Tips for Improving Rosacea Recognition in Patients With Skin of Color at Elevate-Derm

Addressing issues in recognizing rosacea in patients with skin of color continues to be an important topic, Hilary Baldwin, MD, told attendees of the 2025 Elevate-Derm Fall Conference.^1,2 Baldwin, who runs the Acne Treatment and Research Center in Brooklyn, New York, emphasized the diagnostic and treatment considerations for this patient population in her talk. “This is a specific issue, not so much because treatment is different or because lesion morphology is different, but because we simply are not recognizing the entity,” Baldwin told Dermatology Times.

Diagnostic Barriers Stem From Underrecognized Visual Cues

Erythema, one of the earliest signs of rosacea, is often less obvious in darker skin tones, Baldwin said. Similarly, recognizing telangiectasias can be harder to appreciate in darker skin tones without additional tools. Because of these factors, Baldwin encourages clinicians to “keep a high index of suspicion so that we recognize when our patients actually have rosacea.”

In many cases, aside from obviously papules and phyma, symptoms rather than visible findings offer the clearest clues to diagnosis, she added. Baldwin recommends asking about sensations such as “itch, burn, sting, maybe some feeling of warmth in the skin that perhaps is episodic” that are indicative of a potential diagnosis.

Baldwin outlined several practical strategies to enhance recognition. For instance, using a glass slide for compression could help clinicians better appreciate subtle erythema by blanching surrounding vessels. Dermoscopy also allows improved visualization of telangiectasias. Ultimately, she emphasized the importance of clinical vigilance: “A diagnosis not considered is a diagnosis not made.”

Treatment Principles Align, With Key Caution for Irritation

Once diagnosed, Baldwin noted that therapeutic approaches for rosacea in patients with skin of color were “exactly the same as for lighter skinned individuals,” with one important exception. She cautioned that clinicians should avoid excessive irritation from topical agents, as this could lead to iatrogenic postinflammatory hyperpigmentation. “We need to be a little bit more gentle,” she said in the interview.

For that reason, Baldwin favors the newest branded products for the topical treatment of rosacea. When systemic therapy was needed, she turns to options such as modified-release doxycycline, low-dose minocycline, or low dose isotretinoin, which she described as very helpful for papules and pustules.

Baldwin underscored that improved diagnostic awareness could significantly enhance outcomes for patients whose rosacea might otherwise go unrecognized.

References

1. Baldwin H. Diagnosing & Managing Rosacea in Patients with Skin of Color. Presented at the 2025 Elevate-Derm Fall Conference; November 12-16, 2025; Tampa, Florida.

2. Lim HW, Zhang C, Taylor M, Dlova NC, Conceição K, Jablonski N, Gupta N, Wangari-Olivero J, Alexis A. International Expert Consensus on Knowledge Gaps in Care for Dermatologic Disorders in Skin of Color. Int J Dermatol. 2025 Nov 6. doi: 10.1111/ijd.70101. Epub ahead of print. PMID: 41195756.