Efficacy and safety of combining microneedling with oral doxycycline for the treatment of rosacea: a retrospective comparative cohort study

Purpose/Aim of the Study Oral doxycycline (DOX) is a first-line systemic therapy for rosacea; however, persistent vascular features, such as fixed erythema and flushing, and neurosensory symptoms, such as burning, may respond incompletely to DOX alone. This study aimed to evaluate whether adding microneedling to oral DOX improves clinical outcomes in patients with rosacea.Materials and Methods This retrospective comparative cohort study included 160 patients with clinically confirmed rosacea. Patients received either 12 weeks of oral DOX monotherapy at 100 mg/day (control group, n = 80) or the same DOX regimen combined with three monthly microneedling sessions (intervention group, n = 80). The primary endpoint was the treatment success rate for facial erythema at week 12. Secondary outcomes included improvement in inflammatory papulopustular lesions, flushing, capillary dilation, swelling, burning sensations, quality of life, 6-month erythema relapse rate, and safety.Results At week 12, the intervention group showed a significantly higher treatment success rate for facial erythema than the control group (57.5% vs. 25.0%, p < 0.001). Improvement in inflammatory papulopustular lesions was substantial in both groups but did not differ significantly between them (75.0% vs. 70.0%, p = 0.478). Compared with DOX monotherapy, combination therapy produced significantly greater improvements in flushing, capillary dilation, swelling, burning sensations, and overall quality of life (all p < 0.01). The 6-month erythema relapse rate was also markedly lower in the intervention group than in the control group (20.0% vs. 68.4%, p < 0.001). No severe adverse events were observed.Conclusions Adding microneedling to oral DOX was associated with greater improvement in vascular and neurosensory manifestations of rosacea, particularly facial erythema, flushing, and burning sensations. The combination approach also reduced erythema relapse at 6 months and was well tolerated.