Rosacea Clinical Characteristics Reveal Differences Across Age Groups

Age has a notable effect on rosacea and is more challenging to treat in women older than 45 years of age.

Clinical features and trigger factors of rosacea vary significantly across age groups among women and may be more complex and trickier to treat in women over the age of 45 years than in younger women, according to study findings published in the Journal of Cosmetic Dermatology.

Researchers at Sichuan University, Chengdu, China sought to examine and compare clinical characteristics of rosacea among women in varying age groups. They hypothesized that the clinical characteristics of rosacea in women will differ with varying physiological stages based on estrogen levels.

They conducted a retrospective study from October 2019 to January 2022 that included 840 women (mean age 35.9±10.23 years) with rosacea. The patients were divided into 3 groups according to age at diagnosis: those 30 years of age and younger (peak estrogen), patients 31 to 44 years of age (stable estrogen), and those 45 years and older (decreasing estrogen). In all, patients ranged from 12 to 73 years of age. Exclusion criteria were patients with clear causes or disease-induced flushing. Researchers examined 16 aggravating factors with high likelihood of causal associations based on previous studies, clinical experience, and modifiability directly or indirectly.

They noted the most common aggravating factors as hot temperature (89.9%), emotional changes (67.3%), spicy food (55.6%), and sun exposure (50.7%). Age-related differences were found in temperature increment (P =.03), emotional changes (P =.001), spicy food (P =.008), and applying cosmetics (P =.002). They observed the common symptoms of burning/stinging sensation (89.3%), telangiectasia (82.6%), persistent erythema (82.0%), dry sensation (74.0%), and pruritus (41.9%).

The clinical manifestations, trigger factors, and systemic diseases of patients in different age groups were found to be significantly different.

Researchers found middle-aged and older patients more likely to have more serious telangiectasia and persistent erythema. These same patients had more systemic diseases of the endocrine metabolic system, the digestive system, and the cardiovascular system and were less affected by some of the influencing factors (P <.05). Group 3 (≥45 years) also had a statistically significant higher frequency of edema and pruritus.

They noted a statistically significant incidence of perioral distribution (P =.029) and eye involvement P =.009), and eye involvement was highest in group 3. No statistical significance in distribution of other lesions was found.

They noted systemic disorder comorbidities in some patients (20.4%). They found a significant number of patients faced anxiety (48.8%) and depression (35.2%), as assessed with the Hospital Anxiety and Depression Scale. The incidence of anxiety was not statistically significant, and the distribution of depression showed a statistical difference by age group with a higher percentage of women with depression in group 3.

Study limitations include the retrospective nature, and failure to account for physiological states of menstruation and menopause.

Researchers concluded that common symptoms of rosacea across age groups include pruritus, dry sensation, burning or stinging, telangiectasia, and persistent erythema. Common aggravating factors include emotional changes, spicy food, sun exposure, and hot environment. Anxiety and depression were seen across all age groups and researchers said “the clinical manifestations, trigger factors, and systemic diseases of patients in different age groups were found to be significantly different,” and the middle-aged and patients who were older “were prone to more severe persistent erythema, telangiectasia, pruritus, edema, and other refractory symptoms, and were less affected by triggering factors, and suffer from more systemic diseases such as digestive system, endocrine metabolic system, (and) cardiovascular system.” 


Yang F, Wang L, Shucheng H, Jiang X. Differences in clinical characteristics of rosacea across age groups: a retrospective study of 840 female patients. J Cosmet Dermatol. Published online October 13, 2022. doi:10.1111/jocd.15470