Deciphering Childhood Rosacea: A Comprehensive Review

Abstract

Childhood rosacea is a lesser known, yet significant, skin condition presenting diagnostic and treatment challenges. Although often underdiagnosed due to unclear diagnostic criteria, it manifests similarly to adult rosacea, with features such as papulopustular, telangiectasia, granulomatous, idiopathic facial aseptic granuloma, and ocular rosacea. The complex pathophysiology involves genetic, immunological, and environmental factors. Distinguishing childhood rosacea from conditions like acne, steroid rosacea, sarcoidosis, and lupus vulgaris is crucial but complicated by the lack of established criteria. Treatment strategies, mainly extrapolated from adult management protocols, include topical therapies, systemic medications, and laser treatments, adapted for pediatric patients. Special attention is given to ocular rosacea, often preceding skin manifestations, necessitating multidisciplinary care. The review underscores the urgent need for clear diagnostic guidelines, increased awareness, and tailored pediatric treatment protocols to improve patient outcomes and mitigate the condition's evolution into adulthood.

Keywords: children; diagnosis; management; pediatric; rosacea.

Figure 1

Representative clinical photographic images of childhood rosacea (A) Papulopustular rosacea in a 12-year-old girl. (B) Telangiectasia and erythema in a 4-year-old girl with rosacea (C) Granulomatous rosacea in an 8-year-old.

Figure 2

Clinical and ultrasonographic images of idiopathic facial aseptic granuloma in a 4-year-old girl. (A) Representative clinical photograph of idiopathic facial aseptic granuloma. (B) Ultrasonographic images show hypoechoic ovoid nodular lesion in infraorbital subcutis with relatively homogeneous boundaries and subtle vascularity in the surrounding areas.

Figure 3

Treatment options for childhood rosacea according to age of the patient. * Minocycline is available ≥9 years old in some countries. Abbreviation: Bid, two times a day; Qd, once a day. Created with BioRender.com.