The multifaceted, waxing and waning nature of rosacea requires physicians to be able to distinguish its many manifestations from those of similar conditions, according to a recent review.1
“The typical patient suffering with rosacea has been stereotyped as a 30- to 60-year old white woman of Northern European ancestry who gets red-faced while drinking alcohol and often has pimples on her cheeks,” says lead author Sandra Marchese Johnson, M.D. She is a Fort Smith, Arkansas-based board-certified dermatologist in private practice.
“We now know not everyone is typical.” Modern textbooks reflect a more nuanced understanding, says Dr. Johnson; although, perhaps not all dermatologists are reading them.
Rosacea is common and affects up to 10% of the population; however, its true prevalence is unknown, she says, because the condition is often underdiagnosed. Dr. Johnson says in her clinical experience, rosacea is most underdiagnosed in darker skin types because it is more difficult to appreciate erythema or telangiectasias.
Darker-skinned patients may have a lower genetic propensity for rosacea, write Johnson et al., and/or melanin may protect against ultraviolet light as a rosacea trigger. Whatever the reasons, say Alexis et al. in a separate publication, rosacea in Fitzpatrick types IV to VI often presents in women previously misdiagnosed with late-onset acne.2 In diagnosing such patients, Alexis et al. suggest focusing on history of exacerbating factors, sensitivity to topical products, episodic facial flushing and ocular symptoms. Rosacea’s complexity also contributes to underdiagnosis, as does the fact that symptoms often occur transiently and independently. The four main presentations of rosacea can overlap, adds Dr. Johnson.
Dr. Johnson is or has been a consultant, speaker and investigator for Galderma.
1. Johnson SM, Berg A, Barr C. Recognizing rosacea: tips on differential diagnosis. J Drugs Dermatol. 2019;18:888-894.
2. Alexis AF. Rosacea in patients with skin of color: uncommon but not rare. Cutis. 2010;86:60-62.
3. Gold LS, Papp K, Lynde C, et al. Treatment of rosacea with concomitant use of topical ivermectin 1% cream and brimonidine 0.33% gel: a randomized, vehicle-controlled study. J Drugs Dermatol. 2017;16:909-916.
4. Webster G, Schaller M, Tan J, et al. Defining treatment success in rosacea as “clear” may provide multiple patient benefits: results of a pooled analysis. J Der- matol Treat. 2017;28:469-474.