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


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


METHODS
Ambulatory care university hospital.


METHODS
Referral patients from pediatricians serving a population of 3.4 million.


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


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


RESULTS
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.


CONCLUSIONS
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.
Weston
W L
WL
Department of Dermatology, University of Colorado School of Medicine, Denver, USA. william.weston@exchange.uchsc.edu
Morelli
J G
JG
D000284:Administration, Oral; D000287:Administration, Topical; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D002981:Clindamycin / Q000008:administration & dosage; D004917:Erythromycin / Q000008:administration & dosage; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D006854:Hydrocortisone; D008297:Male; D004366:Nonprescription Drugs / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D012393:Rosacea / Q000139:chemically induced* / Q000188:drug therapy / Q000235:genetics
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D004366:Nonprescription Drugs; D002981:Clindamycin; D004917:Erythromycin; D006854:Hydrocortisone