**Background:** Rosacea is a chronic inflammatory skin disorder affecting over 5% of the global population, with symptoms including erythema, telangiectasia, papules, and pustules. Its pathogenesis involves immune dysregulation, vascular dysfunction, oxidative stress, and triggers like UV exposure and spicy foods. Standard treatments (e.g., metronidazole, azelaic acid, doxycycline) have side effects, leading to poor compliance. Natural compounds offer anti-inflammatory, antioxidant, and vasoprotective benefits with fewer adverse effects.
**Methods:** This narrative review searched Springer, MDPI, PubMed, and Google Scholar from February to September 2023 using keywords like "rosacea treatment" and "rosacea pathogenesis." It included preclinical and clinical studies on botanicals for rosacea management, focusing on mechanisms and efficacy.
**Key Results:** The review covers 14 botanicals. Notable findings include:
- **Glycyrrhiza glabra/inflata (licorice):** Licochalcone A (from G. inflata) in a skincare product improved erythema and quality-of-life scores at 4 and 8 weeks, with efficacy similar to azelaic acid and metronidazole. A 2% G. glabra gel significantly reduced erythema, edema, and itching in atopic dermatitis.
- **Chrysanthemum indicum:** A 1% cream (n=125) significantly improved erythema severity and overall rosacea severity vs. placebo (n=121) over 12 weeks (p<0.05).
- **Quassia amara:** A 4% topical gel in 30 patients (grades I–IV) for 6 weeks showed improvement in flushing, erythema, telangiectasia, and papule/pustule scores, with significant effects on telangiectasia.
- **Artemisia annua:** Artemether emulsion (1%) for 4 weeks led to greater symptom improvement than metronidazole emulsion (3%), with benefits maintained for 8 weeks. Artesunate inhibits JAK-STAT3 signaling, showing potential similar to doxycycline with fewer side effects.
- **Camellia sinensis (green tea):** Topical catechins (e.g., epigallocatechin gallate) reduce UV-induced erythema and DNA damage, and suppress VEGF and HIF-1, inhibiting angiogenesis.
- **Avena sativa (colloidal oat):** An oatmeal lotion improved skin barrier and moisture significantly (p<0.05) over 5 weeks, decreasing TEER by 52%.
- **Aloe vera:** A 0.5% aloe extract cream cleared psoriatic plaques in 82.2% vs. 7.7% placebo. Aloe gel scavenges free radicals and NO, and inhibits bacterial protein synthesis.
- **Other botanicals:** Feverfew PFE reduced IL-1α release by 60% after UV exposure. Potentilla erecta has vasoconstrictor effects via NO scavenging. Citrus junos essential oils suppress LL-37 and KLK5, normalizing innate immune response.
**Clinical Implications:** Natural compounds can serve as adjunctive therapies to reduce side effects and improve compliance. However, most studies are small, lack standardized formulations, and assess symptom improvement rather than disease modification. The review calls for more rigorous clinical trials and standardized botanical preparations to validate efficacy and safety.