Symptoms, not signs, may aid in diagnosis of rosacea in patients with skin of color
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Key takeaways:
- Rosacea symptoms in patients with skin of color include stinging, burning, pruritus and more.
- Appropriate treatments include ivermectin cream 1%, minocycline 1.5% foam and microencapsulated benzoyl peroxide 5%.
NEW YORK — Signs of rosacea may be different in patients with darker skin types, but the symptoms remain the same, according to a presentation here.
Hilary E. Baldwin, MD, medical director at the Acne Treatment & Research Center and clinical associate professor at Rutgers Robert Wood Johnson Medical Center, opened her presentation on rosacea at the Skin of Color Update 2023 meeting with a slide of the epidemiology of the disease in the United States.
“Everything on this slide is wrong,” Baldwin said.
“The precise epidemiology is clearly unknown,” she continued. “We say about 10% of people have rosacea adding up to about 16 million people in the U.S., but that doesn’t include any patients with skin of color.”
According to the 1993 to 2010 U.S. National Ambulatory Medical Care Survey, which was referenced in another poster presentation here at the conference, 2% of rosacea patients are Black, 2.3% are Pacific Islander and 3.9% are Hispanic or Latino, making a global prevalence of about 40 million. While rosacea is not uncommon among patients with skin of color, these patients remain highly underdiagnosed.
So, the question remains, why is rosacea significantly underdiagnosed among patients with skin of color and what can practitioners do about it?
Signs of the disease, such as flushing and telangiectasia, are often difficult to spot in patients with darker skin types, resulting in this underdiagnosis crisis. However, the symptoms are still present.
“Symptoms may be a better way to make the diagnosis than signs of the disease,” Baldwin said.
According to Baldwin, symptoms in patients with skin of color may include stinging, burning, pruritus, a warm sensation that may be episodic, painful eyes and sensitivity to skin products. Additionally, 72% of patients with skin of color report that the sun worsens their symptoms, like other populations.
After diagnosing the patient, Baldwin encourages dermatologists to specifically ask their patients which symptoms are the most bothersome in order to proceed with treatment options.
“When choosing a treatment for a patient with skin of color, you must avoid using drugs that induce irritation and hyperpigmentation,” Baldwin said.
According to Baldwin, the treatments with the best efficacy and tolerability data that can be used for patients with skin of color are ivermectin cream 1%, minocycline 1.5% foam and microencapsulated benzoyl peroxide 5%.