Gaps in knowledge and clinical practice are contributing factors to the under-detection, misdiagnosis, and delayed diagnosis of rosacea in individuals with skin of color, according to findings from a study published in Drugs in Context.

Researchers conducted a literature search in May 2021 for relevant studies published in English in PubMed, Google Scholar, SCOPUS, MEDLINE, and the Cochrane Database of Systematic Reviews.

Overall, limited data were found regarding the prevalence of rosacea in those with darker skin tones. Persistent facial erythema and telangiectasias are less frequently reported than papules and pustules in this population, likely owing to the difficulty in their visualization.


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Documented clinical characteristics of rosacea in people with skin of color include a greater percentage of individuals with the papulopustular subtype and granulomatous subtype, a higher percentage of women affected vs men, sun exposure as a frequent trigger, prior misdiagnoses, and ongoing symptoms lasting more than a year.

A history of facial stinging or burning sensation, facial flushing, acne diagnosis, and failed acne treatments can aid the diagnosis of rosacea in patients with highly pigmented skin. Other signs include xerosis or scale, edema, facial acneiform papules and pustules, and hyperpigmentation. Proper lighting is important when assessing telangiectasia in patients with dark skin, noted the investigators.

The differential diagnosis for rosacea in patients with skin of color should include acne vulgaris, topical corticosteroid-induced acneiform eruptions, contact dermatitis, and seborrheic dermatitis, among others.

Treatment options are similar in patients with skin of color and those with lighter skin tones, although data are limited on the treatment of rosacea in those with skin of color. Individuals with darker skin tones have an increased risk for postinflammatory hypopigmentation or hyperpigmentation.

Differences in photoprotective behaviors in patients with darker phototypes occur when sunscreen use and other sun-protective behaviors are less frequently followed. Patients with darker skin tones may have a white residue with regular physical sunscreen use, and a tinted physical sunscreen may be recommended. Color matching of cosmetic camouflage products in patients with skin of color may be challenging owing to limited availability.

The risk of device-associated dyspigmentation may be increased in patients with skin of color, and the risk of hemosiderin pigmentation from resolving purpura may also be greater. Conservative vascular laser treatment settings, including lower fluence and longer pulse duration, should be used to minimize the risk of scarring and postinflammatory hyperpigmentation during laser therapy in patients with skin of color, according to the researchers.

The main study limitation is the lack of information regarding rosacea in patients of skin of color.

“Having a higher index of suspicion for rosacea among patients with darker skin and real-world clinical strategies for recognizing and managing this disease may support timely diagnosis and appropriate management,” stated the investigators. “This may help reduce the disparities in managing rosacea across our diverse patient population.”

Disclosure: A study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Maliyar K, Abdulla SJ. Dermatology: how to manage rosacea in skin of colour. Drugs Context. 2022;11:2021-11-1. doi:10.7573/dic.2021-11-1