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Rosacea-like findings associated with over-the-counter intranasal corticosteroid use: a survey study
Journal article   Peer reviewed

Rosacea-like findings associated with over-the-counter intranasal corticosteroid use: a survey study

Taylor Merkle, Caitlyn Curley, Ryan Rezaee, Harrison Cook, Dylan Wambold and Erum N. Ilyas
Archives of dermatological research, v 318(1), 406
10 Sep 2026
DOI: https://doi.org/10.1007/s00403-026-04899-8
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Abstract

Medicine Medicine & Public Health Short Report Dermatology
Corticosteroid-containing intranasal sprays, particularly fluticasone propionate (FP), are commonly used for allergic rhinitis and chronic sinusitis, yet their potential relationship with rosacea-like symptoms has been understudied despite topical corticosteroid exposure being well-established for triggering rosacea. This study aimed to investigate the relationship between intranasal FP and self-reported rosacea symptoms. A 21-question cross-sectional survey utilizing the “ Rosascreen ” diagnostic algorithm was administered to assess rosacea-associated symptoms related to intranasal FP usage frequency, duration, and symptom burden. The standardized questionnaire evaluated the presence of cutaneous signs associated with rosacea including facial redness, facial blood vessels, eyelid irritation, facial warmth and/or stinging/burning, thickened nose skin, and pimples. This study was approved by the Drexel University College of Medicine Institutional Review Board (IRB). Participation was voluntary, and all participants were informed that their responses would remain anonymous and confidential. Statistical analysis including simple statistics, Chi-square, and odds ratios from ordinal logistic regression models were applied to compare symptom presence from 155 valid survey responses. The data showed that only facial redness was significantly associated with frequency and duration categories (χ² = 6.05, 14.14 p  = 0.049, 0.0009) respectively. Acute users (< 3 months exposure) showed the highest odds of increased symptom burden (OR 4.06, 95% CI 1.52–10.85, p  = 0.005). Chronic use remained significantly associated with higher symptom burden (OR 2.05, 95% CI 1.09–3.87, p  = 0.026). Frequent use similarly predicted higher symptom burden (OR 2.44, 95% CI 1.28–4.66, p  = 0.007). This data highlights the associations between rosacea-like symptom burden with both frequency and duration of intranasal FP use. Intranasal corticosteroids may transiently reduce facial inflammation through vasoconstriction, but reduced or inconsistent use can provoke rebound vascular reactivity resembling steroid-induced rosacea. Limitations include convenience sampling, reliance on self-reported symptoms, uncontrolled demographic and clinical confounders, inability to assess underlying conditions such as rhinitis or sinusitis, and the need for controlled studies to clarify causal effects of intranasal steroids on cutaneous outcomes This study highlights the importance of inquiring about over-the-counter intranasal steroids when patients present with unexplained facial redness.

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