Steroid rosacea in prepubertal children

To examine clinical associations, family history of rosacea, and response to treatment in prepubertal children with steroid rosacea.

Retrospective case-series evaluation of children younger than 13 years with steroid rosacea seen over an 8-year period (1991-1998).

Ambulatory care university hospital.

Referral patients from pediatricians serving a population of 3.4 million.

Abrupt cessation of topical corticosteroid use and initiation of treatment with oral erythromycin stearate for 4 weeks.

Age at onset, class of topical corticosteroid used, family history of rosacea, location of lesions, treatment, and weeks to clearing.

We evaluated 106 (46 boys and 60 girls) who developed steroid rosacea. Preceding steroids used were predominantly (54% of children) class 7 agents including 1% hydrocortisone and over-the-counter hydrocortisone preparations. Only 3% of children had used superpotent (class 1) topical corticosteroids. The mean age at onset was 7.04 years (range, 6 months to 13 years). Twenty-nine children were younger than 3 years. A family history of rosacea was found for 20% of the children. After abruptly stopping topical steroid use and starting treatment with oral erythromycin, 86% of children had complete clearing within 4 weeks and 100% by 8 weeks. Clearing within 3 weeks was observed in 22% of children.

Abrupt discontinuation of topical corticosteroids and institution of oral antibiotics resulted in clearing within 4 weeks. This finding does not support the concept that prepubertal children with steroid rosacea need to continue low-strength steroids in a gradual withdrawal strategy. This conclusion is supported by the finding that 54% developed the steroid rosacea while being treated with the lowest-strength (class 7) topical corticosteroids. Even over-the-counter hydrocortisone preparations induced steroid rosacea in susceptible children. Susceptibility may be genetic as 20% of children had a first-degree relative with rosacea.