Rosacea

ETIOLOGY​​

Associations with IUDs

• Liletta (levonorgestrel 52 mg) had the highest incidence of rosacea at all time points (1, 3, and 5 years post-insertion), followed by Mirena, while Skyla (lower-dose levonorgestrel) showed no significant association​. Hormonal IUDs, particularly higher-dose levonorgestrel devices, may increase the risk of rosacea, likely due to hormonal modulation of androgen and estrogen receptors, whereas nonhormonal IUDs were not linked to increased risk. (39447756)

TREATMENT

Dietary Interventions

• 70.5% of patients report that diet impacts disease severity of rosacea. (37892480)

• Foods for which there is some evidence (although limited in its scope and certainty) for exacerbation or development of rosacea include: (35096255)

  • alcohol (most frequent purported trigger)​

  • spicy foods

  • cinnamaldehyde-containing foods: tomatoes, citrus fruits, chocolate

  • hot drinks

  • histamine-rich foods: aged cheese, wine, processed meats

• Coffee and caffeinated beverages, which were thought to be trigger appear not to be and may be protective. (30347034)​

• For patients with ocular rosacea, supplementation with omega-3 fatty acids may be affective. (27050028)​

Gabapentin

Gabapentin is an efficacy treatment for facial flushing and erythema of erythematotelangiectatic rosacea: A randomized clinical noninferiority trial. J Am Acad Dermatol. 2025. PMID: 39710117.

This study is a randomized clinical trial comparing gabapentin to carvedilol for treating erythematotelangiectatic rosacea.  (ETR), particularly facial Gabapentin (300 mg, 3x/day) was noninferior to carvedilol (5 mg, 2x/day) over 12 weeks.  Gabapentin provided faster relief for flushing symptoms (within , and also improved sleep disorders and migraines in ETR patients. However, it was less effective than carvedilol for treating anxiety and depression.