Consensus Statements on the Management of Rosacea in Skin of Color

A panel of dermatologists authored a series of statements on the prevalence, diagnosis, and management of rosacea in patients of color, published in the Journal of Drugs in Dermatology. Statements on the use of cleansers and moisturizers were also provided.

The panel comprised 5 dermatologists from the United States and convened during the American Academy of Dermatology Summer Meeting on August 7, 2021. Before the meeting, panelists conducted a literature review on rosacea and associated skincare in different racial/ethnic populations. A total of 50 relevant articles were reviewed, although data were too sparse to conduct a systematic review, it was noted. During the convening, panel members discussed rosacea treatment recommendations per clinical studies, clinical guidelines, and grey literature. From 14 draft statements, a total of 5 statements were put forth.

Statement 1: While data are limited, studies suggest that rosacea is more common in patients with darker skin than previously reported.

Studies on rosacea have been primarily conducted in White cohorts, resulting in a dearth of data on its prevalence in patients of color. Recent research suggests that rosacea may be less common in pigmented skin but is not rare, with prevalence estimates of up to 2.85% in patients with dark skin.

Statement 2: A history of “skin sensitivity” should alert dermatologists to the possibility of rosacea in patients with skin of color.

Clinical features of rosacea are often less conspicuous in dark skin, which can impede diagnosis. Patient-reported “sensitive skin” should alert dermatologist to the possible presence of rosacea. Patients with rosacea may also report low tolerance to certain skincare products.

Statement 3: To avoid underdiagnosis, dermatologists should have a high “index of suspicion” of rosacea in patients with skin of color presenting with facial erythema, papules, and pustules. 

Certain subtypes of rosacea can be more difficult to recognize in pigmented skin types. To avoid delayed diagnosis, clinicians should carefully examine patients who present with erythema, papules, and pustules. Concentrated lighting, blanching of the skin, and dermoscopy may support accurate diagnosis during examination.

Statement 4: The role of skincare in rosacea treatment is poorly studied. Quality moisturizers may improve symptoms when used in tandem with other therapies. Certain skin cleansers may not be suitable for patients with rosacea.

The overall treatment approach in skin of color is similar to that for lighter skin, comprising anti-demodex, anti-inflammatory, and anti-angiogenesis modalities. Certain high-quality moisturizers may repair skin barrier function, enhance hydration, and reduce irritation. By contrast, certain cleansers—particularly those with harsh surfactants—may trigger or worsen rosacea. The role of skincare in rosacea requires further study, particularly in patients of color.

Statement 5: Patients should be educated on the best ways to mitigate their rosacea.

Clinicians should educate patients on the importance of avoiding rosacea triggers, using gentle cleansers, avoiding skincare products with elevated pH, avoiding excessive cleansing and moisturizing, using quality moisturizers, choosing skincare products carefully, and using mineral sun protection. Educating patients on known rosacea triggers is associated with improved rosacea outcomes across various studies.

Conclusions: Although there are limited data on the diagnosis and treatment of rosacea in skin of color, experts agree that the disorder is not rare. Clinicians should carefully assess patients who present with redness, irritation, and a self-reported history of “sensitive skin.” Once diagnosed, patients should be consulted on the appropriate use of skincare products and means of avoiding triggers.

“Increasing [skin of color (SOC)] subjects in clinical trials and increasing resident/physician dermatology education on rosacea in SOC are two critical steps towards increasing awareness of rosacea in SOC,” investigators concluded.

Disclosure: This research was supported by Cerave International. Please see the original reference for a full list of disclosures

Reference

Alexis A, Woolery-Lloyd H, Andriessen A, Desai S, Han G, Rodriguez D. Improving rosacea outcomes in skin of color patients: a review on the nuances in the treatment and the use of cleansers and moisturizers. J Drugs Dermatol. 2022;21(6):574-580. doi: 10.36849/JDD.6838.