The Latest in Rosacea News
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Every year, the National Rosacea Society (NRS) designates April as Rosacea Awareness Month, designed to educate, raise awareness, and reduce stigma for patients with this complex skin condition. This year’s focus is on a holistic approach to treatment that addresses all aspects of skin health, including everyday skin care, medical therapy, and lifestyle changes.1 Follow what the NRS is doing to further physician and patient education, as well as rosacea research, in this summary of recent news.
NRS Introduces Updated Rosacea Treatment Algorithms
The NRS has published an updated version of its Rosacea Treatment Algorithms in the physicians’ section of its website, rosacea.org. The new version is organized according to the phenotype model established by the 2017 updated standard classification and pathophysiology of rosacea.2 It suggests therapeutic approaches to mild, moderate, and severe presentations of each phenotype based on the 2019 update to the standard management options for rosacea,3 as well as presenting the original management options4 and studies of more recently developed therapies.
“Rosacea varies greatly from patient to patient in terms of signs and symptoms, environmental and lifestyle triggers, and responses to treatment,” said Andrew Huff, president and executive director of the NRS. “The Rosacea Treatment Algorithms are intended to provide a comprehensive summary of therapeutic options for each phenotype of the disease, allowing physicians to tailor therapy for each individual case to achieve optimal patient outcomes.”
Rosacea is a chronic disorder of the facial skin that is often characterized by flareups and remissions. Because rosacea’s signs and symptoms can vary so widely, it was initially classified into 4 subtypes. However, with the explosion of research in the last 20 years, it has become clear that rosacea’s often fluctuating and seemingly unrelated signs and symptoms are part of a single underlying inflammatory continuum. Rosacea is now identified according to its individual characteristics, or phenotypes, which may appear in different combinations and at different times.
According to the updated standard classification of rosacea, the presence of persistent facial redness or, less commonly, phymatous changes where the facial skin thickens is considered diagnostic of the disorder. Additional major signs, which often appear with these diagnostic features, include papules and pustules, flushing, telangiectasia, and certain ocular manifestations. The presence of 2 or more major features independent of the diagnostic signs is also considered diagnostic of rosacea. Secondary signs and symptoms include burning or stinging, swelling, and dry appearance. This new targeted approach encourages consideration of the full range of potential signs and symptoms, better assessment of their severity, and selection of treatment that is more precisely tailored for each individual case.
The NRS offers additional educational materials to patients and physicians, including “Understanding Rosacea,” a free patient booklet that provides an overview of rosacea’s potential signs and symptoms; “Coping with Rosacea,” a patient guide to eliminating lifestyle and environmental factors that aggravate rosacea in individual cases; “Recognizing Redness,” a measurement gauge for the most common sign of rosacea; Rosacea Review, a newsletter for rosacea patients; and the “Rosacea Diary,” a booklet containing diary pages to help patients identify and avoid their personal rosacea triggers. The materials may be ordered online at rosacea.org.
The updated version of the Rosacea Treatment Algorithms was made possible by a grant from Journey Medical Corp.
Topical Ivermectin May Improve Rosacea Indirectly
In addition to improving the clinical signs of rosacea, topical ivermectin, a US Food and Drug Administration-approved antiparasitic agent for papulopustular rosacea, may also be effective because it alters the bacterial composition of the skin, according to a recent NRS-funded study in the Journal of Investigative Dermatology.5
“In this study, we provide evidence that topical ivermectin not only decreases the density of Demodex but also affects the bacterial community on the skin of rosacea patients,” said Dr Tissa Hata, the study’s lead researcher.
Demodex, a microscopic mite that is a normal inhabitant of healthy skin, has been found in 15 to 18 times greater numbers in patients with rosacea than in healthy subjects.6 The action of ivermectin against Demodex is believed to be substantial, but the role of the mites as the sole driver of rosacea has been unclear. An imbalance of the microbiome has been observed on the skin of patients with rosacea, although the reasons for this imbalance are still largely unknown. Demodex frequently co-infects the skin with various bacterial pathogens; in addition to an increased number of Demodex on skin with rosacea lesions, the bacteria Cutibacterium acnes and Staphylococcus epidermidis were found on affected and non-affected skin of both patients and controls before therapy.
After treatment, while ivermectin decreased the number of Demodex mites and the amount of C. acnes showed no change, the S. epidermidis population on the facial skin increased. Certain strains of S. epidermidis may be beneficial in that they are anti-inflammatory, and some produce their own antimicrobial substances, which can suppress the overgrowth of harmful bacteria.
