Version for print Main / Articles / Pediatric rosacea: present understanding of the condition (literature review)

Pediatric rosacea: present understanding of the condition (literature review)

Scopus

Abstract

DOI: 10.32364/2587-6821-2026-10-6-12

Pediatric rosacea: present understanding of the condition (literature review)

M.N. Ostretsova¹, E.I. Kasikhina^1,2, E.V. Tolstoguzova², O.V. Zhukova^1,2

¹ Peoples' Friendship University of Russia, Moscow, Russian Federation

²Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Moscow, Russian Federation

Rosacea is a chronic inflammatory skin disorder affecting the central face. In pediatric practice, it occurs much less frequently than in adults and commonly remains underrecognized because of the lack of unified diagnostic criteria and insufficient awareness among specialists. This review analyzes current data on the epidemiology, etiopathogenesis, clinical manifestations, diagnosis, and treatment approaches for this dermatosis in childhood. Pediatric rosacea has been shown to account for approximately 1% of all rosacea cases; disease onset most commonly occurs after the age of 4 years, and the sex distribution is approximately equal. Key pathogenetic mechanisms include innate immune dysregulation, neurovascular dysfunction, genetic predisposition, and excessive cutaneous colonization by Demodex mites. The clinical presentation of pediatric rosacea is polymorphic. Several subtypes are distinguished: erythematotelangiectatic rosacea, papulopustular rosacea, the periorificial variant, granulomatous rosacea, ocular rosacea, and idiopathic facial aseptic granuloma. Phymatous forms have not been described in children. The diagnosis is usually established clinically on the basis of phenotypic criteria according to ROSCO. Treatment is based on adapted recommendations developed for adult patients. The prevailing perception within the dermatological community that rosacea is primarily a disease of adults often leads to its exclusion from the differential diagnostic spectrum, despite similar symptoms, trigger factors, and patterns of disease development. The absence, in the Russian scientific literature available to the authors, of publications on rosacea in children and adolescents based on the authors' own clinical experience supports the relevance of further investigation of this issue.

Keywords: rosacea, children, adolescents, pediatric rosacea, idiopathic facial aseptic granuloma.

For citation: Ostretsova M.N., Kasikhina E.I., Tolstoguzova E.V., Zhukova O.V. Pediatric rosacea: present understanding of the condition (literature review). Russian Medical Inquiry. 2026;10(6):411–417 (in Russ.). DOI: 10.32364/2587-6821-2026-10-6-12

About the authors:

Maria N. Ostretsova — C. Sc. (Med.), Associate Professor of the Department of Dermatovenereology, Allergology, and Cosmetology, Medical Institute, Peoples' Friendship University of Russia; 6, Miklukho-Maklaya str., Moscow, 117198, Russian Federation; ORCID iD 0000-0003-3386-1467

Elena I. Kasikhina — Dr. Sc. (Med.), Associate Professor of the Department of Dermatovenereology, Allergology, and Cosmetology, Medical Institute, Peoples' Friendship University of Russia; 6, Miklukho-Maklaya str., Moscow, 117198, Russian Federation; dermatovenereologist, Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology; 17, Leninsky Ave., Moscow, 119071, Russian Federation; ORCID iD 0000-0002-0767-8821

Elvira V. Tolstoguzova — statistician, Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology; 17, Leninsky Ave., Moscow, 119071, Russian Federation; ORCID iD 0009-0008-8853-3341

Olga V. Zhukova — Dr. Sc. (Med.), Professor, Head of the Department of Dermatovenereology, Allergology, and Cosmetology, Medical Institute, Peoples' Friendship University of Russia; 6, Miklukho-Maklaya str., Moscow, 117198, Russian Federation; Chief Medical Officer, Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology; 17, Leninsky Ave., Moscow, 119071, Russian Federation; ORCID iD 0000-0001-5723-6573

Contact information: Maria N. Ostretsova, e-mail: ostretsova-mn@rudn.ru

Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.

There is no conflict of interest.

Received 13.03.2026.

Revised 07.04.2026.

Accepted 30.04.2026.

