Dr. Alexis will also often use combination therapies to target as many pathogenic factors of acne at once, as well as to address hyperpigmentation. This could be a topical retinoid and topical BPO/clindamycin formulation, with or without an oral antibiotic, depending on the severity of symptoms. Adjunctive use of superficial chemical peels and bleaching agents can be considered for more severe cases.
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Patients with skin of color generally have a lower awareness of rosacea being a possibility, as most information suggests that one would expect to see rosacea in people of Northern European ancestry with fair skin. The perception that rosacea does not affect darker skin types is simply untrue, Dr. Alexis says. Rosacea in patients with skin of color can often be difficult to diagnose and may be under-recognized due to the challenges in detecting the erythema.
Patients will usually suspect that they have acne but upon closer inspection, one sees an absence of comedones and maybe some degree of erythema. The distribution of the papules and pustules is typical for rosacea on the central medial cheeks on the face and forehead, and the patients usually report the usual triggers for rosacea for flares.
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“Clinicians should be wary to have an index of suspicion for rosacea even in darker skin patients because it is under recognized. In addition, the history can be helpful as well as a close inspection for the characteristic signs for rosacea will help home in on the accurate diagnosis,” Dr. Alexis says.
Disclosure: Dr. Alexis reports no relevant disclosures.