A Closer Look at Rosacea in People of Color

Physiologically, the skin of Afro-Caribbean, Korean, and Southeast Asian patients has been found to have lower vascular endothelial function.2 Despite this, the risk factors and triggers for rosacea are the same for people of all skin colors.2 Global studies have found a correlation between rosacea and risk factors such as residing in an area with a hotter climate and increased sun exposure, indicating a unique link to geographic areas with high concentrations of people of color.2

Clinical characteristics commonly seen in rosacea in people with skin of color include:2

·                     Higher proportions of women than men

·                     Presence of papules and pustules

·                     Prior demodicidosis diagnosis

·                     An association with prior steroid use

·                     Sun exposure as a frequent trigger

·                     Prior misdiagnoses

·                     Symptoms that have persisted beyond a year

A 2014 study of skin conditions in dark-skinned Saudi women found that of those who had been diagnosed with rosacea, family history was reported in only 18% of patients, which is lower than the rate reported by lighter-skinned patients.5 Extrafacial lesions, which have not typically been reported by lighter-skinned patients with rosacea, were seen in the ears, neck, upper chest, and back of the dark-skinned Saudi women examined in this study.5 Furthermore, 16% of the women also reported a history of migraine.5

Detecting Rosacea in Darker Skin

Studies show that delayed diagnosis has been reported in significant groups of Asian patients, African patients in Europe and North America, and South American patients.2

Researchers have found that detecting, diagnosing, and treating rosacea in people of color carries a set of challenges. Persistent facial erythema is reported less frequently than papules and pustules, which might be a result of the difficulty of visualizing erythema in dark skin.2 Further, erythema can be masked by postinflammatory hyperpigmentation, which is more common in skin of color.2 The granulomatous subtype of rosacea, which often involves perioral and periocular lesions and may not include the typical signs of rosacea, might be seen more often in patients of color.2

To accurately diagnose rosacea in people of color, researchers say clinicians should listen carefully to the patient’s observations and medical history. Specifically:2

·                     Do they describe experiencing a warm sensation over their face?

·                     Do they flush easily?

·                     Do they think their skin appears red?

·                     Do they experience a burning or stinging sensation when applying skin care products?

·                     Have they been diagnosed with acne, yet treatments did not provide relief?

·                     Do symptoms correspond with heat, spicy foods, or stress?

·                     Do they have mixed ancestry?

·                     Do they have a family history of rosacea or a relative with the symptoms of rosacea?

Although the signs of rosacea are the same regardless of skin color, the clinical presentation may be different for darker-skinned patients than in patients with lighter skin. For example, look for signs concentrated in the central face. Phymatous rosacea can start as a thickening of the nasal and medial cheek skin.2 Even though erythema might not be readily visible, patients of color may exhibit edema, hyperpigmentation, and/or the appearance of dry skin.2