Rosacea in the Pediatric Population
Rosacea is a condition of vasomotor instability characterized by facial erythema most notable in the central convex areas of the face, including the forehead, cheek, nose, and perioral and periocular skin. Rosacea tends to begin in childhood as common facial flushing, often in response to stress. A diagnosis beyond this initial stage of rosacea is unusual in the pediatric population. If a child is identified with the intermediate stage of rosacea, consisting of papules and pustules, an eye examination should be performed to rule out ocular manifestations. It may be beneficial to recognize children in the early stage of rosacea; however, it is uncertain if prophylactic treatment is necessary.
The treatment of steroid rosacea is a slow process often involving antiacne agents such as benzoyl peroxide and oral or topical antibiotics.23 Abrupt discontinuation of topical steroids followed by administration of antibiotics is a suitable treatment option. Prior recommendation has been to taper all topical steroids to prevent rebound flare; however, one study found clearing of symptoms by week 3 in 22% of patients, by week 4 in 86% of patients, and by week 8 in 100% of patients following abrupt cessation of topical steroids and a regimen of oral erythromycin stearate or topical clindamycin phosphate in children with erythromycin allergy or intolerance.8 Thus, a gradual withdrawal of topical nonfluorinated steroids may not be necessary. However, it is more common than not for children to experience an initial flare of their condition upon withdrawal from topical fluorinated steroids. This is followed by a slow and steady fading.23
