It’s National Rosacea Month, and as anyone with the condition knows, it can be at best uncomfortable and at worst completely debilitating. But for as many studies as there are on the inflammatory disease and its side effects (like redness, itching, and texture issues), there is a glaring lack of understanding about rosacea on Black and brown skin, often resulting in it being under-diagnosed or completely missed. According to the Journal of American Academy of Dermatology, up to 40 million people of color struggle with rosacea. If this is the case, then why is rosacea so frequently missed on darker complexions — and what needs to happen to help these patients get the proper care?
While the exact cause of rosacea is still unknown, it is defined as a skin condition that presents as redness and visible blood vessels in the skin. “Flushed cheeks is followed by a constant warm, tingling sensation, which then develops into permanent redness around the cheeks and nose,” Dr. Ewoma Ukeleghe, founder & CEO of SKNDOCTOR, tells TZR. “Other symptoms are dilated blood vessels, dryness, spots, and sensitivity.” She explains that while it is more common in women, rosacea symptoms are often more severe in male patients, and can be exacerbated by triggers like stress, heat, alcohol, sunlight, spicy food, and wind.
According to Dija Ayodele, founder of Westroom Aesthetics and Black Skin Directory, “When rosacea is apparent in the skin, the blood vessels dilate and the oil glands become inflamed, hot, and flushed. The lighter you are, the more the blood vessels will be visible. The inflammation of the oil glands causes spots and papules, and it can also cause thickening and swelling of the skin, notably around the nose and the cheeks.” But while some of these symptoms are universal, regardless of skin color, the most obvious sign of rosacea — the tell-tale redness — does not present the same way on darker skin tones.
Why The Rosacea Misdiagnosis?
Since rosacea is easy to spot on lighter skin tones (at least when it comes to the redness in the skin), it stands to reason that having a darker skin tone would affect the inflammation’s appearance and color. Ayodele explains that, “Due to the dark tone of Black skin, this does not always show as significantly, if at all. In Black skin, some types of rosacea can often look remarkably like other skin conditions such as acne. This can lead to confusion and misdiagnosis and incorrect treatment.”
Dr. Ahmed continues, explaining that, “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 also feel 'swollen' or 'thick' and it may differ in texture from unaffected areas as well as skin-colored or yellow/brown bumps.”
Currently, there is a notable absence of imagery and studies on Black and brown skin in dermatology textbooks and publications, which means that medical professionals do not have the tools they need to care for their patients of color — plus, the next generation of doctors will not be armed with everything required to properly diagnose skin conditions on a range of skin tones.
There is also the worry that as dermatology continues to adopt AI technology, misdiagnoses will increase because the machines that are learning the algorithms are trained using images that are predominately of lighter-skinned patients. Clearly, the medical community has a long way to go to ensure that Black and brown people receive the same standard of care for rosacea (and many other dermatological diseases).
How To Spot Rosacea On Black Skin
So, if rosacea’s appearance on the skin is harder to spot due to the difference in pigmentation, what are the signs or symptoms medical professionals should look out for in order to properly diagnose? Dr Alia Ahmed, dermatologist at GetHarley shares with TZR, “Some symptoms are similar such as sensitive skin, stinging, dryness and/or oiliness. However, in skin of color, the complexion will not look 'red' or 'flushed'. It is more likely to look dusky or have a violet tone in deeply pigmented skin, and discoloration may develop in areas of inflammation.”
Whether or not you think you may have rosacea, it’s important to consult a dermatologist before trying out any new product regimen to treat irritation. To note: there is no definitive cure for rosacea, and treatment involves the complex management between skin care (both prescription and over-the-counter), and lifestyle adjustments. However, with the correct medical guidance, your symptoms (and overall quality of life) can improve.
How To Soothe The Skin From Rosacea
Once you visit your dermatologist to confirm that you do in fact have rosacea, managing it can involve some trial and error to find the best products that work for your skin.
To start, Dr. Ewoma recommends a soothing and moisturizing skin care routine as “it’s important to use active [ingredients] which work to repair your skin’s barrier.” She suggests looking for products that contain amino acids, which can help soothe, protect, and moisturize irritated skin, while also rebuilding some of the damage. “Look out for soothing anti-inflammatory ingredients like aloe vera, and antioxidants like niacinamide to repair the skin post-flare-up and improve appearance,” she says. “For moisturizers, I’ve found silicone-based ones to be effective [for soothing rosacea]. In terms of SPF, physical sunscreens are less irritating than chemical ones.”
Dija also stresses the importance of adequate skin hydration for rosacea patients, explaining that “using hydrating ingredients such as hyaluronic acid alongside gentle exfoliating ingredients, such as poly hydroxy acids [like] gluconolactone, lactobionic, and maltobionic acids, will help to reduce inflammation, dehydration, and discomfort in the skin.” She also recommends ingredients like niacinamide, ceramides, peptides, and zinc, all of which can soothe and strengthen the skin.
While establishing a consistent and gentle skin care routine can benefit rosacea symptoms, TZR’s experts also said that some cases may need in-clinic treatments such as LED light therapy to strengthen and rejuvenate the skin. Your medical professional will be able to speak to those options during your consultation. As for prescription topicals, Dr. Ahmed says, “Antibiotic creams or oral antibiotics are ideal for reducing inflammation whilst short term treatments such as Mirvaso gel can control redness and flushing.”
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