Rosacea Review - Newsletter of the National Rosacea SocietyRosacea Review - Newsletter of the National Rosacea Society

Underdiagnosis of Rosacea Common in Skin of Color

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 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 in skin of color 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, darker skinned patients should 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 may be the main signs of rosacea’s early presence.

Alexis AF, Callender VD, Baldwin HE, et al. Global epidemiology and clinical spectrum of rosacea, highlighting skin of color: Review and clinical practice experience. J Am Acad Dermatol 2018 Sep 19. doi: 10.1016/j.jaad.2018.08.049. [Epub ahead of print]