Underdiagnosed Rosacea Common Among Patients of Color

Patients with darker skin tones have lower rates of being diagnosed with rosacea than white patients even though they’re just as susceptible to developing the skin condition, according to a study recently published in the Journal of the American Academy of Dermatology.

Lead study author Andrew F. Alexis, MD, MPH, chair of the department of dermatology at Mount Sinai Beth Israel, explains that rosacea might be underreported and underdiagnosed among patients of color, and that statistics contradict low diagnosis rates. One recent U.S. medical care survey determined that 3.9 percent of Latino patients presented positive symptoms for rosacea, along with 2.3 percent of Asian or Pacific Islander patients, and 2 percent of black patients.

The disparity in diagnosis could be due to the fact that it’s challenging to detect erythema (skin inflammation), telangiectasia (dilated blood vessels that appear as tiny red lines), and the assumption that people with more melanin in their skin are less vulnerable to sun exposure.

The authors point out that ignoring a possible rosacea diagnosis in patients of color could increase their risk of developing ocular disease, loss of vision, and disfigurement with disease progression. They list some factors that should be taken into consideration when evaluating a patient with darker skin color for rosacea, such as noting that postinflammatory hyperpigmentation, a common condition in patients of color, could mask erythema.

“Patients with skin of color may have unique clinical features that need to be addressed during the treatment of rosacea, such as post-inflammatory pigment alteration or risk of developing this complication with laser/light-based therapies,” the authors wrote.