References

1. Hoepfner A., Marsela E., Clanner-Engelshofen B.M. et al. Rosacea and perioral dermatitis: a single-center retrospective analysis of the clinical presentation of 1032 patients. J Dtsch Dermatol Ges. 2020;18(6):561–570. DOI: 10.1111/ddg.14120 2. Spoendlin J., Voegel J.J, Jick S.S., Meier C.R. A study on the epidemiology of rosacea in the U.K. Br J Dermatol. 2012;167(3):598–605. DOI: 10.1111/j.1365-2133.2012.11037.x 3. Потекаев Н.Н., Хамаганова И.В., Новожилова О.Л., Лебедева Г.А. Эпидемиология розацеа. Клиническая дерматология и венерология. 2016;15(1):4–7. DOI: 10.17116/klinderma20161514-7. Potekaev N.N., Khamaganova I.V., Novozhilova O.L., Lebedeva G.A. Epidemiology of rosacea. Russian Journal of Clinical Dermatology and Venereology. 2016;15(1):4–7 (in Russ.). DOI: 10.17116/klinderma20161514-7 4. Rueda L.J., Motta A., Pabón J.G. et al. Epidemiology of rosacea in Colombia. Int J Dermatol. 2017;56(5):510–513. DOI: 10.1111/ijd.13491 5. Ahn C.S., Huang W.W. Rosacea Pathogenesis. Dermatol Clin. 2018;36(2):81–86. DOI: 10.1016/j.det.2017.11.001 6. Chamaillard M., Mortemousque B., Boralevi F. et al. Cutaneous and ocular signs of childhood rosacea. Arch Dermatol. 2008;144:167–171. DOI: 10.1001/archdermatol.2007.50 7. Woo Y.R., Kim H.S. Deciphering Childhood Rosacea: A Comprehensive Review. J Clin Med. 2024;13(4):1126. DOI: 10.3390/jcm13041126 8. Laude T.A., Salvemini J.N. Perioral dermatitis in children. Semin Cutan Med Surg. 1999;18(3):206–209. DOI: 10.1016/s1085-5629(99)80018-2 9. Korsing S., Stieler K., Pleyer U. et al. Rosacea in childhood and adolescence: A review. J Dtsch Dermatol Ges. 2025;23(6):684–691. DOI: 10.1111/ddg.15693 10. Wang L., Wang Y.J., Hao D. et al. The Theranostics Role of Mast Cells in the Pathophysiology of Rosacea. Front Med (Lausanne). 2020;6:324. DOI: 10.3389/fmed.2019.00324 11. Chen C., Wang P., Zhang L. et al. Exploring the Pathogenesis and Mechanism-Targeted Treatments of Rosacea: Previous Understanding and Updates. Biomedicines. 2023;11(8):2153. DOI: 10.3390/biomedicines11082153 12. Woo Y.R., Lim J.H., Cho D.H., Park H.J. Rosacea: Molecular Mechanisms and Management of a Chronic Cutaneous Inflammatory Condition. Int J Mol Sci. 2016;17(9):1562. DOI: 10.3390/ijms17091562 13. Abram K., Silm H., Maaroos H.I., Oona M. Risk factors associated with rosacea. J Eur Acad Dermatol Venereol. 2010;24(5):565–571. DOI: 10.1111/j.1468-3083.2009.03472.x 14. Chosidow O., Cribier B. Epidemiology of rosacea: updated data. Ann Dermatol Venereol. 2011;138(Suppl 3):S179–S183. DOI: 10.1016/S0151-9638(11)70087-4 15. Chang A.L.S., Raber I., Xu J. et al. Assessment of the genetic basis of rosacea by genome-wide association study. J Invest Dermatol. 2015;135(6):1548–1555. DOI: 10.1038/jid.2015.53 16. Sáez-de-Ocariz M., Suárez-Gutiérrez M., Migaud M. et al. Rosacea as a striking feature in family members with a STAT1 gain-of-function mutation. J Eur Acad Dermatol Venereol. 2020;34(6):e265–e267. DOI: 10.1111/jdv.16241 17. Baghad B., El Fatoiki F.Z., Benhsaien I. et al. Pediatric Demodicosis Associated with Gain-of-Function Variant in STAT1 Presenting as Rosacea-Type Rash. J Clin Immunol. 2021;41(3):698–700. DOI: 10.1007/s10875-020-00942-z 18. Jarmuda S., O'Reilly N., Żaba R. et al. Potential role of Demodex mites and bacteria in the induction of rosacea. J Med Microbiol. 2012;61(Pt 11):1504–1510. DOI: 10.1099/jmm.0.048090-0 19. Brown M., Hernández-Martín A., Clement A. et al. Severe demodex folliculorum-associated oculocutaneous rosacea in a girl successfully treated with ivermectin. JAMA Dermatol. 