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

J Am Acad Dermatol. 2020 Oct;83(4):1088-1097. doi: 10.1016/j.jaad.2020.04.129. Epub 2020 Apr 29.


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 β-blockers.

Objectives: To evaluate the efficacy of oral β-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 β-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 β-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 β-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.

Keywords: beta-adrenergic blockers; carvedilol; facial erythema; flushing; nadolol; propranolol; rosacea; systematic review.

Publication types

  • Systematic Review

MeSH terms

  • Administration, Oral
  • Adrenergic beta-Antagonists / administration & dosage
  • Adrenergic beta-Antagonists / adverse effects
  • Adrenergic beta-Antagonists / therapeutic use*
  • Bradycardia / chemically induced
  • Carvedilol / therapeutic use
  • Dermatologic Agents / administration & dosage
  • Dermatologic Agents / adverse effects
  • Dermatologic Agents / therapeutic use*
  • Drug Evaluation
  • Erythema / drug therapy*
  • Erythema / physiopathology
  • Facial Dermatoses / drug therapy*
  • Facial Dermatoses / physiopathology
  • Flushing / drug therapy*
  • Flushing / etiology
  • Flushing / physiopathology
  • Humans
  • Hypotension / chemically induced
  • Nadolol / therapeutic use
  • Propranolol / therapeutic use
  • Retrospective Studies
  • Rosacea / complications
  • Rosacea / drug therapy*
  • Rosacea / physiopathology
  • Treatment Outcome


  • Adrenergic beta-Antagonists
  • Dermatologic Agents
  • Carvedilol
  • Nadolol
  • Propranolol