TOPLINE

In patients with rosacea receiving standard first-line therapy, adding ear acupressure targeting the auricular branch of the vagus nerve improved treatment success and lowered serum biomarker levels more than sham. 

METHODOLOGY

• Researchers conducted a single-center, randomized, assessor-masked trial of 204 patients with rosacea receiving standard first-line treatment (doxycycline 100 mg once daily orally for 12 weeks and topical 15% azelaic acid gel applied twice daily for 20 weeks) in China between October 2025 and May 2026.
• Participants were randomly assigned to active auricular acupressure (n = 102; mean age, 32.51 year; 84.3% women; 57.8% had Fitzpatrick skin type III) or sham auricular acupressure (n = 102; mean age, 30.82 years; 84.3% women; 48.0% had Fitzpatrick skin type III).
• In the active acupressure group, a Vaccaria segetalis seed was taped to the cavum conchae and cymba conchae of both ears (areas supplied by the auricular branch of the vagus nerve). In the sham group, the seed was taped to the auricular tubercle on both ears (pure somatosensory innervation); participants applied continuous pressure for 30 seconds, three times daily for 8 weeks.
• The main outcome was treatment success (defined as proportion of patients with an Investigator Global Assessment [IGA] score of 0 or 1 at week 8); secondary outcomes were Clinical Erythema Assessment (CEA) success, changes in Dermatology Life Quality Index (DLQI), and Perceived Stress Scale-14 (PSS-14) scores.
• Researchers assessed serum levels of cathelicidin antimicrobial peptide (LL-37), calcitonin gene-related peptide (CGRP), TNF-α, and interleukin (IL) 6 at baseline and week 8, and performed multispectral imaging at baseline and week 4 to assess immediate vascular responses.

TAKEAWAY

• At week 8, 56.9% of patients in the active acupressure group vs 35.3% of those in the sham group achieved an IGA score of 0 or 1 (relative risk [RR], 1.61; P = .003), and the number needed to treat was five.
• CEA treatment success, defined as a score of 0 or 1, was more common with active acupressure (52.0% vs 31.4%; RR, 1.66; P = .01), as was a drop of 2 or more points in CEA score (53.9% vs 36.3%; RR, 1.49; P = .02). DLQI and PSS-14 also improved faster with active acupressure than with sham, based on significant group-by-time interaction effects.
• Blood levels of serum biomarkers dropped more with active acupressure than with sham, with the following differences in change from baseline: CGRP (−5.17 pg/mL; P < .001), IL-6 (−1.40 pg/mL; P < .001), LL-37 (−155.97 pg/mL; P < .001), and TNF-α (−2.15 pg/mL; P = .002).
• Imaging showed immediate vascular improvement in 59.3% of active acupressure assessments vs 7.4% of sham assessments (RR, 8.07; P < .001).

IN PRACTICE

"This safe, device-free, low-cost, and on-demand intervention yielded incremental clinical benefits (NNT [number needed to treat] = 5) when combined with first-line pharmacotherapy," the authors wrote. "It exerted dual effects, including immediate symptomatic relief and long-term neuroimmune modulation, and addressed an unmet need for prompt active intervention during acute rosacea flares."

SOURCE

The study was led by Bingyang Xu, The Second Affiliated Hospital of Xi'an Jiaotong University in Xi'an, China. It was published online on October 14 in JAMA Dermatology.

LIMITATIONS

The single-center design may have limited generalizability. Vagal activation was not measured directly. Because serum biomarkers were assessed at only two time points, the trajectory of change could not be evaluated. Imaging assessment was semiquantitative, and week 4 data were incomplete for some participants.

DISCLOSURES

The study was supported by a grant from the IIT Clinical Research Fund of The Second Affiliated Hospital of Xi'an Jiaotong University. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.