Rosacea in Older People: Less Common or Underdiagnosed?

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Does rosacea become less of an issue as we age? Or is it just less commonly diagnosed? Two recent studies aim to shed light on this puzzling phenomenon.

According to a study published in the journal Immunity, Inflammation and Disease, the lower incidence of rosacea in older adults may be a result of an aging-related impaired immune response.¹ Noting that epidemiologic studies^2-4 show the incidence of rosacea peaking between the ages of 30 and 50 years, the researchers reported similar findings in 8340 individuals free of systemic diseases from the Xiangya Hospital in Changsha, China. The highest incidence of rosacea, at 4.5%, was in the 25 to 44.9 age group, followed by a notable decline to 2.9% in those 45 to 64.9 years old, and 0.9% in those aged 65 years and older.

To further investigate this trend, the researchers injected mice with the cathelicidin LL-37—a factor in the innate immune response thought to contribute to rosacea by inducing inflammation and promoting blood vessel growth—to induce these characteristic rosacea responses. Whereas the skin of younger mice aged 2 months displayed pronounced rosacea-like features that escalated with successive doses, the skin of older mice aged 20 months showed milder erythema, lighter coloration, and reduced area involvement.

In addition, the researchers analyzed mouse keratinocyte (MK) samples treated with LL-37 in vitro for a variety of characteristic disease-related molecules found in patients with rosacea, including KLK-5, CAMP, TLR2, TNF-α, MMP-9, and MMP-2. They found that LL-37 significantly increased the levels of these factors in the MK samples from 2-month-old mice, which exceeded the levels observed in MK samples from the 20-month-old mice.

“These findings indicate a compromised ability of the aging immune system to mount effective responses to pathogens and external stimuli,” the researchers concluded.

However, the authors of a research letter in the Journal of the American Geriatrics Society suggest a very different explanation for the decreased incidence of rosacea in older adults: it may simply be underdiagnosis.⁵

Investigators in Finland performed a retrospective cross-sectional study of 1306 individuals. Five hundred twenty-two individuals ranging in age from 70 to 93 years accepted the invitation for a full clinical examination and were also asked to fill out a detailed health questionnaire that included the question, “Has a doctor ever diagnosed you with rosacea?”

About a quarter of the subjects (137) were diagnosed with rosacea during the study. Of those, only 10 reported having previously received a rosacea diagnosis. Among subjects who did not receive a diagnosis of rosacea during the researchers’ examination, 11 reported a previous diagnosis in the survey, while rosacea was listed in the electronic health records of 3 others. None of those who were previously diagnosed received their diagnosis via a primary care visit. The researchers noted that their results support findings from a US study, which found 80% of people with rosacea are undiagnosed.⁶

The investigators suggested that time constraints at primary care visits may hamper the ability of physicians to identify rosacea. They also noted that the persistent erythema and telangiectasia of rosacea may be mistaken by some physicians as normal signs of aging.

The findings of both studies underscore the value of a dermatologist’s expertise in the diagnosis of rosacea and other skin-related issues, as well as the importance of examining patients for emerging dermatoses later in life.

Andrew Huff is the president and executive director of the National Rosacea Society.

References

1. Long J, Deng Z, Chen M, Tangxiele L. Impaired angiogenesis and Th1/Th17 polarization: a possible explanation for the decreased incidence of rosacea in the aged. Immun Inflamm Dis. 2024;12(12):e70108. doi:10.1002/iid3.70108
2. Li J, Wang B, Deng Y, et al. Epidemiological features of rosacea in Changsha, China: a population-based, cross-sectional study. J Dermatol. 2020;47(5):497-502. doi:10. 1111/1346-8138.15301
3. Rueda LJ, Motta A, Pabón JG, et al. Epidemiology of rosacea in Colombia. Int J Dermatol. 2017;56(5):510-513. doi:10.1111/ijd.13491
4. Abram K, Silm H, Oona M, Prevalence of rosacea in an Estonian working population using a standard classification. Acta Derm Venereol. 2010;90(3):269-273. doi:10. 2340/00015555-0856
5. Jäntti J, Jokelainen JJ, Huilaja L, Sinikumpu SP. Rosacea is an underdiagnosed disease among subjects aged over 70 years. J Am Geriatr Soc. 2025 Apr 24. Online ahead of print. doi:10.1111/jgs.19488
6. Wehausen B, Hill DE, Feldman SR. Most people with psoriasis or rosacea are not being treated: a large population study. Dermatol Online J. 2016;22(7):13030/ qt4nc3p4q2.