Rosacea might be underdetected and often misdiagnosed in skin of color patients, according to Plano, Texas, dermatologist Seemal R. Desai, M.D., FAAD, immediate past president of the Skin of Color Society and author of a review and clinical practice experience on rosacea in skin of color published June 2019 in the Journal of the American Academy of Dermatology.
Misdiagnoses could result in inappropriate and inadequate treatment. Delays in the diagnosis could result in greater morbidity and uncontrolled, progressive disease with disfiguring consequences, including phymatous rosacea, the authors report.
Dr. Desai says it’s important to increase dermatologists’ awareness of how rosacea might present differently in skin of color and how best to treat it without causing post-inflammatory hyperpigmentation or other sequelae.
“I think the thing to think about with rosacea in skin of color is recognizing that erythema may look different. It may look brown. It may have a more brownish, purplish color,” Dr. Desai tells Dermatology Times.
MAKING THE DIAGNOSIS
Among the clinical characteristics of rosacea in skin of color: Patients often have experienced symptoms for longer than a year; women are more likely to present with rosacea symptoms; and papules and pustules are usually present — more commonly so than persistent facial erythema, the review authors write.
“Patients with skin of color may not know they have rosacea because they have not been able to appreciate the redness on their skin but may have symptoms of burning, stinging and flushing,” Dr. Desai says. “It’s important to really frame that dialogue and have that discussion.”
Allergan funded the research. Dr. Desai has served as a consultant and investigator for Allergan, but reports he has no conflicts of interest in relation to this specific article.
Alexis AF, Callender VD, Baldwin HE, Desai SR, Rendon MI, Taylor SC. Global epidemiology and clinical spectrum of rosacea, highlighting skin of color: Review and clinical practice experience. J Am Acad Dermatol. 2019;80(6):1722-1729.e7.