Gabapentin May Help Patients With Neurogenic Rosacea

Neurogenic rosacea is a less common form of the disease that may be mistaken for erythematotelangiectatic rosacea (ETR), formerly referred to as subtype 1. The 2 subtypes share persistent facial redness and flushing as their primary signs. However, individuals with ETR are more likely to have dry, itchy skin, whereas those with neurogenic rosacea experience intense burning and stinging sensations that will not go away.¹

“These are the type of patients who sometimes come in with ice cubes, a cooler, or a fan that they are carrying with them, and they are really bothered by the heat and discomfort of their face,” Dr Yolanda Helfrich, professor and chief of medical dermatology at the University of Michigan Medical School, explained at the 2026 American Academy of Dermatology Annual Meeting.

Patients with neurogenic rosacea are often the hardest to treat because their signs and symptoms tend not to improve with standard therapies. Interestingly, studies have identified connections between this condition and posttraumatic stress disorder,² and physicians have found some success with treatments usually reserved for psychiatric use.

“When we make a diagnosis of neurogenic rosacea, our typical rosacea therapies are not very helpful,” Dr Helfrich said. “We can sometimes use them, and some patients might experience minimal or some relief, but we typically turn to neuroleptic agents, such as gabapentin and pregabalin, or tricyclic antidepressants.”

A recent study found that gabapentin reduced rosacea-like symptoms by suppressing cathelicidin LL37 and related molecules that cause inflammatory response in both a mouse model and human subjects.³ Gabapentin performed as well as a combination of oral minocycline and hydroxychloroquine, a commonly used therapy for neurogenic rosacea, in reducing facial redness and swelling.

Unfortunately, a separate small study found that although gabapentin was able to significantly reduce redness and flushing in patients with neurogenic rosacea, it was less effective in relieving burning, stinging, and itching sensations.⁴ The investigators suggested that a larger scale study may be necessary.