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Do more women or men have rosacea?

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More Women than Men Have Rosacea?
In the past in medical literature on rosacea, the general consensus has been that more women have rosacea than men, particularly in certain variants of rosacea. Typical examples of medical authorities who report that more women than men have rosacea are shown below:

Mayo Clinic
"Rosacea can occur in anyone. But it most commonly affects middle-aged women who have fair skin." Under Risk Factors, the Mayo Clinic says, "you may be more likely to develop it if you are a woman."

National Institute of Arthritis and Musculoskeletal and Skin Diseases
Under the tab, Who gets rosacea?  "Women, especially during menopause."

American Osteopathic College of Dermatology
"Rosacea is most common in white women between the ages of 30 and 60."

National Institute of Health, Genetics Home Reference
"For reasons that are unclear, women appear to be affected more often than men."

New England Journal of Medicine
"Women are more commonly affected than men, and rosacea has been shown to be particularly common among fair-skinned people of Celtic origin." [4]

Medline Plus
"Rosacea is most common in women and people with fair skin."

John Hopkins Medicine
"It is more common in fair-skinned people and women in menopause."  UCLA also says, "is more common in fair-skinned people and women in menopause."

Severity Scores Reveal More Men than Women Have Rosacea
One report concluded, "Self-assessment severity scores were significantly higher in men (3.6 ± 1.3) than women (3.2 ± 1.0; P = .04).The authors conclude that rosacea is more severe in men and younger patients." [1]

What Phenotype or Variant of Rosacea?
It depends on which phenotype or variant of rosacea being discussed whether more women or more men have rosacea. We will use this post to collect papers on this subject. If you find any papers on this subject, please reply to this post what you have found. 

Glandular Rosacea 
Glandular rosacea, a variant of rosacea, occurs predominantly in males.

Rosacea Lymphedema (Morbihan Disease)
Also known as Morbihan syndrome, "a rare entity that more commonly affects women in the third or fourth decade of life."

Phenotype 4
"Firstly, the papulo-pustular stage mainly occurs in males in whom rosacea is a more serious disease at all stages. The papulo-pustular stage is actually uncommon in females.” [2]

Phenotype 5
Phenotype 5 occurs much more often in men than in women (approximate ratio, 20:1). [3]

Rosacea Perioral Dermatitis 
Rosacea Perioral Dermatitis [POD], a rosacea variant, usually effects young females and results from topical steroid use. Overuse of heavy face creams and moisturizers are another common factor. 

Rosacea Fulminans (Pyoderma Faciale or Rosacea conglobata)
This rosacea variant is possibly the most extreme form of Rosacea and usually only occurs in women.

End Notes

[1] Dermatol Clin. 2018 Apr;36(2):97-102. doi: 10.1016/j.det.2017.11.004. Epub 2017 Dec 16.
Measurement of Disease Severity in a Population of Rosacea Patients.
Alinia H, Tuchayi SM, James SM, Cardwell LA, Nanda S, Bahrami N, Awosika O, Richardson I, Huang KE, Feldman SR.

[2] A Personal Critique on the State of Knowledge of Rosacea Albert M. Kligman , M.D., Ph.D.
Department of Dermatology, University of Pennsylvania, Philadelphia, PA, U.S.A.
The William J. Cunliffe Lectureship 2003—Manuscript

[3] Phymatous Explained 

[4] N Engl J Med 2017; 377:1754-1764
DOI: 10.1056/NEJMcp1506630
Rosacea
November 2, 2017, Esther J. van Zuuren, M.D.

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