Beyond the surface: Radiotherapy’s promising results for rosacea relief

The ICF-funded ROSEND clinical trial is exploring innovative uses for radiotherapy, applying it to help manage the lifelong skin condition rosacea.

At Icon Cancer Foundation (ICF), our mission goes beyond cancer. We proudly support research into serious health conditions where cancer therapies may offer new hope. By exploring how proven cancer treatments can be adapted to treat other chronic and debilitating diseases, we’re helping uncover innovative solutions that improve lives.

One such project is the ROSEND clinical trial – a world-first study investigating the use of volumetric modulated arc radiotherapy (VMAT) to treat recalcitrant symptomatic rosacea, a common but often misunderstood inflammatory skin condition characterised by flushing in the central face, which affects an estimated 10 percent of Caucasian and Asian populations.

Led by Professor Gerald Fogarty OAM, radiation oncologist at Icon Cancer Centre and one of Australia’s leading researchers in this space, the trial is challenging the traditional approach in dermatology.

Addressing the gaps in rosacea research

The idea for the trial emerged unexpectedly. Professor Fogarty, who specialises in skin radiotherapy, was treating multi-focal skin cancers of the nose. He noticed a surprising trend: patients who received radiotherapy treatment for skin cancers also experiencing long-term remission of their rosacea symptoms.

“I was treating a woman for her skin cancers around her nose, who also had rosacea. When she returned a year later for a check-up, the cancers were gone, but so was her rosacea,” he said. This prompted Professor Fogarty to revisit other patients with rosacea who had undergone radiotherapy – and he discovered they had had a similar experience.

Despite its prevalence and significant impact on quality of life, research into rosacea has remained limited and often short-term. “I started to look into rosacea, and I realised the was not sufficient long term research,” said Professor Fogarty.

Investigator-led, patient inspired

The ROSEND trial is grounded in patient experiences and clinical observation. As Professor Fogarty explains, “I wouldn’t have thought of this trial without my patient asking me to treat other areas where she suffered from rosacea.”

That single question sparked a broader investigation into rosacea’s impact.

“Rosacea can have a huge impact on quality of life,” Professor Fogarty said. “Some patients avoid social settings because their rosacea is triggered by alcohol. I had one patient who would be triggered by other people’s perfume. This isn’t just cosmetic – it’s deeply personal.”

The hope is that VMAT radiotherapy could provide a long-term treatment. This kind of real-world, patient-led insight is why investigator-led research matters. It enables clinicians to pursue the unanswered questions they encounter in practice. ICF proudly supports this kind of research because it leads to meaningful, patient-centred innovation that might otherwise go unexplored.

Expanding the scope of radiotherapy

The ROSEND trial, co-led by dermatologist Associate Professor Stephen Shumack, is a randomised study comparing standard dermatological care with fractionated low-dose radiotherapy. The study’s primary endpoint is at one year, with 40 participants split evenly across both treatment arms.

“We’re using fractionated radiotherapy. We can preserve the normal cells, but get rid of the abnormal cells,” Professor Fogarty explains. “It’s a brief treatment – 90 seconds beam time per session over four weeks.”

The ROSEND study also opens the door to further applications of low-dose radiotherapy for other benign skin conditions. Professor Fogarty is beginning to explore its use in psoriasis, adult viral warts, and hidradenitis suppurativa.

“This is a disruptive trial,” he added. “Two treatment modalities are being put head-to-head. One is going to win, but more importantly, patients will win. We’re not just looking to manage symptoms. We’re looking for something better.”