Advances in the Pathogenesis and Treatment of Rosacea: A Narrative Review

Rosacea is a chronic inflammatory dermatosis characterized by heterogeneous clinical manifestations and a fluctuating disease course. It most commonly presents with persistent central facial erythema and episodic flushing, with or without papules, pustules, telangiectasia, phymatous changes, and ocular involvement. Accumulating evidence indicates that rosacea pathogenesis is multifactorial, involving genetic susceptibility, neurovascular regulatory abnormalities, dysbiosis of the gut and skin microbiota, and immune system dysfunction. At present, no curative therapy is available. Clinical management therefore remains centered on trigger avoidance and lifestyle modification, topical and systemic pharmacologic interventions, and selected physical modalities. As disease expression varies substantially among individuals, precision medicine–oriented strategies that emphasize accurate phenotypic assessment are increasingly important for optimizing therapeutic outcomes. This review synthesizes recent domestic and international advances over the past five years in the understanding of rosacea pathogenesis and treatment, with the aim of providing clinicians with updated diagnostic insights, evidence-based therapeutic perspectives, and practical guidance for individualized patient care.