2014;150(1):61–63. DOI: 10.1001/jamadermatol.2013.7688 20. Koller B., Müller-Wiefel A.S., Rupec R. et al. Chitin modulates innate immune responses of keratinocytes. PLoS One. 2011;6(2):e16594. DOI: 10.1371/journal.pone.0016594 21. Noguera-Morel L., Hernández-Martín A., Torrelo A. Childhood rosacea and related disorders. Clin Exp Dermatol. 2021;46(3):430–437. DOI: 10.1111/ced.14419 22. Gao Y., Yang X.J., Zhu Y. et al. Association between rosacea and helicobacter pylori infection: A meta-analysis. PLoS One. 2024;19(4):e0301703. DOI: 10.1371/journal.pone.0301703 23. Manfredini M., Barbieri M., Milandri M., Longo C. Probiotics and Diet in Rosacea: Current Evidence and Future Perspectives. Biomolecules. 2025;15(3):411. DOI: 10.3390/biom15030411 24. Kim Y.J., Park J.M., Lee H.M. et al. Clinical Manifestations and Treatment Outcomes of Pediatric Rosacea Patients: A Retrospective Study. J Clin Med. 2025;14(24):8783. DOI: 10.3390/jcm14248783 25. Острецова М.Н., Касихина Е.И., Костецкая А.В. и др. Дифференциальная диагностика и лечение флашинг-реакций при розацеа: современные данные и клинический опыт. РМЖ. Медицинское обозрение. 2025;9(6):346–352. DOI: 10.32364/2587-6821-2025-9-6-8. Ostretsova M.N., Kasikhina E.I., Kostetskaya A.V. et al. Differential diagnosis and treatment of flushing in rosacea: current data and clinical practice. Russian Medical Inquiry. 2025;9(6):346–352 (in Russ.). DOI: 10.32364/2587-6821-2025-9-6-8 26. Chiriac A., Wollina U. Rosacea in children: a review. Eur J Pediatr. 2023;182(10):4323–4328. DOI: 10.1007/s00431-023-05083-0 27. Michel J.L., Cabibel F. Frequency, severity and treatment of ocular rosacea during cutaneous rosacea. Ann Dermatol Venereol. 2003;130:20–24. 28. Thiboutot D., Anderson R., Cook-Bolden F. et al. Standard management options for rosacea: The 2019 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol. 2020;82(6):1501–1510. DOI: 10.1016/j.jaad.2020.01.077 29. Mohamed-Noriega K., Loya-Garcia D., Vera-Duarte G.R. et al. Ocular Rosacea: An Updated Review. Cornea. 2025;44(4):525–537. DOI: 10.1097/ICO.0000000000003785 30. Kuperman Wilder L., Lamberti A., Boggio P. et al. Idiopathic aseptic facial granuloma: A retrospective study of 43 cases. Pediatr Dermatol. 2024;41(2):243–246. DOI: 10.1111/pde.15571 31. Docampo Simón A., Sánchez-Pujol M.J., Schneller-Pavelescu L. et al. [Idiopathic facial aseptic granuloma: Clinical, pathological, and ultrasound characteristics]. An Pediatr (Engl Ed). 2020;92(5):297–299. (in Spanish). DOI: 10.1016/j.anpedi.2019.05.015 32. Knöpfel N., Gómez-Zubiaur A., Noguera-Morel L. et al. Ultrasound findings in idiopathic facial aseptic granuloma: Case series and literature review. Pediatr Dermatol. 2018;35(3):397–400. DOI: 10.1111/pde.13324 33. Miconi F., Principi N., Cassiani L. et al. A Cheek Nodule in a Child: Be Aware of Idiopathic Facial Aseptic Granuloma and Its Differential Diagnosis. Int J Environ Res Public Health. 2019;16(14):2471. DOI: 10.3390/ijerph16142471 34. Patrocínio J., Garrido P.M., Turpin S. et al. Idiopathic Facial Aseptic Granuloma: A Case Report. Cureus. 2025;17(10):e95862. DOI: 10.7759/cureus.95862 35. Boralevi F., Léauté-Labrèze C., Lepreux S. et al. Idiopathic facial aseptic granuloma: a multicentre prospective study of 30 cases. Br J Dermatol. 2007;156(4):705–708. DOI: 10.1111/j.1365-2133.2006.07741.x 36. Salerni G., Peralta R., Bertaina C. et al. Dermoscopy of idiopathic facial aseptic granuloma. Clin Exp Dermatol. 2020;45(5):605–606. DOI: 10.1111/ced.14174 37. Тлостанова Д.З., Клятова А.М., Масюкова С.А., Ильина И.В. Клинический случай болезни Морбигана. Вестник Медицинского института непрерывного образования. 2024;4(2):91–95. DOI: 10.36107/2782- 1714_2024-4-2-91-95. Tlostanova D.Z., Klyatova A.M., Masyukova S.A., Ilyina I.V. A Clinical Case of MorbiHan's Disease. Bulletin of the Medical Institute of Continuing. 