Can a young person develop rosacea?

Rosacea in Young People

Yes, young people, including children, can develop rosacea, though it is uncommon in pediatric populations and has distinct clinical presentations compared to adult forms. 1, 2, 3

Epidemiology and Presentation in Young People

• Rosacea primarily affects adults aged 35-50, with peak onset in the 40s and 50s 4, 5
• Pediatric rosacea is uncommon but well-documented in medical literature 3, 6
• In children, rosacea often presents differently than in adults:
  • Ocular manifestations may appear before cutaneous signs 1, 2
  • Children may present with chronic recurrent keratoconjunctivitis, phlyctenules, punctate erosions, keratitis, meibomian gland dysfunction, or recurrent chalazia 1
  • Facial rosacea is less frequent in children, and associated atopy is common 1
  • Phymatous subtypes (like rhinophyma) do not typically occur in pediatric rosacea 3
  • A special subtype seen in infants and children is idiopathic facial aseptic granuloma 3

Diagnostic Features in Young People

• Diagnosis is based on clinical symptoms, with persistent centrofacial erythema being a key diagnostic feature 1, 2
• Children with ocular rosacea often present with:
  • Corneal involvement
  • Asymmetry of ocular disease
  • Potential for visual impairment such as corneal melting/perforation 1
• Children with a history of styes have an increased risk of developing adult rosacea 1
• Diagnosis may be challenging in patients with darker skin tones due to difficulty visualizing telangiectasia or facial flushing 1, 2

Clinical Pitfalls and Considerations

• Rosacea is often misdiagnosed or overlooked in children because:
  • Many patients exhibit only mild signs like telangiectasia and easy facial flushing 1
  • Ocular findings may precede cutaneous manifestations 1, 2
  • Symptoms may be subtle or atypical compared to adult presentations 3
• Differential diagnosis in young people includes:
  • Acne vulgaris
  • Granulomatous perioral dermatitis
  • Sarcoidosis
  • Contact dermatitis 2, 6

Management Approach for Young Patients

• Treatment follows similar principles as adult rosacea but with age-appropriate modifications:
  • Avoidance of triggers
  • Mild cleansing agents and moisturizing regimens
  • Photoprotection with wide-brimmed hats and broad-spectrum sunscreens 7
• For inflammatory lesions:
  • Topical agents like metronidazole or azelaic acid are first-line 7
  • Caution with oral tetracyclines in children due to potential adverse effects including discoloration of teeth and impairment of enamel 3
  • Systemic antibiotics may be needed for more severe cases 6

Prognosis

• Young patients with rosacea typically respond well to appropriate therapy 6
• Early diagnosis and treatment are crucial to prevent progression and permanent skin changes 2
• Rosacea is a chronic condition with periods of exacerbation and remission that requires ongoing management 2, 7

Understanding that rosacea can affect young people is important for early recognition and appropriate management, particularly since presentation may differ from adult forms and can significantly impact quality of life and visual outcomes if left untreated.