Rosacea more common than expected among patients with skin of color

Rosacea is more common among patients with skin of color than may be expected, and skin care regimens such as prescription medicine, cleansers or sunscreen showed potential for improvement in symptoms, according to a study.

“The clinical presentation of rosacea across diverse skin types varies widely, and clinical features may be less conspicuous in individuals with richly pigmented skin,” Andrew F. Alexis, MD, MPH, of Weill Cornell Medical College in New York, and colleagues wrote in the Journal of Drugs in Dermatology.

The researchers gathered a panel to review literature and discuss aspects of rosacea in patients with skin of color (SOC) as well as viable treatment options. Between study data and anecdotal clinical experience, the panel agreed on the inclusion and wording of five statements.

Statement 1: Although data are limited, studies and anecdotal clinical experience suggest that rosacea is more common in individuals with darker skin than previously reported.

The researchers noted that data on non-white patients with rosacea is limited. Many of the studies they found had small populations in general or particularly limited representation of patients with SOC.

Statement 2: A history of “skin sensitivity” (eg, burning, stinging from many over-the-counter skin care products) should raise suspicion for diagnosing rosacea in SOC patients.

“Classification of rosacea comprises a patient-focused phenotype approach reflecting the myriad clinical presentations of rosacea patients,” the researchers wrote.

Statement 3: To avoid underdiagnosis of rosacea in SOC patients, dermatologists should also have a high index of suspicion of rosacea in SOC patients presenting with facial erythema, papules and pustules.

“The use of suitable lighting, blanching of the skin, photography of the area against a dark blue background and dermatoscopy may support accurate diagnosis,” the researchers wrote.

Statement 4: Quality moisturizers may repair or maintain stratum corneum or barrier function, enhance skin hydration, reduce the likelihood of skin irritation and can be used as adjuvants to other rosacea therapies. The use of some cleaners may not be suitable for rosacea patients. Combining appropriate skin care with prescription medications may improve rosacea management; however, skin care’s role and beneficial ingredients for rosacea are not well defined and require more studies.

Statement 5: Educate SOC patients with rosacea on the importance of:

avoidance of triggers;

using gentle cleaners;

avoiding skin care products with elevated pH;

avoiding excessive cleaning and exfoliating;

frequent use of quality moisturizers;

choosing skin care that promotes a healthy barrier; and

using mineral sun protection with SPF 30 or higher.

“There are limited data in SOC, but the condition is not rare in this population,” Alexis and colleagues wrote. “In addition, history of skin sensitivity should raise the index of suspicion of rosacea in SOC populations.”