2024;4(2):91–95 (in Russ.). DOI: 10.36107/2782-1714_2024-4-2-91-95 38. Потекаев Н.Н., Соколова А.А. Опыт успешной терапии болезни Морбигана. Клиническая дерматология и венерология. 2010;8(1):28–30. Potekaev N.N., Sokolova A.A. Successful experience with the treatment of Morbihan's disease. Russian Journal of Clinical Dermatology and Venereology. 2010;8(1):28–30 (in Russ.). 39. Boparai R.S., Levin A.M., Lelli G.J.Jr. Morbihan Disease Treatment: Two Case Reports and a Systematic Literature Review. Ophthalmic Plast Reconstr Surg. 2019;35(2):126–132. DOI: 10.1097/IOP.0000000000001229 40. Shammas R., Gudino-Rosales S., Kneiber D. et al. Facial Swelling in a Young Adult With Type 1 Diabetes: Morbihan Disease as a Scleroderma Mimic. Cureus. 2026;18(1):e101635. DOI: 10.7759/cureus.101635 41. Schaller M., Almeida L.M.C., Bewley A. et al. Recommendations for rosacea diagnosis, classification and management: update from the global ROSacea COnsensus 2019 panel. Br J Dermatol. 2020;182(5):1269–1276. DOI: 10.1111/bjd.18420 42. Tan J., Almeida L.M., Bewley A. et al. Updating the diagnosis, classification and assessment of rosacea: recommendations from the global ROSacea COnsensus (ROSCO) panel. Br J Dermatol. 2017;176(2):431–438. DOI: 10.1111/bjd.15122 43. Neri I., Raone B., Dondi A. et al. Should idiopathic facial aseptic granuloma be considered granulomatous rosacea? Report of three pediatric cases. Pediatr Dermatol. 2013;30(1):109–111. DOI: 10.1111/j.1525-1470.2011.01689.x 44. Gonser L.I., Gonser C.E., Deuter C. et al. Systemic therapy of ocular and cutaneous rosacea in children. J Eur Acad Dermatol Venereol. 2017;31(10):1732–1738. DOI: 10.1111/jdv.14402 45. Mitoma C., Takahara M., Furue M. Severe Granulomatous Rosacea in a Boy Successfully Treated with Topical Azelaic Acid. Indian J Dermatol. 2015;60(3):323. DOI: 10.4103/0019-5154.156460 46. Noguera-Morel L., Gerlero P., Torrelo A., Hernández-Martín Á. Ivermectin therapy for papulopustular rosacea and periorificial dermatitis in children: A series of 15 cases. J Am Acad Dermatol. 2017;76(3):567–570. DOI: 10.1016/j.jaad.2016.10.034 47. Ollech A., Yousif R., Kruse L. et al. Topical calcineurin inhibitors for pediatric periorificial dermatitis. J Am Acad Dermatol. 2020;82(6):1409–1414. DOI: 10.1016/j.jaad.2020.01.064 48. Goel N.S., Burkhart C.N., Morrell D.S. Pediatric periorificial dermatitis: clinical course and treatment outcomes in 222 patients. Pediatr Dermatol. 2015;32(3):333–336. DOI: 10.1111/pde.12534 49. Da Silva Dias V., Lafargue O., Dompmartin A. Idiopathic facial aseptic granuloma in children: Management and long-term follow-up. Ann Dermatol Venereol. 2023;150(3):173–179. DOI: 10.1016/j.annder.2023.02.005 50. Khaslavsky S., Starkey S.Y., Avraham S. et al. Treatment of pediatric ocular rosacea: A systematic review. Ann Dermatol Venereol. 2023;150(3):199–201. DOI: 10.1016/j.annder.2023.05.004 51. Firooz A., Firoozabadi M.R., Dowlati Y. Rosacea fulminans (pyoderma faciale): successful treatment of a 3-year-old girl with oral isotretinoin. Int J Dermatol. 2001;40(3):203–205. DOI: 10.1046/j.1365-4362.2001.01138-5.x 52. Cantarutti N., Claps A., Angelino G. et al. Multi-drugs resistant acne rosacea in a child affected by Ataxia-Telangiectasia: successful treatment with Isotretinoin. Ital J Pediatr. 2015;41:23. DOI: 10.1186/s13052-015-0125-7 53. Lacz N.L., Schwartz R.A. Rosacea in the pediatric population. Cutis. 2004;74(2):99–103. PMID: 15379362 54. Kellen R., Silverberg N.B. Pediatric rosacea. Cutis. 2016;98(1):49–53. PMID: 27529708

This work is licensed under a Creative Commons «Attribution» 4.0 License.

Read the article in PDF in Russian

Role of azelaic acid in modern acne trea...

540

Comparison of efficacy of photodynamic t...

438

All articles