Why is rosacea in skin of colour mismanaged?
Rosacea can be difficult to diagnose in skin of colour (SOC) or deeply pigmented skin, the reason for this is the widely recognised symptoms of ‘flushing’ or ‘redness’ look different in pigmented skin. There has been a lot of attention paid recently to how SOC is represented (or the lack of representation) in medical textbooks and traditional teaching materials, highlighting lack of experience in this area. Although rosacea is reported more often in northern European skin, it is not uncommon in SOC and in fact may be under-reported, meaning it does exist!
What symptoms present in SOC with rosacea?
SOC will not look ‘red’ or ‘flushed’, it is more likely to look dusky or have a violet tone in deeply pigmented skin. Discoloration may develop in areas of inflammation.
If rosacea is diagnosed later or with more severe symptoms there is a higher chance that there will be added issues like hyperpigmentation or changes to skin texture.
Skin can feel ‘swollen’ or ‘thick’, it may differ in texture from unaffected areas
Skin-coloured or yellow/brown bumps
Sensitive skin (e.g., reacts easily to skincare products)
Feelings of burning, stinging or hot/warm skin
Feeling of dryness or oiliness in the skin
Pus-filled spots/pimples (acne-like breakouts)
What are the recommended treatments for rosacea in SOC?
Although there are some differences in the signs of rosacea in SOC, the treatments are largely similar. Management of rosacea is complex, it is usually a combination of medical, skincare, lifestyle and psychological management:
- Antibiotic creams – reduce inflammation
- Antiparasitic creams – act against the demodex mite and reduce inflammation
- Azelaic acid – reduces redness and inflammation
- Oral antibiotics – used at low doses as an anti-inflammatory
- Consider using short-term treatments like Mirvaso gel (prescribed by your GP or dermatologist) to control redness and flushing (e.g. before a social occasion or in pressurised situations)
- If the above do not lead to improvement, low dose oral retinoids are a long-term option
It is also important to incorporate good skin care. This typically includes gentle cleansers to wash the face, physical UV protection (be aware this can leave a white cast and make skin tone look ashy) and light moisturisers.
Image by Kone Kassoum