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Steroid Rosacea in Prepubertal Children
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Short Description: the concept that prepubertal children with steroid rosa-. cea need to continue low-strength ... rations induced steroid rosacea in susceptible children. ...
Content Inside: ARTICLE Steroid Rosacea in Prepubertal Children William L. Weston, MD; Joseph G. Morelli, MD Objective: To examine clinical associations, family his- tisone preparations. Only 3% of children had used su- tory of rosacea, and response to treatment in prepuber- perpotent (class 1) topical corticosteroids. The mean age tal children with steroid rosacea. at onset was 7.04 years (range, 6 months to 13 years). Twenty-nine children were younger than 3 years. A fam- Design: Retrospective case-series evaluation of chil- ily history of rosacea was found for 20% of the children. dren younger than 13 years with steroid rosacea seen over After abruptly stopping topical steroid use and starting an 8-year period (1991-1998). treatment with oral erythromycin, 86% of children had complete clearing within 4 weeks and 100% by 8 weeks. Setting: Ambulatory care university hospital. Clearing within 3 weeks was observed in 22% of chil- dren. Patients: Referral patients from pediatricians serving a population of 3.4 million. Conclusions: Abrupt discontinuation of topical corti- costeroids and institution of oral antibiotics resulted in Interventions: Abrupt cessation of topical corticoste- clearing within 4 weeks. This finding does not support roid use and initiation of treatment with oral erythro- the concept that prepubertal children with steroid rosa- mycin stearate for 4 weeks. cea need to continue low-strength steroids in a gradual withdrawal strategy. This conclusion is supported by the Main Outcome Measures: Age at onset, class of topi- finding that 54% developed the steroid rosacea while be- cal corticosteroid used, family history of rosacea, loca- ing treated with the lowest-strength (class 7) topical cor- tion of lesions, treatment, and weeks to clearing. ticosteroids. Even over-the-counter hydrocortisone prepa- rations induced steroid rosacea in susceptible children. Results: We evaluated 106 (46 boys and 60 girls) who Susceptibility may be genetic as 20% of children had a developed steroid rosacea. Preceding steroids used were first-degree relative with rosacea. predominantly (54% of children) class 7 agents includ- ing 1% hydrocortisone and over-the-counter hydrocor- Arch Pediatr Adolesc Med. 2000;154:62-64 documented in children, but there are no Editor's Note: This study should serve as a reminder of a diag- series of more than 14 affected children nosis (and treatment) that you just might encounter, especially con- reported.1-8 Several different topical ste- sidering the association with even low-dose, topical steroids. roid preparations have been implicated in precipitating the lesions, but it is unclear Catherine D. DeAngelis, MD as to which potency classes of topical ste- P roids are involved.2-5 The relationship to E R I O R A L dermatitis is a adult rosacea is unclear, but we recently chronic papulopustular skin reported identical twins who were af- condition with many fea- fected and suggested that genetic suscep- tures of acne rosacea.1-3 It is tibility may be involved.9 Treatment has observed on facial skin not been standard, with a variety of thera- around the mouth, nose, or eyes. It is char- peutic strategies used.2-8 A common treat- acterized by red skin interspersed with red ment is to continue the use of low- papules and/or pustules. When it is pre- potency topical steroids in addition to cipitated by the application of topical cor- using antibiotics. There are no reports of From the Departments of ticosteroids (hereafter referred to as ste- time to clearing after treatment is initi- Dermatology and Pediatrics, roids) to the facial skin, it is called steroid ated, except with the use of topical met- University of Colorado School of Medicine, Denver. rosacea.2,3 Steroid rosacea has long been ronidazole that required 8 to 14 weeks for ARCH PEDIATR ADOLESC MED/ VOL 154, JAN 2000 WWW.ARCHPEDIATRICS.COM 62 on December 25, 2008 www.archpediatrics.com Downloaded from �2000 American Medical Association. All rights reserved.
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