Photoprotection and Restoration of the Skin Barrier, Microbiome, and Vascular System in Antibiotic-Free Management of Severe Papulopustular Rosacea: A Case Report

Rosacea is a chronic, multifactorial inflammatory dermatosis involving innate immune dysregulation, neurovascular instability, and microbiome imbalance. Severe papulopustular phenotypes often relapse and exhibit resistance to conventional topical therapy, creating a need for antibiotic-sparing strategies aligned with antimicrobial stewardship. The authors report a 45-year-old female with severe, recurrent papulopustular rosacea refractory to topical ivermectin and metronidazole. An integrative, antibiotic-free protocol was implemented, combining a functional dermocosmetic regimen (barrier repair, mineral photoprotection) with oral probiotics for microbiome modulation. Complete remission of inflammatory lesions occurred by Week 6, with sustained clearance at 6-month follow-up. No adverse events were observed, and patient adherence was excellent. This case highlights the potential of multimodal dermocosmetic maintenance combined with microbiome support as an effective alternative to systemic antibiotics in severe rosacea, supporting phenotype-driven care and antimicrobial stewardship principles.