Rosacea: The Truth Behind It

By Dr. Hope Mitchell, MD, FAAD
close up of female face depicting rosacea on cheek

According to the U.S. government, more than 14 million people are living with rosacea. Although this chronic skin condition most commonly affects fair-skinned, blonde hair and blue-eyed individuals, rosacea can affect anyone, including people with darker skin tones. Rosacea is actually more prevalent than you might think in people with darker skin and interestingly, it is reported with estimates as high as 40 million in this population worldwide1. Unfortunately, rosacea is often viewed as an afterthought to other skin conditions like allergic reactions, seborrheic dermatitis, nodulocystic acne, or lupus. Misdiagnosis or delayed diagnosis negatively impacts prognosis as signs and symptoms will worsen if the condition is not properly treated.

Difficulty in detecting rosacea characteristics in darker skin tones may lead to its late diagnosis or underdiagnosis. Rosacea often begins with redness, flushing, or blushing in the central face that is easily detected on lighter skin tones - signs that are difficult to recognize in darker skin. The redness in people with darker skin may look dry, reddish brown, dusky, or grayish purple in appearance. Since people with darker skin tones are more likely to receive a later diagnosis, the skin findings may be more advanced than persistent facial redness and also include post-inflammatory hyperpigmentation, perioral and periocular hard bumps, thickened skin texture and firm, hyperpigmented, acne breakouts that won’t clear with traditional acne medications.

Over time people can develop permanent redness of the nose and cheeks, as well as dilated blood vessels and dry, flaky skin that burns and stings with the application of skincare products. Rosacea may also affect the eyes, causing swollen eyelids, crusty eyes, or dry, itchy, or watery eyes that burn or sting.

What really are the reasons behind the misdiagnosis of rosacea in darker skin?

Certain signs of rosacea in individuals with darker skin (like Black skin for example), may bear a striking resemblance to other dermatological conditions, such as acne. Also, there is a lower public awareness of the risk of rosacea in Black people and a lower index of suspicion for rosacea in Black people from healthcare providers. This may cause incorrect diagnoses and inappropriate treatment.

With treatment, rosacea can be prevented from worsening and is the same for darker skin as for lighter skin

Rosacea signs and symptoms are likely to wax and wane, therefore, it is important to establish a consistent gentle skincare regimen that is fragrance-free, made for “sensitive skin” and incorporates sunscreen with an SPF of 30-50. Identify triggers through journaling activities that seem to flare the condition and take steps to avoid those triggers.

Why Seek Out a Board-Certified Dermatologist?

Good news! Although not curable, rosacea is manageable under the care of a board-certified dermatologist and it is possible to live a fulfilling life with this condition. Your dermatologist may add to your regimen - medical prescriptions and procedures such as chemical peels or laser treatment to help improve your rosacea. To find a dermatologist who can help manage your rosacea, use the Vaseline x Hued Find A Dermatologist tool.