“Symptoms of burning, stinging, erythema, papules and pustules negatively impact patient quality of life, and patients may suffer needlessly,” says Dr. Taylor.
Undiagnosed rosacea moreover may progress to disfiguring rhinophyma. Likewise, the fact that the granulomatous variant of rosacea has been predominantly reported in black patients may stem from increased susceptibility in these patients.3
To highlight erythema and telangectasias in SOC, Taylor et al. recommend using adequate lighting, skin blanching and dermatoscopy.
“When you apply pressure to the skin with a slide or dermatoscope,” explains Dr. Taylor, “the blood will drain from the skin, and the skinappears white beneath the slide or dermatoscope. Then when you release the pressure, the blood comes back into the skin, and you can then appreciate the redness.”
Similarly, photographing the affected area against a dark blue background provides a contrast that makes identifying redness easier, she adds.
In the differential diagnosis of rosacea, systemic lupus erythematosus (SLE) occurs particularly more commonly in SOC, Dr. Taylor says. The malar or butterfly rash of SLE can appear similar to rosacea, but the malar rash typically spares the nasolabial folds, while rosacea does not. Conversely, papules and pustules rarely occur in SLE.
Dr. Taylor has been an investigator, speaker and advisory board member for Aclaris (maker ofoxymetazoline) and an advisory board member for Galderma (maker of brimonidine).
1. Onalaja AA, Lester JC, Taylor SC. Establishing the diagnosis of rosacea in skin of color patients. Cutis. 2019;104:38-41.
2. Alexis AF. Rosacea in patients with skin of color: uncommon but not rare. Cutis. 2010;86:60-62.
3. Dlova NC, Mosam A. Rosacea in black South Africans with skin phototypes V and VI. Clin Exp Dermatol. 2017;42:670-673.