Rosacea in Patients with Skin of Color: Diagnosis and Management

Rosacea is a chronic central face dermatosis caused by a combination of dysregulated innate and adaptive immunity and hyperreactive cutaneous neurovasculature. Although classically associated with lighter skin phototypes, rosacea may affect up to 2-4% of Black, Asian, Pacific Islander, and Hispanic/Latino American populations and its prevalence is likely underestimated given our current diagnostic reliance on phenotypic expression (e.g., fixed erythema with or without intermittent exacerbations, flushing, and/or telangiectasias) that may be difficult to appreciate in more heavily pigmented skin. In patients with richly pigmented skin, a careful history of symptoms to assess the minor/secondary criteria (i.e., burning or stinging, edema, dryness, flushing, low tolerance for over-the-counter products, symptoms with classic 'triggers', family history and/or ocular symptoms), along with patient participation during the physical exam to establish their baseline skin tone, may facilitate diagnosis. Rosacea treatment regimens are centered around presentation and can include over-the-counter agents, lifestyle modifications, prescription topical, systemic, and procedural therapies. Optimal regimens may be tailored to best address patient-perceived disease severity and concerns and to minimize any further irritation/inflammation which may drive pigmentary alteration.