Early investigational agents for the treatment of rosacea: drugs in phase I and II clinical development

Rosacea is a multifactorial chronic dermatologic condition with a psychosocial burden for patients. There are topical, systemic, laser, and light treatments FDA-approved, but many patients remain under- or non-responsive to those available, leaving a need for more options. Based on a literature search using databases, PubMed, Embase, Cochrane Library, and Clinicaltrials.gov, using keywords 'rosacea clinical trials,' we discuss treatments undergoing phase I and II clinical trials for rosacea, as well as other early clinical studies. The evolving understanding of rosacea's multifaceted pathophysiology, including neurovascular dysregulation and immune responses, has led to exploration of novel treatments. Mainstays of treatment are topical and systemic antibiotics, topical vasoconstrictors, pulsed dye laser, and intense pulsed light. However, even with these treatment options, some patients remain unsatisfied with results. Addressing the underlying pathophysiology of rosacea may be more effective than a siloed approach. Therapies on the horizon, such as phosphodiesterase-4 inhibitors, biologics, topical tyrosine kinase inhibitors, neurotoxin, topical probiotics, Dermaceuticals, oral tranexamic acid, oral supplements, and neuropeptide modulators are investigated as targeted interventions. Use of lasers in synergy with topical treatments offers a multipronged personalized approach. While management remains challenging, ongoing research provides promise for additional effective and individualized treatment plans.