Rosacea in Adolescents and Young Adults: High Prevalence Concurrent with Acne Vulgaris Treated with Benzoyl Peroxide and/or Adapalene

BACKGROUND The incidence of rosacea in adolescents and young adults with acne vulgaris has been increasing; however, the underlying factors and clinical symptoms have not been clearly described. AIM To investigate the factors underlying the recent increase in the prevalence of rosacea with acne vulgaris, with a focus on changes in social and medical factors over the past decade. METHODS A case series of rosacea conducted from April 2022 to May 2023. Characteristics and clinical symptoms of rosacea with acne vulgaris in adolescents and young adults were investigated. As a countermeasure against rosacea, two-color (blue and red) light-emitting diodes (LED) were irradiated. RESULTS Of the total 84 patients with rosacea, 34 (40.8%) had rosacea with acne vulgaris. All patients had onset before the age of 30 years, particularly in the teenage years (25 cases). All patients with rosacea and acne vulgaris developed rosacea during benzoyl peroxide and/or adapalene (BPO/adapalene) therapy, with a higher incidence in females than in males. During the study period, 863 patients with acne vulgaris were identified in the author’s clinic, and 34 (3.9%) had rosacea and acne vulgaris. Among the 863 patients with acne vulgaris, 437 (50.6%) were using BPO/adapalene, whereas all (100%) patients with rosacea and acne vulgaris were using BPO/adapalene (p = 0.0083). Among the female patients with acne vulgaris, 265 used BPO/adapalene, and 29 (10.9%) developed rosacea. Contrastingly, 172 males used BPO/adapalene, and 5 (2.9%) developed rosacea, which was a lower rate than that in females (p = 0.0051). CONCLUSION In the present study, all patients with rosacea and acne vulgaris had an age of onset of less than 30 years, and most were teenage females. All patients developed rosacea during BPO/adapalene therapy for acne vulgaris and wore masks for at least 6 hours per day. Rosacea in patients with acne vulgaris may be induced by BPO/adapalene and prolonged mask-wearing. Preventing rosacea development during acne vulgaris treatment is important, especially in female adolescents; mask-wearing should be avoided as much as possible, and additional LED therapy may help prevent rosacea during BPO/adapalene therapy.