New research suggests that rosacea, a chronic inflammatory skin disease, may meaningfully accelerate the progression of diabetic retinopathy (DR) in patients with early-stage disease.
The findings were presented at the 2026 Association for Research in Vision and Ophthalmology (ARVO) annual meeting in Denver, Colorado.
Give me some background first.
Some context: Rosacea is a chronic inflammatory disease of the skin and ocular surface, affecting roughly 5.5% of adults worldwide.
- Its pathophysiology centers on vascular dysregulation paired with elevated vascular endothelial growth factor (VEGF) expression in lesional skin.
DR, meanwhile, affects roughly 22% of people with diabetes globally and remains a leading cause of vision loss in the working-age population.
Chronic inflammation and dysregulated angiogenesis drive both conditions.
… and the question?
Researchers asked: If rosacea is a systemic inflammatory state with elevated VEGF activity, does it push nonproliferative diabetic retinopathy (NPDR) toward something worse?
Now, talk about the study.
A team at the University of Texas Southwestern Medical Center ran a retrospective propensity-matched analysis using a deidentified multicenter database to evaluate the risk of DR progression and vision-threatening complications in patients with rosacea and NPDR.
Cohorts were tracked at 1, 3, and 5 years for progression to proliferative diabetic retinopathy (PDR), diabetic macular edema (DME), vitreous hemorrhage (VH), tractional retinal detachment (TRD), and neovascular glaucoma (NVG).
The team also tracked the need for intravitreal (IVT) anti-VEGF injections, panretinal photocoagulation (PRP), and pars plana vitrectomy (PPV).
Who was included in the study?
Investigators started with 4,846 NPDR patients with rosacea and 146,869 NPDR controls without rosacea. After propensity score matching, 4,830 patients remained in each cohort.
Secondary analyses compared rosacea-treated versus rosacea-untreated NPDR patients, and sensitivity analyses adjusted for diabetes duration.
And what were the findings?
At 5 years, the rosacea cohort showed sharply elevated risks across nearly every endpoint:
- PDR: RR 2.14 (95% CI 1.69 to 2.71; p < 0.001)
- DME: RR 4.75 (95% CI 3.68 to 6.14; p < 0.001)
- VH: RR 1.91 (95% CI 1.38 to 2.65; p < 0.001)
- NVG: RR 1.86 (95% CI 0.97 to 3.55; p = 0.057)
The DME signal was the largest. Rosacea patients faced nearly five times the risk of developing macular edema compared to matched controls.
Tell me more.
Treatment burden tracked the disease progression. Over the 5-year window, rosacea patients needed substantially more intervention:
- Anti-VEGF therapy: RR 3.97 (95% CI 2.80 to 5.63; p < 0.001)
- PRP: RR 2.73 (95% CI 1.68 to 4.44; p < 0.001)
- PPV: RR 3.92 (95% CI 2.14 to 7.20; p < 0.001)
Any specific findings that stood out?
Patients whose rosacea was actively treated showed a lower risk of PDR progression than untreated rosacea patients (RR 0.76, 95% CI 0.42 to 1.36; p = 0.36).
- The signal didn't reach statistical significance, but the direction is suggestive.
Also worth noting: Sensitivity analyses adjusting for diabetes duration produced results consistent with the primary data. That makes it harder to dismiss the association as a function of longer-standing diabetes in the rosacea group.
Limitations?
As a retrospective database study, causality could not be established. The authors flagged this explicitly.
Other considerations:
- The database captures coded diagnoses, so rosacea severity, subtype, and presence of ocular rosacea weren't characterized
- The "rosacea-treated" definition wasn't broken out by therapy class, such as topical, oral, anti-inflammatory, or antibiotic
- No data on glycemic control or lipid profile, both of which independently drive DR progression
Expert opinion?
No outside expert commentary was included in the conference abstract.
Their position: The authors argued that rosacea, given its established links to systemic inflammation and elevated VEGF activity, may accelerate the vascular damage already underway in diabetic eyes. Whether the relationship is causal or reflects shared inflammatory biology remains open.
Anything else?
The directionally lower PDR risk in rosacea-treated patients hints at something worth exploring: whether aggressive control of rosacea could reduce the systemic inflammatory load enough to slow DR progression.
This dataset can't answer that, but it points toward a prospective study worth running, especially given how inexpensive and well-tolerated standard rosacea therapy is.
And lastly: the take home.
For clinicians managing patients with both rosacea and NPDR, closer retinal surveillance may be warranted. The rosacea cohort showed roughly double the risk of PDR development and several-fold higher rates of needing anti-VEGF, PRP, or PPV over 5 years.
As such: Treating rosacea, when present, may offer more than cosmetic benefits.
The signal isn't definitive, but it's strong enough to consider integrating dermatologic comorbidity into DR risk stratification for patients with diabetes.