Current and emerging pharmacotherapy for rosacea: a misunderstood and undertreated condition

Rosacea is a chronic inflammatory skin disease characterized by heterogeneous features, including erythema, telangiectasias, papules, pustules, ocular symptoms, and phymatous changes, which can impact quality of life. Its complex pathophysiology involves dysregulated innate immune, neurovascular, and inflammatory pathways, leading to an expanding range of therapeutic options.

A narrative review was conducted using the PubMed database to identify peer-reviewed articles published between 2014 and 2026. Keywords such as 'rosacea,' 'advances,' 'emerging,' 'management,' 'treatment,' 'off label,' 'device,' 'lasers,' and 'pathogenesis' were used to evaluate established and emerging pharmacologic and procedural therapies for rosacea. The following article summarizes the established and emerging agents for each treatment modality available for rosacea, with emphasis placed on mechanism of action, efficacy, and safety profiles.

Current management reflects a phenotype-driven approach to guide personalized treatment regimens. Emerging agents targeting novel inflammatory and neurovascular pathways may address limitations in tolerability and durability of response. Cost and evidence gaps continue to limit widespread clinical adoption. Further investigation is needed to define long-term safety, comparative efficacy, and cost-effectiveness to optimize individualized treatment strategies.