Press-and-hold ear therapy improves rosacea outcomes

Clinical takeaway: Consider auricular acupressure as a low-cost adjunct to standard rosacea therapy; in this randomized trial, it improved treatment success rates, provided rapid relief of flare-associated vascular changes, and was well tolerated.

Rosacea is driven by neurovascular and inflammatory pathways, and many patients continue to experience flushing, erythema, and symptom flares despite standard therapies. Prior studies suggested benefit from device-based vagus nerve stimulation, but practical, self-administered alternatives have been lacking.

In this single-center randomized, sham-controlled trial, 204 adults with rosacea receiving standard treatment with doxycycline and topical azelaic acid were assigned to active or sham auricular acupressure for 8 weeks. The intervention used small plant seeds affixed to specific points on both ears, with participants instructed to apply pressure for 30 seconds three times daily and during flare-ups as needed.

At 8 weeks, 57% of patients receiving active acupressure achieved treatment success, defined as clear or almost clear skin on Investigator Global Assessment scoring, compared with 35% in the sham group. In practical terms, treating five patients with adjunctive acupressure resulted in one additional treatment success beyond standard therapy alone.

Patients in the active-treatment group were also nearly twice as likely to achieve a substantial improvement in disease severity and reported higher treatment satisfaction rates (74% vs 46%). Benefits extended beyond clinical scores, with greater reductions in circulating levels of several biomarkers implicated in rosacea pathogenesis, including LL-37, calcitonin gene-related peptide, TNF-α, and IL-6.

One of the study’s most notable findings was its effect on acute symptoms. Immediate vascular improvement on facial imaging occurred in 59% of active-treatment assessments versus 7% of sham assessments, suggesting a potential role during active flushing episodes. Improvements in disease severity and erythema scores remained significantly better at 20-week follow-up. No serious adverse events occurred.

“The 30-second, self-administered procedure requires no equipment or private space, shifting patients from passive trigger avoidance to active self-regulation,” the authors wrote.

Source: Xu B, et al. (2026 Oct 14) JAMA Dermatol. Device-Free Auricular Acupressure for Rosacea: A Randomized Clinical Trial