April is Rosacea Awareness Month – Are you Aware of Rosacea in Children?
April is rosacea awareness month as attributed by the National Rosacea Society. Affecting more than 16 million Americans, this skin disorder typically is characterized by persistent flushing or redness (with or without acneiform lesions) on the cheeks, nose, chin, or forehead. According to patient surveys it can present at any age but is more prevalent in middle-aged women. Men tend to have a more severe disease course, and some evidence suggests that it may run in families and people of northern or eastern European descent.
One article recently published in the Journal of Clinical Medicine suggests rosacea presentations, although much fewer than adults, can be seen in children, and the lack of diagnostic criteria may lend to underdiagnosis. It may present like adults with features of telangiectasia, idiopathic facial aseptic granuloma, and even ocular rosacea.
Papulopustular subtype is the most common form of childhood rosacea and is characterized by the appearance of papules and pustules on the face, especially on the central convex area, with or without persistent erythema or flushing. Children may also have symptoms of itching, burning, or stinging and can even present with open or closed comedones commonly seen in acne. The flushing in telangiectatic rosacea can be aggravated by potential triggers such as heat, exercise, and ultraviolet radiation.
Idiopathic facial aseptic granuloma (IFAG) can be seen as single or multiple red, inflamed papules on cheeks, although it can also present as recurrent chalazions, histologically consistent with a subtype of granulomatous rosacea. Fulminant rosacea is rarely reported in children. As one of the severe subtypes, it is characterized by rapidly evolving nodules, cysts, papules, and pustules in younger women.
Ocular rosacea may be seen alone or in combination with other cutaneous manifestations. In roughly 33-55% of childhood rosacea patients, orbital symptoms precede cutaneous involvement.
Increasing awareness will hopefully lead to the early recognition needed to prevent further complications and improve outcomes for children with rosacea.
Currently, there are no specific guidelines for managing childhood rosacea, and treatments are largely based on treatments for adults—avoidance of aggravating factors (i.e., environmental triggers, temperature, emotional stress, and exercises). Mild cases can be treated with topical therapies such as metronidazole, azelaic acid, ivermectin, tacrolimus, and pimecrolimus. Moderate and severe disease may warrant systemic therapy in which age will be a rate-limiting factor. Prescribers should avoid using oral doxycycline in children younger than eight to avoid tooth staining. Erythromycin may be considered a good treatment option for those children unable to take an oral tetracycline class of antibiotics.
Children suffering from ocular forms, or more inflammatory IFAG on eyelids, may need a multi-disciplinary approach to include ophthalmology.
Although more common in adults, childhood rosacea should be on our radar. As dermatology PAs and NPs, let us continue to learn and grow together, ultimately providing exceptional care for our rosacea patients despite their age.
References:
Research of doxycycline and tooth staining. Centers for Disease Control and Prevention. Updated February 19, 2019. Accessed March 12, 2024. https://www.cdc.gov/rmsf/doxycycline/index.htm
All About Rosacea: Signs & Symptoms and Treatment. Accessed March 12, 2024. https://www.rosacea.org/patients/all-about-rosacea
Gallo RL, Granstein RD, Kang S, et al. Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol 2018 Jan;78(1):148-155
Woo YR, Kim HS. Deciphering Childhood Rosacea: A Comprehensive Review. Journal of Clinical Medicine. 2024; 13(4):1126. https://doi.org/10.3390/jcm13041126
Justin Love, MPAS, PA-C, resides in the blue zone of Loma Linda, CA. He works for Loma Linda University Department of Dermatology. In his spare time, he enjoys any ocean-related activities and spending time with his family.
IMPORTANT NOTICES: Any medical information in this video is not intended as a substitute for informed medical advice and you should not take any action before consulting with a licensed healthcare professional. Any licensed healthcare professional in a healthcare encounter must independently make decisions on medical testing, diagnosis, medication prescribing, and treatment administration based on their professional judgment and training, regardless of the information in this video.