Topical steroids as a cause of acne rosacea in children

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Topical steroids as a cause of acne rosacea in children

American Family Physician; Kansas City;

Apr 15, 2000; T Kirchner;

Steroid-induced acne rosacea is usually treated with an antibiotic and

continuation of a low-potency topical steroid. The time required for

clearing of the lesions after institution of treatment is unknown. When

topical metronidazole is used to treat steroid rosacea, eight to 14 weeks of

therapy are required to clear the lesions. Weston and Morelli evaluated the

clinical features of steroid rosacea and the response to treatment in 106

prepubertal children.

Children in the retrospective study were less than 13 years of age and were

seen during an eight-year period at a university-based ambulatory care

center. There were 46 boys and 60 girls. The topical steroids were

classified according to strength from class 1 to class 7, with class 7 being

the weakest and including over-the-counter 1 percent hydrocortisone. Class 7

agents had been the steroid used in 54 percent of the children; only 3

percent used superpotent (class 1) agents.

The authors believe that evidence does not support continuing use of topical

steroids of any potency if steroid rosacea develops in a child. Thus, they

recommended complete and abrupt discontinuation of these products. Acne

rosacea was treated with oral erythromycin stearate, in a dosage of 30 mg

per kg daily in two divided doses for four weeks, or with topical

clindamycin twice daily for four weeks in patients with a history of

erythromycin intolerance or allergy.

The mean age of onset for the skin condition was 7.04 years (range: six

months to 13 years), but 29 (27 percent) of the children were less than

three years of age. The lesions were in the perinasal area in 98 children,

in the perioral area in 94 children and in the periorbital area in 44

children. About 20 percent of the children had a family history of rosacea.

The rosacea lesions had completely cleared within three weeks of abrupt

withdrawal of the topical steroid and initiation of antibiotic therapy in 22

percent of the children. In 86 percent of the children, the lesions had

resolved within four weeks. In all of the children, the lesions had

completely cleared by eight weeks.

The authors conclude that even topical steroids at the lowest potency can

induce rosacea. Low-strength steroids were implicated in more than one half

of the patients in their series. The authors believe the findings support

the abrupt withdrawal of steroids as one component of treatment rather than

switching the patient to a lower steroid dosage, which is often the

practice. They recommend the use of oral erythromycin as the treatment of

choice in children with steroidinduced rosacea. They also recommend that

topical steroids, including class 7 agents, be especially avoided in

children who are susceptible to steroid-induced rosacea.

JEFFREY T. KIRCHNER, D.O.