A case of pediatric rosacea-Skin and ocular involvement

Ocular Rosacea: An Updated Review

PURPOSE

Ocular rosacea is a chronic inflammatory disorder affecting the ocular surface, often associated with cutaneous rosacea. This review aims to explore its pathogenesis, treatment approaches, and future directions for management.

METHODS

A review of current literature on the pathophysiology, clinical features, and treatment strategies of ocular rosacea in adults and children (pediatric blepharokeratoconjunctivitis) was conducted. Emerging research on immune dysregulation, microbiome alterations, and potential therapeutic targets was analyzed.

RESULTS

Ocular rosacea involves dysregulation of the immune and neurovascular systems, with toll-like receptor activation and complement system involvement leading to chronic ocular surface inflammation. Alterations in the ocular microbiome have been implicated in disease progression. Treatment strategies emphasize a stepwise approach, incorporating ocular and skin hygiene, lifestyle modifications, and pharmacological interventions. Recent advancements in understanding the disease mechanisms have led to the exploration of targeted therapies, including biologics and small-molecule inhibitors.

CONCLUSIONS

Ocular rosacea remains challenging to diagnose and treat, particularly in children (pediatric blepharokeratoconjunctivitis), often leading to delayed intervention and poor outcomes. A multidisciplinary approach, including new therapeutic options, holds promise for improving patient care. Further research into the genetic and molecular basis of ocular rosacea may enable more personalized treatments.

Rosacea in childhood and adolescence: A review

Despite presenting with similar symptoms, triggers, and progression patterns as adults, rosacea in children and adolescents is frequently overlooked as a primary differential diagnosis. However, initial manifestations of classic clinical types can be observed from infancy onwards. The frequent association of childhood rosacea with ophthalmologic manifestations is of particular importance in addition to the knowledge of special subtypes such as idiopathic aseptic facial granuloma. Therapeutic options of pediatric rosacea partly overlap with those of common differential diagnoses such as acne vulgaris or perioral dermatitis. However, both the disease itself and its manifestation in this age group entail challenges in the selection of active ingredients and the development of therapeutic concepts. In addition, advice on triggering and aggravation factors is required in order to provide optimal long-term support for those affected.

Ocular rosacea without facial erythema involvement manifesting as bilateral multiple recurrent chalazions: A case report

BACKGROUND

In addition to the non-specific symptomatology of ocular rosacea, currently, there are no reliable diagnostic tests for the disease, which may lead to its misdiagnosis. Here, we report a case of ocular rosacea presenting with multiple recurrent chalazion on both eyelids.

CASE SUMMARY

A 63-year-old female patient presented with multiple chalazion and dry eyes in both eyes, with no facial erythema. Initial management done were application of steroid eye ointment on both eyelids, hot compresses, and eyelid margin cleaning; noting that there was no relief of symptoms. Surgical excision of the chalazion was done on both eyes, however, bilateral recurrence occurred post-operatively. The pathological studies showed infiltration of a small amount of fibrous tissue with many chronic inflammatory cells. Immunohistochemistry studies were positive for LL-37. Resolution of the chalazion occurred after oral administration of doxycycline and azithromycin.

CONCLUSION

Our findings show that ophthalmologists should recognize the ocular manifestations of skin diseases.

Case Series: Underdiagnosis of Ocular and Oculocutaneous Rosacea in an African American Pediatric Population

SIGNIFICANCE

As the global multiracial population grows, this case series highlights the current under- and misdiagnosis of ocular and oculocutaneous rosacea and the importance of properly identifying the condition in a darkly pigmented pediatric population.

PURPOSE

This series aims to report the clinical presentation of ocular and oculocutaneous rosacea and adverse sequelae of misdiagnosis in two pediatric African American patients.

CASE REPORT

One 11-year-old male and one 10-year-old female, both darkly pigmented African American patients, presented with a history of chronic ocular irritation. The male patient was seen by an eyecare provider eight times over the past seven years for recurrent anterior ocular inflammation. The female patient presented to the clinic with chronic anterior segment ocular inflammation for one year. Both patients were previously treated for their acute signs and symptoms. The male patient was diagnosed with ocular rosacea and the female patient was diagnosed with oculocutaneous rosacea. Both patients were subsequently treated for their underlying inflammatory condition, yielding an improvement in their ocular health.

CONCLUSIONS

These two cases bring attention to the under- and misdiagnosis of ocular and oculocutaneous rosacea in pediatric patients with darkly pigmented skin. Timely and accurate diagnosis is critical to minimize the risk of significant visual and dermatological sequelae.