The link between corticosteroid exposure and rosacea is not itself new. Dermatologists have known for decades that topical steroids applied directly to the face can trigger a condition known as steroid-induced rosacea, in which the very drug meant to calm inflammation ends up provoking redness, burning and visible blood vessels. What has been far less studied is whether the same risk applies when the steroid is sprayed into the nose rather than rubbed onto the cheeks. Intranasal fluticasone propionate is a mainstay of treatment for allergic rhinitis and chronic sinusitis, available in many countries without a prescription, which means millions of users may never discuss the drug with a physician who could monitor its skin effects.

To probe that question, the research team, led by Taylor Merkle and senior author Erum N. Ilyas, designed a cross-sectional survey of twenty-one questions built around a validated diagnostic tool called Rosascreen. Developed and evaluated in 2016, Rosascreen asks about the cardinal cutaneous signs of rosacea: facial redness, visible facial blood vessels, eyelid irritation, facial warmth or a stinging and burning sensation, thickened skin on the nose, and pimples. Participants were also asked about how often they used intranasal fluticasone propionate and for how long, allowing the researchers to separate acute exposure, defined as less than three months, from chronic and frequent patterns of use. The study received approval from the Drexel University College of Medicine Institutional Review Board, and participation was voluntary, anonymous and confidential, with no compensation offered.

The analysis ultimately drew on 155 valid survey responses. Using simple statistics, chi-square tests and odds ratios derived from ordinal logistic regression models, the investigators compared symptom presence across categories of use frequency and duration. The most striking single finding concerned facial redness, which was the only individual symptom significantly associated with both how often and how long people used the spray, with chi-square values of 6.05 and 14.14 and p-values of 0.049 and 0.0009 respectively. In other words, the more often people used the medication and the longer they stayed on it, the more likely they were to report the persistent flushing and redness that characterizes rosacea.

Perhaps counterintuitively, the heaviest symptom burden was seen in the newest users. People who had been using the spray for less than three months showed the highest odds of increased symptom burden, with an odds ratio of 4.06 and a 95 percent confidence interval of 1.52 to 10.85, reaching statistical significance at p equals 0.005. Chronic users did not escape the association either: long-term use remained significantly linked to a higher symptom burden, with an odds ratio of 2.05 and a confidence interval of 1.09 to 3.87 at p equals 0.026. Frequent users similarly faced elevated odds, at an odds ratio of 2.44 with a confidence interval of 1.28 to 4.66 and p equals 0.007. Taken together, the numbers suggest that the relationship between intranasal steroid exposure and rosacea-like symptoms tracks both frequency and duration of use.

The proposed biological explanation hinges on the peculiar way corticosteroids interact with blood vessels in the skin. Glucocorticoids are potent vasoconstrictors, and when they are first introduced they can transiently reduce facial inflammation and even narrow superficial blood vessels, which may initially feel or look like an improvement. The trouble begins when doses are reduced or used inconsistently. Rebound vascular reactivity can follow, a phenomenon in which the vessels dilate beyond their baseline state, producing the flushing, burning and telangiectasia that closely mimic classic steroid-induced rosacea. For intranasal users, the drug is absorbed locally in the nasal mucosa, which sits in close anatomical proximity to the facial vasculature, and some systemic and regional exposure is plausible, although the exact distribution of drug effect to facial skin remains to be worked out in controlled studies.

The history of this question stretches back further than many might expect. A case report published in 1999 in the International Journal of Dermatology described rosacea induced by beclomethasone dipropionate nasal spray, an earlier generation intranasal steroid, suggesting that the phenomenon is not unique to fluticasone. A broader systematic review of steroid-induced rosacea published in 2025 consolidated the evidence that topical corticosteroid exposure can reliably provoke the condition, while reviews of intranasal steroid safety have generally focused on systemic concerns such as effects on growth in children, adrenal suppression and local nasal side effects rather than facial skin outcomes. The Drexel study effectively fills a gap between these two literatures, applying dermatological screening tools to a population usually studied only for respiratory symptoms.

The authors are careful to spell out the limitations of their approach, and they are considerable. The survey used convenience sampling rather than a representative population frame, all symptom data were self-reported rather than confirmed by clinical examination, and the study could not control for demographic and clinical confounders. Crucially, the design could not assess underlying conditions such as rhinitis or sinusitis themselves, which might independently correlate with facial flushing or vascular reactivity. Cross-sectional surveys also cannot establish causation; it is possible, for example, that people prone to rosacea experience more nasal symptoms and therefore use more steroid spray, reversing the direction of the association. The authors explicitly call for controlled studies to clarify the causal effects of intranasal steroids on cutaneous outcomes before firm clinical guidance can be written.

Even with those caveats, the practical message for clinicians is straightforward. The researchers highlight the importance of asking patients who present with unexplained facial redness about their use of over-the-counter intranasal steroids. Because these products sit on pharmacy shelves and are marketed for seasonal allergies, patients often do not think of them as medications worth mentioning, and a busy clinician may not think to ask. A simple question about nasal spray use could spare patients a cycle of escalating symptoms and misdirected treatments, including the ironic prescription of additional topical steroids that would only worsen steroid-induced disease.

For the public, the study is less a reason to abandon an effective allergy treatment than a reminder that even familiar over-the-counter drugs can have consequences beyond their intended target. Intranasal corticosteroids remain among the most effective and widely recommended therapies for allergic rhinitis and chronic sinusitis, and the associations reported here are preliminary and observational. But the work underscores a broader theme in modern pharmacology: as medications migrate from prescription pads to self-service shelves, the surveillance of their side effects increasingly falls to researchers willing to ask unusual questions, in this case connecting an ENT remedy to a chronic inflammatory skin disease. Future controlled trials will determine whether the redness in the mirror is truly a rebound from the spray, but for now, users of fluticasone nasal spray who notice new facial redness have good reason to mention it to their doctor.

Subject of Research: Association between over-the-counter intranasal corticosteroid use and rosacea-like facial symptoms

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

Article References: Merkle, T., Curley, C., Rezaee, R., Cook, H., Wambold, D., & Ilyas, E. N. (2026). Rosacea-like findings associated with over-the-counter intranasal corticosteroid use: a survey study. Archives of Dermatological Research, 318(1), Article 406. https://doi.org/10.1007/s00403-026-04899-8

Image Credits: AI Generated

DOI: 10.1007/s00403-026-04899-8

Keywords: rosacea, intranasal corticosteroids, fluticasone propionate, facial redness, allergic rhinitis, chronic sinusitis, steroid-induced rosacea, Rosascreen, dermatology, cross-sectional survey, over-the-counter medication, vascular reactivity