Being diagnosed with rosacea is a relief for many patients who finally have an explanation and treatment plan for their symptoms. However, recent research suggests that dark-skinned rosacea sufferers may never receive their diagnosis, nor the treatment they need.
A recent article in the Journal of the American Academy of Dermatology reviewed epidemiological studies of rosacea in people of color and offered tips on how to better recognize its signs and symptoms in darker skin. The authors, led by Dr. Andrew Alexis, chairman of dermatology at the Icahn School of Medicine at Mount Sinai in New York City, wrote that the misconception that rosacea only affects fair-skinned people, combined with the difficulty detecting redness and other signs and symptoms on darker skin, may explain why the disorder may be underreported and underdiagnosed. In the US, one study found that only 2 percent of diagnosed rosacea patients were black, 2.3 percent were Asian or Pacific Islander, and 3.9 percent were Hispanic or Latino, while global epidemiological studies have estimated higher rates — some as high as 10 percent.
The authors pointed out that darker skin tones can make persistent redness more difficult to detect — and darkening from post-inflammatory hyperpigmentation, which is more common in skin of color, may also help mask it. The investigators hypothesized that the difficulty visualizing persistent redness in darker skin may be why rosacea is often undiagnosed until the later stages of disease progression, after facial disfigurement has occurred.
Because it may be more difficult to detect rosacea in its early stages, Dr. Alexis urged darker skinned patients to pay greater attention to burning or stinging sensations, changes in their skin’s appearance, and a history of skin problems. In the absence of visible redness, these are the main signs of rosacea’s early presence.
Many rosacea sufferers who have not been diagnosed or have been misdiagnosed may not receive information about skincare and avoiding rosacea triggers like sun exposure. A lack of information can lead to more severe symptoms and eventual disfigurement.
The authors noted that treatment for rosacea patients with darker skin is the same as for those with lighter complexions. Patients and physicians should work together to determine the best therapeutic regimen for each individual, including both prescription therapies and skin care products such as moisturizers and sunscreen, they added.
Alexis AF, Callender VD, Baldwin HE, Desai SR, Rendon MI, Taylor SC, Global Epidemiology and Clinical Spectrum of Rosacea, Highlighting Skin of Color: Review and Clinical Practice Experience, Journal of the American Academy of Dermatology (2018), doi: https://doi.org/10.1016/j.jaad.2018.08.049.