Skin of Color: Rosacea

While often considered a problem in white skin, rosacea is also a common concern in skin of color patients.

The clinical signs of rosacea are often hard to diagnose in Fitzpatrick skin types III-VI, and are often not associated with clinical signs and symptoms of flushing or telangiectasias. Trigger factors associated with rosacea flares – hot beverages, spicy foods, caffeine, alcoholic drinks, heat, and exercise – are often completely absent in skin of color.

Rosacea occurs mainly on the central malar cheeks, forehead, chin, and nose.  Erythema and red/brown papules are common and are often confused with acne. As the condition progresses, the skin becomes persistently red and can feel uneven or even thicker. Hyper or hypopigmentation may develop in areas with inflammation. Perioral or periorficial papules, a form of rosacea commonly seen in skin of color, is also often misdiagnosed.

It has been my experience that rosacea in skin of color is often refractory to traditional topical medications and patients will often need a short course of oral antibiotics. Sulfur/sodium sulfacetamide topicals, in addition to azelaic acid, are a great adjunct to oral treatment. Topical steroids may initially improve symptoms, but will actually make the disease progress when the steroids are stopped, so they should be avoided. Strict photo protection should be encouraged.

For years, the cause of rosacea was unknown. However a team of researchers, led by Dr. Richard L. Gallo, chief of dermatology and professor of medicine and pediatrics at the University of California San Diego, found that overproduction of two interactive inflammatory proteins results in excessive levels of a third protein that cause rosacea symptoms. His team found skin antimicrobial peptides, cathelicidins, were altered and overproduced in patients with rosacea (Nat. Med. 2007;13:975-80).

Approximately 14 million people in the United States have rosacea. Early diagnosis and management with combination oral and topical medications are effective at controlling this highly prevalent yet often misdiagnosed disease. Future research into the underlying cause of rosacea will offer targeted therapies aimed at the abnormally processed antimicrobial peptides present in the skin of rosacea patients.

While often considered a problem in white skin, rosacea is also a common concern in skin of color patients.

The clinical signs of rosacea are often hard to diagnose in Fitzpatrick skin types III-VI, and are often not associated with clinical signs and symptoms of flushing or telangiectasias. Trigger factors associated with rosacea flares – hot beverages, spicy foods, caffeine, alcoholic drinks, heat, and exercise – are often completely absent in skin of color.

Rosacea occurs mainly on the central malar cheeks, forehead, chin, and nose.  Erythema and red/brown papules are common and are often confused with acne. As the condition progresses, the skin becomes persistently red and can feel uneven or even thicker. Hyper or hypopigmentation may develop in areas with inflammation. Perioral or periorficial papules, a form of rosacea commonly seen in skin of color, is also often misdiagnosed.

It has been my experience that rosacea in skin of color is often refractory to traditional topical medications and patients will often need a short course of oral antibiotics. Sulfur/sodium sulfacetamide topicals, in addition to azelaic acid, are a great adjunct to oral treatment. Topical steroids may initially improve symptoms, but will actually make the disease progress when the steroids are stopped, so they should be avoided. Strict photo protection should be encouraged.

For years, the cause of rosacea was unknown. However a team of researchers, led by Dr. Richard L. Gallo, chief of dermatology and professor of medicine and pediatrics at the University of California San Diego, found that overproduction of two interactive inflammatory proteins results in excessive levels of a third protein that cause rosacea symptoms. His team found skin antimicrobial peptides, cathelicidins, were altered and overproduced in patients with rosacea (Nat. Med. 2007;13:975-80).

Approximately 14 million people in the United States have rosacea. Early diagnosis and management with combination oral and topical medications are effective at controlling this highly prevalent yet often misdiagnosed disease. Future research into the underlying cause of rosacea will offer targeted therapies aimed at the abnormally processed antimicrobial peptides present in the skin of rosacea patients.

While often considered a problem in white skin, rosacea is also a common concern in skin of color patients.

The clinical signs of rosacea are often hard to diagnose in Fitzpatrick skin types III-VI, and are often not associated with clinical signs and symptoms of flushing or telangiectasias. Trigger factors associated with rosacea flares – hot beverages, spicy foods, caffeine, alcoholic drinks, heat, and exercise – are often completely absent in skin of color.

Rosacea occurs mainly on the central malar cheeks, forehead, chin, and nose.  Erythema and red/brown papules are common and are often confused with acne. As the condition progresses, the skin becomes persistently red and can feel uneven or even thicker. Hyper or hypopigmentation may develop in areas with inflammation. Perioral or periorficial papules, a form of rosacea commonly seen in skin of color, is also often misdiagnosed.

It has been my experience that rosacea in skin of color is often refractory to traditional topical medications and patients will often need a short course of oral antibiotics. Sulfur/sodium sulfacetamide topicals, in addition to azelaic acid, are a great adjunct to oral treatment. Topical steroids may initially improve symptoms, but will actually make the disease progress when the steroids are stopped, so they should be avoided. Strict photo protection should be encouraged.

For years, the cause of rosacea was unknown. However a team of researchers, led by Dr. Richard L. Gallo, chief of dermatology and professor of medicine and pediatrics at the University of California San Diego, found that overproduction of two interactive inflammatory proteins results in excessive levels of a third protein that cause rosacea symptoms. His team found skin antimicrobial peptides, cathelicidins, were altered and overproduced in patients with rosacea (Nat. Med. 2007;13:975-80).

Approximately 14 million people in the United States have rosacea. Early diagnosis and management with combination oral and topical medications are effective at controlling this highly prevalent yet often misdiagnosed disease. Future research into the underlying cause of rosacea will offer targeted therapies aimed at the abnormally processed antimicrobial peptides present in the skin of rosacea patients.