Rosacea is also characterized by an overproduction of the anti-microbial peptide cathelicidin.7 In a related study,8 the investigators found that this increase depletes the beneficial strains of bacteria. However, treatment with ivermectin inhibits the expression of cathelicidins, and thus indirectly promotes the anti-inflammatory effects of the beneficial bacteria. “Alteration of the microbiome with these beneficial strains may further improve the inflammatory homeostasis in rosacea,” the investigators noted.
Because the beneficial or detrimental functions of the skin’s bacteria are dependent on which strains of bacteria are present, larger additional studies are necessary to fully understand the effects of ivermectin on the functions of the skin microbiome.
NRS Celebrates 25 Years of Awarding Research Grants
The NRS is currently accepting applications for funding from its research grants program, which is celebrating its 25th anniversary in 2025. Supported exclusively by individual donations from those impacted by rosacea, the NRS research grants program has awarded more than $1.7 million to support 78 studies since 2000, with the goal of increasing knowledge and understanding of the potential causes and other key aspects of rosacea that may lead to improvements in its treatment and prevention, and a potential cure.
“This important program has fostered dramatic advances in the understanding of the disease process, which have provided an essential foundation for developing improvements in treatment,” said Dr Richard Gallo, chairman of dermatology at the University of California-San Diego and a member of the NRS Medical Advisory Board, which selects studies for funding. “Thanks to NRS-funded research, dermatologists now have a much better understanding of rosacea, and a growing array of innovative therapies are now available to treat and potentially fully eliminate its signs and symptoms.”
The NRS awards grants of up to $25,000, or more in special cases, for research on rosacea. Because the etiology of rosacea is unknown, high priority is given to research in such areas as the pathogenesis, progression, mechanism of action, cell biology, and potential genetic factors of this conspicuous and often life-disruptive condition. Studies may also be funded in such areas as epidemiology, predisposition, quality of life, and associations with environmental and lifestyle factors. Product development studies, such as drug or device testing, which are more appropriately funded by commercial sources, will not be considered.
The submission deadline for this year’s proposals is July 1, 2025. Researchers interested in applying for grants may obtain forms and instructions through the research grants section of the NRS website, rosacea.org, or by contacting the NRS at 4619 N Ravenswood Ave, Ste 103, Chicago, IL 60640; by telephone at 1-888-662-5874; or by email at info@rosacea.org.
“As funding sources become more scarce, the NRS research grants program offers an increasingly important resource for basic researchers in dermatology,” Dr Gallo said. “In particular, it should encourage those early in their careers to take advantage of this opportunity to make significant contributions to the body of research into this widespread but often overlooked disease.”
Mary Erhard is the director of medical communications at the NRS.
References
- Rosacea Awareness Month calls for holistic approach. National Rosacea Society. April 1, 2025. Accessed April 3, 2025. https://www.rosacea.org/press/2025/april/ rosacea-awareness-month-calls-for-holistic-approach
- Gallo RL, Granstein RD, Kang S, et al. Standard classification and pathophysiology of rosacea: the 2017 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol. 2018;78(1):148-155. doi:10.1016/j.jaad.2017.08.037
- Thiboutot D, Anderson R, Cook-Bolden F, et al. Standard management options for rosacea: the 2019 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol. 2020;82(6):1501-1510. doi:10.1016/j.jaad.2020.01.077
- Odom R, Dahl M, Dover J, et al. Standard management options for rosacea, part 2: options according to subtype. Cutis. 2009;84:97-104.
- Nakatsuji T, Cheng JY, Butcher A, et al. Topical ivermectin treatment of rosacea changes the bacterial microbiome of the skin. J Invest Dermatol. 2024:S0022-202X(24)02869-0. doi:10.1016/j.jid.2024.10.592
- The ecology of your face: Demodex, rosacea and you. National Rosacea Society. Accessed April 1, 2025. https://www.rosacea.org/patients/the-ecology-of-your-face-demodex-rosacea-and-you
- Yamasaki K, Di Nardo A, Bardan A, et al. Increased serine protease activity and cathelicidin promotes skin inflammation in rosacea. Nat Med. 2007;13(8):975-980. doi:10.1038/nm1616
- Nakatsuji T, Brinton SL, Cavagnero KJ, et al. Competition between skin anti-microbial peptides and commensal bacteria in type 2 inflammation enables survival of S. aureus. Cell Rep. 2023;42(5):112494. doi:10.1016/j.celrep.2023.112494
