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Patient Story

A 14-year-old girl presents with a red face and a history of easy facial flushing over the last two years (Figure 97-1). Her face has become persistently redder and she would like some treatment.


Rosacea in a 14-year-old girl showing erythema and papules. (Used with permission from Richard P. Usatine, MD.)

Her mom is in the room and has similar redness in her face. The family is from northern European heritage. The girl also has developed some “pimples.” Physical examination reveals some papules and erythema. No comedones are seen. She knows that the sun makes it worse but finds that many sunscreens are irritating to her skin. The patient is started on 0.75 percent metronidazole gel once daily. She agrees to wear a hat and stay out of the sun during the middle of the day. She will continue to look for a sunscreen she can tolerate. She knows that precipitating factors for her include hot and humid weather, alcohol, hot beverages, and spicy foods.


Rosacea is an inflammatory condition of the face and eyes that mostly affects adults but can start in childhood. Most commonly the face becomes reddened over the cheeks and nose and this is often accompanied by telangiectasias and a papulopustular eruption (Figures 97-2 and 97-3).


Close-up of papules and pustules in a young woman with rosacea. Note the absence of comedones. This is not acne. This is papulopustular rosacea. (Used with permission from Richard P. Usatine, MD.)


Close-up showing telangiectasias on the nose and papules around the mouth and chin. (Used with permission from Richard P. Usatine, MD.)


Rosacea is also called acne rosacea.


  • Common in fair-skinned people of Celtic and northern European heritage.

  • Women and girls are more often affected than men and boys.

  • Men are more prone to the extreme forms of hyperplasia, which causes rhinophymatous rosacea. However, even young women can have rhinophymatous rosacea. (Figure 97-4).


Rhinophymatous rosacea with hypertrophy of the skin of the nose of a young woman with acne scarring from adolescence. The patient denies heavy alcohol intake. This type of rosacea is very rare in children. (Used with permission from Richard P. Usatine, MD.)

Etiology and Pathophysiology

  • Although the exact etiology is unknown, the pathophysiology involves nonspecific inflammation followed by dilation around follicles and hyperreactive capillaries. ...

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