Rosacea is a chronic skin condition characterised by papules, pustules, transient erythema (flushing), persistent erythema, telangiectasia and phymatous changes. Rosacea can be associated with substantial effects on quality of life. Rosacea is most commonly treated with topical therapy, but little is known about the relative efficacy of these treatment options.

Since most randomised controlled trials of topical rosacea therapies do not include active comparators (ie, head-to-head comparisons), indirect comparisons must be made to understand the relative efficacy, safety and tolerability of these treatment options. The aim of this study is to conduct a living network meta-analysis evaluating topical therapies for moderate to severe rosacea. The results of this study can guide clinical decision-making and improve patient outcomes.

Data search will be conducted in the Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Web of Science and Embase. Screening of titles, abstracts and full papers, as well as data extraction, will be conducted by two independent researchers in duplicate. Primary outcomes will include mean change in absolute lesion count, Investigator Global Assessment (IGA) and treatment discontinuation for adverse events or side effects. Secondary outcomes will include percentage change in lesion count, changes in quality of life, Patient Global Assessment, Clinician Erythema Assessment (CEA) and change in rosacea facial redness. For each outcome with enough qualified data, a network meta-analysis using a random-effects model will be carried out. We plan for a living review with continuous updating of the analysis as new treatments become available.

Dissemination in a peer-reviewed scientific journal is planned.

CRD420251103231.