking images of patients who had cleared papules and pustules but were left with unresolved redness. Topical alpha agonists like brimonidine and oxymetazoline, she explained, can offer quick relief, though she warned about potential rebound and paradoxical erythema in a small subset of patients. Daily use, she noted, may offer cumulative benefits over time.
On the topic of flushing, Dr Harper described it as a separate, often undertreated component—one that may respond better to systemic agents like carvedilol or even gabapentin, both of which showed promise in recent studies. She also spotlighted botulinum toxin injections as a clever off-label tool for treating facial flushing and background redness alike.
The conversation then moved beyond the skin to the eyes, an area patients rarely associate with rosacea. “They are not going to just assume that their eye symptoms are related to ocular rosacea,” she said, outlining basic care like warm compresses and artificial tears, and even showcasing a case in which topical ivermectin helped resolve both facial and ocular signs.
Dr Harper also introduced attendees to neurogenic rosacea—a painful subtype marked by stinging, burning, and heat sensitivity—and reminded the audience to approach these cases with neuromodulators and extra caution around lasers and devices.
The talk wrapped with a spotlight on rosacea fulminans, a severe, sudden-onset presentation most often seen in young women, and a quick tour of the latest treatment approvals, including modified-release minocycline 40 mg, which bested doxycycline in head-to-head trials and, encouragingly, showed no significant disruption to the microbiome.
To tie it all together, Dr Harper offered a vivid metaphor: Rosacea management is like serving a multi-course meal, yet many clinicians reach for just one utensil. “Think about the forks for rosacea as being those products that are indicated for the papules and pustules… spoons for background erythema… knives, our devices,” she said.
“Rosacea is more than just pimples,” she concluded. “And if we’re only treating pimples, we’re missing a whole lot more.”
For more meeting coverage, visit the Dermatology Week newsroom.
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Reference
Harper JC. What you're missing in rosacea. Presented at: Dermatology Week; May 14–16, October 22–25, 2025; Virtual.
