Use of beta-blockers for rosacea-associated facial erythema and flushing: A systematic review and update on proposed mode of action

Background: Flushing and erythema are frequent skin symptoms in rosacea. Because their adequate treatment remains a clinical challenge, new treatment options are explored, such as oral beta-blockers. Objectives: To evaluate the efficacy of oral beta-blockers for rosacea-associated facial flushing and erythema. Methods: PubMed, Embase, Web of Science, and Cochrane Library were systematically searched, including studies providing original data on the efficacy of oral beta-blockers in rosacea patients with facial flushing and/or persistent erythema. Risk of bias was assessed using the Cochrane Risk of Bias tool, Newcastle-Ottawa scale, and Quality in Prognosis Studies tool. Results: Nine studies evaluating the use of carvedilol, propranolol, nadolol, and beta-blockers in general were included. Articles studying carvedilol and propranolol showed a large reduction of erythema and flushing during treatment with a rapid onset of symptom control. Bradycardia and hypotension were the most commonly described adverse events. Limitations: Most studies had a retrospective design with a small sample size, and outcome measurement was often subjective. Conclusions: Oral beta-blockers could be an effective treatment option for patients with rosacea with facial erythema and flushing that does not respond to conventional therapy. Larger prospective trials with objective outcome assessment are needed to validate the promising results of these studies.