Rosacea Gets a Treatment Upgrade: What's New in 2025

Rosacea treatment has entered a new era in 2025, with FDA-approved extended-release medications and innovative therapies offering patients more effective options with reduced side effects. The chronic inflammatory skin condition, affecting up to 10% of the global population, now has a broader therapeutic arsenal that addresses both the inflammatory lesions and persistent redness that have long challenged dermatologists.

What Makes the New Treatments Different?

The standout advancement is DFD-29 (marketed as Emrosi), an extended-release minocycline formulation approved by the FDA in 2024. This represents the lowest-dose oral minocycline available for rosacea treatment, addressing a key concern with traditional antibiotics. "Minocycline was always one of my favorite oral treatments for rosacea, but it's nice now that it's low-dose because then you don't get all the microbial adverse effects and resistant organisms, and a lot of the gastrointestinal upset and photosensitivity is reduced," explained Dr. Zoe Diana Draelos in her research on the medication.

The dual-release formulation tackles both erythema (redness) and inflammatory lesions simultaneously, published results from the MVOR-1 and MVOR-2 studies in JAMA Dermatology supporting its efficacy.

What Other Treatment Options Are Emerging?

Beyond oral medications, 2025 has brought several innovative approaches to rosacea management. Dermatologists are increasingly incorporating adjunctive therapies that target different aspects of the condition:

• Platelet-Rich Plasma (PRP) Injections: Studies showed reduced rosacea symptoms and decreased dependence on oral medications across all five case studies examined
• Hyaluronic-Succinic Mesotherapy: This treatment demonstrated an 80% reduction in rosacea redness, offering a cost-effective adjunct therapy option
• Radiofrequency Microneedling: New analysis found this approach superior for treating rosacea erythema and improving patient satisfaction compared to other energy-based treatments
• Lotilaner Eye Drops: Originally approved for Demodex blepharitis, these drops show promise for ocular rosacea since the condition is also partly due to Demodex presence

For patients with moderate-to-severe rosacea, treatment protocols now follow a comprehensive three-pillar approach combining general skincare, physical modalities, and pharmaceutical agents. A typical regimen might include morning application of oxymetazoline 1% cream with broad-spectrum sunscreen, and evening use of ivermectin 1% cream alongside doxycycline 40 mg extended-release.

Why Are These Advances Important for Patients?

The evolution reflects a shift from limited treatment options to personalized care addressing the condition's complexity. "In the beginning, we had only a few different therapies, such as oral tetracyclines and erythromycin, but we didn't know a lot about skin care," noted Dr. James Del Rosso. "Now, we understand the importance of skin care in rosacea and being cautious about what you're doing, including avoiding things that will irritate the skin."

Research has also expanded understanding of rosacea triggers, including the role of histamine-containing foods and the gut microbiome connection. Histamine receptors H2R and H3R are upregulated in rosacea patients' skin, explaining why certain foods like avocados, tomatoes, chocolate, and fermented foods can worsen symptoms.

The global ROSacea COnsensus (ROSCO) panel now emphasizes phenotype-based treatment approaches rather than traditional subtypes, allowing for more targeted therapy selection. This personalized approach considers individual symptom patterns, from fixed centrofacial erythema to phymatous changes and ocular manifestations.

Despite these advances, challenges remain. "We're getting very good at treating the acne component of rosacea, but the redness component was only temporarily addressed by topical agents," Dr. Draelos noted. "We need something that addresses the actual mechanism of action of the disease and not just constricting blood vessels." Future research continues exploring biologic treatments and more targeted approaches to persistent erythema, promising even more effective options ahead.