A recent study in Finland found that among people aged at least 70 years with rosacea, fewer than 10% were diagnosed before enrollment. Because of rosacea’s burden and its association with potentially serious comorbidities in this age group, the authors said, older patients would benefit from increased awareness of rosacea among providers and better access to dermatologic care.

For the retrospective cross-sectional study, Laura Huilaja, MD, PhD, and Suvi-Päivikki Sinikumpu, MD, PhD, of the University of Oulu, Oulu, Finland, invited local parents of participants in the Northern Finland Birth Cohort 1966 to undergo a skin examination performed by a dermatologist and to complete a health-related questionnaire. Investigators also searched participants’ electronic health records for any rosacea diagnosis between 1996 and 2018.

Of 1306 participants living in the Oulu area, 552 (42.3%; mean age, 78.4 years; range, 70-93 years) underwent total body skin examination and were included in the study, which was published in April 2025 in the Journal of the American Geriatrics Society. Skin examinations revealed rosacea in 137 participants (24.8%), but only 10 of these patients (7.3%) reported a previous rosacea diagnosis. Investigators also found the diagnosis in the health records of another three patients (2.2%). Among the 415 participants without rosacea upon examination, the proportions who reported a history of rosacea or had hospital records thereof were 9 (2.2%) and 2 (0.5%), respectively.

Normal Signs of Aging?

Potential reasons for the underdiagnosis of rosacea included poor symptom recognition, the authors wrote. “Visible signs such as redness or telangiectasias are often interpreted as normal signs of aging or ignored as just a cosmetic nuisance,” they explained. Additional reasons may have included time constraints in primary care, limited rosacea awareness among such providers, and patients’ unwillingness to seek treatment due to the stigma of rosacea, the authors surmised.

Recognizing rosacea in older patients is important, the investigators wrote, because its prevalence rises with age, peaking in men after 70 years, and the risks of strongly associated comorbidities such as Parkinson’s disease, cardiovascular and gastric diseases, metabolic syndrome, depression, and anxiety also increase with age.

Jonathan S. Weiss, MD, said that study findings closely mirrored what he sees among older patients in his practice. Among patients aged 60 years or older, he said, “You see a fair amount of rosacea, and many of them have never had it before.” Weiss is an adjunct assistant professor of dermatology at Emory University, Atlanta. He was not involved with the study but was asked to comment on the findings.

The fact that around two thirds of study patients had erythematotelangiectatic rosacea also matches what Weiss sees clinically among older patients. “And there’s not a ton you can do medically for erythematotelangiectatic rosacea,” he told Medscape Medical News. Patients hear about rosacea treatments, he explained, “and they don’t realize that there are not simple medical treatments for erythematotelangiectatic rosacea, though there are procedural therapies. So they come in with perhaps unrealistic expectations.”

For background erythema, he said, patients in the US are usually satisfied with topical brimonidine (Mirvaso) or topical oxymetazoline (Rhofade). And papulopustular rosacea responds very well to various tetracycline formulations, particularly doxycycline, added Weiss.

Patient Frustrations

American physicians also can consider new low-dose, time-release oral minocycline (Emrosi), Weiss added, although patients are often surprised to learn that branded drugs are difficult to get covered by Medicare. The same can be true for extended-release doxycycline (Oracea), he told Medscape Medical News, although less so because generic alternatives exist. Additionally, Medicare rules exclude devices such as lasers and electrocautery, which he said are among the few effective treatments for telangiectasias, as medically unnecessary.

Study limitations include its failure to address advanced rosacea subtypes such as phymatous rosacea, said Weiss. Additionally, the authors acknowledged that their findings cannot be generalized beyond the White population. Many older patients — especially those with skin of color — may have less access to dermatologists, Weiss pointed out.

The study will have little impact on dermatology, he added, except perhaps to remind dermatologists to exercise caution regarding drug-drug interactions in older patients.

Non-dermatologists should be aware that rosacea can arise without a prior history in older patients, said Weiss. Raising awareness of this possibility among general internists and family practitioners assumes increased importance, he noted, because rosacea also can affect the eyes, with a potentially serious impact on vision. Therefore, he recommended that primary care providers always ask patients with skin symptoms of rosacea about ocular manifestations such as dry eye and treat ocular symptoms if present.

Altogether, the study “underlines the need for increased awareness and education about rosacea among both older patients and healthcare professionals,” wrote Huilaja, Sinikumpu, and colleagues. Improvements in diagnostic protocols and better access to dermatologists, they added, “could help reduce the degree of underdiagnosis and, thereby, could ease the burden of rosacea among older people.”

The study authors reported receiving no funding sources and having no conflicts of interest. Weiss reported being a researcher, consultant, and/or speaker for AbbVie; Arcutis Biotherapeutics; Aslan; Bausch; Biofrontera AG; Bristol Myers Squibb; Cutera, Inc.; Dermavant/Organon; Galderma; Incyte; LEO Pharma; Novartis; Ortho; Pfizer; Regeneron; Sanofi; Sun Pharma; UCB; and Verrica Pharmaceuticals.

John Jesitus is a Denver-based freelance medical writer and editor.