Nerve stimulation beneficial in erythematotelangiectatic rosacea

Transcutaneous auricular vagus nerve stimulation (taVNS) therapy helps lessen facial erythema and flushing in patients with erythematotelangiectatic rosacea, according to the results of a randomized clinical trial.

After 3 weeks of treatment, the primary outcome of the mean Clinician’s Erythema Assessment (CEA) score was significantly lower among patients who underwent taVNS than among those who received sham stimulation (1.56 vs 2.47; mean difference [MD], −0.92, 95 percent confidence interval [CI], −1.3 to −0.53; p<0.001). [JAMA Dermatol 2025;doi:10.1001/jamadermatol.2025.3796]

Results for the secondary outcomes also favoured taVNS vs sham stimulation, with lower mean scores on CEA (1.89 vs 2.42; MD, −0.53, 95 percent CI, −0.92 to −0.14; p=0.01), Patient Self-Assessment (1.83 vs 2.44; MD, −0.60, 95 percent CI, −1.01 to 0.21; p=0.003), and Global Flushing Severity Scale (3.78 vs 5.14; MD, −1.36, 95 percent CI, −2.42 to −0.31; p=0.01) at week 2.

Moreover, taVNS significantly reduced anxiety, depression, sleep disorders, migraine, and fatigue in patients. Mean scores dropped from baseline to week 2 on the respective scales: Generalized Anxiety Disorder–7 (from 11.23 to 5.73), Patient Health Questionnaire–9 (from 12.14 to 5.59), Insomnia Severity Index–7 (from 12.73 to 6.59), Fatigue Severity–9 Scale (from 44.62 to 29.15), and visual analogue scale (from 4.50 to 1.17). These reductions were significantly greater compared with the changes observed in the sham stimulation arm.

These benefits persisted through week 3 and were sustained for 24 weeks during the treatment-free follow-up period, the investigators noted.

In terms of safety, treatment-emergent adverse events (TEAEs) occurred in 5.56 percent of patients in the taVNS arm and in 8.33 percent in the sham stimulation arm. Most of these events were mild and spontaneously resolved after 1–5 days. Commonly reported TEAEs included urticaria and tinnitus in the taVNS arm and tinnitus, dizziness, and stinging sensations in the sham stimulation arm. One patient in the sham stimulation arm withdrew due to tinnitus, whereas none in the taVNS arm did. There were no reports of any serious AEs or significant TEAEs.

“These AEs reflected the sensitivity of monitoring systems, with their transient nature and low occurrence rates suggesting that the associated risks were generally acceptable,” the investigators noted.

The noninvasive taVNS therapy delivers electrical impulses to the auricular vagus nerve. It has been shown to improve somatic and psychological symptoms in several neuroimmune conditions, such as migraine, depression, and autonomic dysfunction. [J Neural Transm (Vienna) 2013;120:821-827; Neurobiol Learn Mem 2016;132:49-56; Headache 2016;56:71-78]

“Collectively, our data expand on prior findings by demonstrating that taVNS concurrently attenuates cutaneous erythema and systemic comorbidities, and this therapeutic profile is distinct from that of localized interventions, such as brimonidine or botulinum toxin,” the investigators said. “[Our] results position taVNS as a novel and cost-effective therapeutic option for erythematotelangiectatic rosacea management.”

The analysis included 72 patients with erythematotelangiectatic rosacea (median age 29.5 years, 93.1 percent female) with a CEA score of at least 2 at baseline. These patients were randomly allocated to the taVNS arm (n=36) or the sham stimulation arm (n=36).

Those in the taVNS arm received stimulation pulses at a frequency of 30 Hz and pulse width of 200 μs for 30 min per day, while those in the sham stimulation arm received stimulation pulses at a frequency of 0 Hz and pulse width of 0 μs for 30 min per day. All patients received 3 weeks of treatment and were followed up for 24 weeks.