15 October 2025

Can ear nerve therapy tame rosacea redness?

Research Rosacea

A brief course of vagus nerve stimulation eased facial flushing and improved mood, sleep and migraine symptoms for months, researchers say.


A simple ear-based nerve stimulation technique may offer a novel new way to treat erythematotelangiectatic rosacea (ETR), according to the first randomised, sham-controlled clinical trial of transcutaneous auricular vagus nerve stimulation (taVNS).

The therapy, which delivers mild electrical impulses to the auricular branch of the vagus nerve, not only improved facial redness and flushing but also eased common systemic comorbidities such as anxiety, depression, insomnia, migraine and fatigue.

Mean anxiety and depression scores dropped by nearly half in the treatment group, and improvements were sustained for months after the intervention ended. Findings have been published in JAMA Dermatology.

“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 localised interventions, such as brimonidine or botulinum toxin,” the researchers wrote.

“This systemic effect aligns with the role of the vagus nerve as a master regulator of the inflammatory reflex and reinforces the hypothesis that rosacea (particularly the erythematotelangiectatic subtype) may represent a systemic disorder that originates due to dysregulated neuroimmune interactions.”

Researchers in China enrolled 72 patients with moderate-to-severe ETR and randomised them to receive either taVNS or sham stimulation once daily for three weeks, followed by six months of observation.

At the end of the treatment phase, patients in the active group had significantly greater reductions in erythema severity compared with the sham group, with benefits persisting throughout the follow-up period.

The primary endpoint was change in Clinician’s Erythema Assessment (CEA) score at week 3. Patients treated with taVNS demonstrated significantly greater improvements than those in the sham group (mean score 1.56 vs 2.47; mean difference −0.92; 95% CI −1.31 to −0.53; P<.001).

Improvements were also observed in patient self-assessments of erythema and flushing, with Patient Self-Assessment and Global Flushing Severity Scale scores both showing significant reductions in the taVNS group compared with sham. Importantly, these cutaneous benefits persisted for the full 24-week follow-up period, suggesting that taVNS may provide durable relief in a condition known for frequent relapses.

The therapy also demonstrated systemic benefits. Patients receiving taVNS reported marked reductions in anxiety, depression, sleep disturbance, migraine and fatigue, as measured by validated scales including the GAD-7, PHQ-9, ISI-7 and Fatigue Severity Scale.

For example, mean GAD-7 scores declined from 11.23 to 5.73 within two weeks of treatment, while PHQ-9 scores dropped from 12.14 to 5.59.

Similar improvements were recorded across all comorbidity domains, and these benefits were maintained throughout the follow-up period. By contrast, patients in the sham group experienced minimal changes in either cutaneous or systemic measures.

Adverse events were infrequent and mild, reported by 5.6% of patients in the taVNS group and 8.3% in the sham group. Events included transient urticaria, tinnitus and dizziness, all of which resolved spontaneously within days. No serious adverse events occurred, and no patients in the taVNS arm discontinued treatment because of intolerance.

ETR remains one of the more difficult subtypes of rosacea to manage. Current options, such as topical vasoconstrictors, oral agents like carvedilol or gabapentin, and light-based therapies, were often limited by partial efficacy, recurrence and side effects.

The researchers said their findings suggested that taVNS, by engaging neuroimmune pathways and modulating systemic inflammation, could offer a non-invasive, cost-effective alternative that addresses both cutaneous and systemic disease manifestations.

Although promising, the trial has limitations. The single-centre design and relatively small sample size may limit generalisability, and sustained cutaneous sensations from active stimulation could not be fully replicated in the sham protocol, raising the possibility of partial unblinding.

In addition, outcomes relied in part on patient-reported measures, which may be influenced by expectation bias.

Further multi-centre studies with larger, more diverse populations and longer follow-up are warranted to validate these results, establish optimal stimulation parameters, and assess integration with standard therapies.

“To our knowledge, this was the first randomised, double-blind, sham-controlled clinical trial to evaluate taVNS for treating ETR,” the researchers concluded.

“Our findings demonstrated that taVNS rapidly improves cutaneous symptoms and systemic comorbidities, with sustained remission being observed during a 24-week follow-up period, and that adverse events were uncommon.

“These results position taVNS as a novel and cost-effective therapeutic option for ETR management.”

JAMA Dermatology, October 2025