Rosacea Treatment for Pregnant Patients: Osteopathic Perspectives

Noto-Bell: Rosacea can range from subtle redness to cysts and inflammatory lesions, with severity influenced by the lymphatic system—impaired drainage worsens congestion and inflammation. During pregnancy, managing symptoms is more difficult, as many standard treatments are unsafe for the fetus. Though frequently understood as common and mild, rosacea can be severe, and its visibility can intensify a pregnant patient’s anxiety, depression, and desire to withdraw socially.

Taking a whole-person approach reveals that rosacea is far more than a cosmetic issue and can be a major daily challenge, particularly for pregnant patients balancing flare-ups with their baby’s safety.

Garelick: I’ve always been interested in exploring how certain medical conditions and their treatments affect pregnant individuals, especially given how few safe and effective options exist for them. Rosacea is often an overlooked condition by patients, healthcare providers, and society as a whole. This review allowed me to examine not only the clinical gaps in rosacea management during pregnancy but also the psychosocial impact of these limitations, and how addressing them could truly make a difference in patients’ lives.

Noto-Bell: Emily and Maggie approached me with an interest in whether osteopathic manipulative treatment (OMT) has ever been used to treat rosacea, particularly during pregnancy. OMT is a hands-on approach targeting somatic dysfunction—any alteration in skeletal, muscular, connective, neural, or circulatory structures—and as osteopathic physicians, we can use it alongside medications, or surgery when needed, to address dysfunction across many conditions.

Because OMT is highly individualized, it is difficult to study through rigid research models, leaving limited evidence for non–musculoskeletal uses like rosacea. The students conducted a broad literature review and identified 20 relevant articles. Only one involved an OMT treatment, and that patient wasn’t pregnant, but they still wanted to highlight its potential application in pregnancy. Although the evidence is limited, it is exciting because it suggests an opportunity to explore, generate new data, and potentially advance the field.

Noto-Bell: We use several OMT models, and for rosacea we focus on the fluidic model, which targets the lymphatic system. I often compare it to a kinked garden hose: when the kink is removed, fluid flows freely. The face has lymphatic pathways that clear fluid, and restrictions—especially at the thoracic inlet—can worsen swelling and redness. By addressing these restrictions and using gentle superficial techniques to stimulate lymphatic flow, we can improve drainage, reduce edema, and decrease facial inflammation.

Garelick: In the studies we reviewed, patients were specifically diagnosed with various forms of rosacea, and the authors detailed their treatment regimens along with corresponding outcomes. We included studies involving both pregnant and non-pregnant patients to gain a comprehensive understanding of available treatment options and to identify which therapies could be considered safest during pregnancy.

What stood out most was the stark contrast in outcomes—non-pregnant patients generally responded well to treatment, while pregnant patients often experienced poorer results. In one particularly striking case, a patient chose to terminate her pregnancy due to the severity of her rosacea and its psychosocial impact. This finding underscored the urgent need to expand safe and effective treatment options for pregnant patients with rosacea.

Noto-Bell: During pregnancy, treatment options for rosacea are limited due to safety concerns: many antibiotics and retinoids are contraindicated, and even steroids must be used at the lowest effective dose for the shortest duration.

Despite these restrictions, we learned that combination therapies—such as topical or oral antibiotics with low-dose, short-term steroids—tend to be most effective, especially when paired with holistic approaches like OMT. Adjunctive options like blue light or compression therapy may also help, but overall, the limited safe options leave a significant treatment gap for pregnant patients.

Garelick: Absolutely—particularly in managing patients who are pregnant or those who haven’t achieved significant improvement with standard dermatologic treatments.

Hurley: I absolutely do. I think there is a lot of research to be done, and many areas for further exploration with regards to this—which was a big motivator for our paper. There are several inflammatory conditions, lymphatic conditions, and even dysesthesia syndromes with underlying physiology that would lend themselves well to some of our common osteopathic treatments. And even if OMT cannot specifically be done, I see a strong role for the osteopathic mindset and approach to holistic management of some of these dermatological conditions.

Noto-Bell: Maintaining an approach that considers not only the presenting symptoms but also their impact on a patient’s overall life is essential—this includes attention to mental health, an area that frequently falls through the cracks in our healthcare system. Taking this broader perspective is a fundamental aspect of osteopathic medicine.

Noto-Bell: Pregnancy creates a temporary immunocompromised state, and rosacea often improves after delivery. While this can be reassuring, symptoms can still be challenging. I encourage patients to seek mental health support and additional opinions if needed. Finding a provider who offers OMT may provide symptomatic relief, and the compassionate, hands-on care itself can positively support mental well-being, especially for patients unaccustomed to this type of care.