Childhood ocular rosacea: Considerations for diagnosis and treatment

Abstract

Rosacea in children is not as well described as it is in adults. Ocular signs may be a dominant feature and some children with what has previously been called periorificial dermatitis may in fact have rosacea. We report three cases of paediatric ocular rosacea responding to prolonged treatment with oral erythromycin. Our cases demonstrate the close association of periorificial dermatitis with childhood rosacea, and highlight the importance of eye signs in its diagnostic criteria.

Ocular rosacea: a review

“…Tetracycline and doxycycline, commonly used for therapy in adults, may result in depressed bone growth and dental staining in this age range (17) . In these cases, erythromycin (20 mg/kg/ day) is preferable (16,17,101) . Doxycycline (100 mg once or twice daily) is considered a good therapeutic option for older children, since it is usually better tolerated than tetracycline.…”

Pediatric ocular rosacea, a misdiagnosed disease with high morbidity: Proposed diagnostic criteria

“…In 13 published series [5][6][7][8][9][10][11][12][13][14][15][16][17] , a total of 259 patients were found and the number of patients in each varied between 3 [16] and 51 [15] . In another series, the largest ever published about POR, the sample included 615 cases, most of them described as mild, by Gupta et al [18] in 2010.…”

“…In others studies, the number of cases was smaller probably because only severe cases were reported [5][6][7][8][9][10][11][12][13][14][15][16][17] . POR is mostly diagnosed by ophthalmologists [6,9,11,14,15] , making this condition rare for other physicians and is underdiagnosed or misdiagnosed by them [5][6][7][8][9][10][11][12][13]15,16] . In two tertiary centers of ophthalmology, in Philadelphia [10] and in New Deli [18] , chronic blepharokeratoconjunctivitis was the reason for referral in 15% and 12.3% of all children, respectively.…”

“…In the 259 patients of the 13 series [5][6][7][8][9][10][11][12][13][14][15][16][17] , 162 are girls (62.5%) and 97 are boys (37.5%), the opposite of what was found by Gupta et al [18] (37.5% vs 62.5%).…”

“…The non-recognition of POR can also be a result of the varied names adopted in the literature and the lack of overall consensus: Chronic blepharokeratoconjunctivitis [6,[9][10][11][14][15][16][17][18] , blepharokeratitis [10] , chronic phlyctenular keratoconjunctivitis [8][9][10]18] phlyctenular blepharokeratoconjunctivitis [10,14,18] , and meibomitis-related keratoconjunctivitis [19] . The main aim of this review is to make the children's health care providers aware of POR, by highlighting its clinical features, epidemiology, easy diagnosis and treatment.…”