Why Rosacea is Misdiagnosed in Black Patients

Diagnosing & Treating Rosacea on Black Skin

Rosacea is famously difficult to diagnose, but in people of color rosacea can be even more problematic to identify.  While many physicians have little experience with darker skin, Dr. Ali has been helping patients with melanin-rich skin receive the best diagnoses and most advanced and appropriate skincare treatments for more than 3 decades.

In this article he discusses the challenges of treating rosacea in Black and brown skin.

What is Rosacea?

Rosacea is a puzzling skin condition that causes chronic flareups of inflammation in more than 14 million people in the U.S. Yet medical science still does not understand completely what cause rosacea. Misinformation about rosacea is also constantly disseminated, making it even harder to treat properly.  And myths about rosacea include untruths such as “it’s just blushing,” “it’s an allergic reaction,” or “only white people get rosacea”.

But the truth is the symptoms of rosacea are the same, regardless of skin color or ethnicity. Although its characteristic redness may be harder to see on brown or Black skin.

Rosacea is an inflammatory condition most commonly seen on the cheeks and nose, that consists of tiny broken blood vessels.  Other rosacea symptoms include skin sensitivity, swelling, and changes in skin texture.

Why Rosacea is Misdiagnosed in Black Patients

On light or Caucasian skin, rosacea is characterized by a very red appearance (medically call erythema) – hence its descriptive name “rosacea”. But the flushing of rosacea can present as a violet, purple, or even a dusky brown hue on Black skin. This is because the melanin in dark skin tends to mask the redness. As a result, more subtle appearing rosacea often gets missed or and misdiagnosed on Black patients.

And in medical textbooks, the majority of the images for rosacea only show it on lighter skin – further perpetuating confusion about its prevalence on Black individuals.

Additionally, rosacea often presents differently on different people. Some patients just have redness while other shave pustules. So, some types of rosacea can look extremely similar to other skin conditions, especially acne. Especially in darker-skinned individuals, rosacea often appears as inflamed bumps and pus-filled pimples – leading to the incorrect diagnosis and improper treatment.

For example, if someone with rosacea is diagnosed with acne, powerful retinoids, salicylic acid and benzoyl peroxide may be prescribed. And while these treatments can improve acne breakouts, they can easily make rosacea-prone skin worse.

Diagnosing Rosacea on Black Skin

When clinically diagnosing rosacea on dark skin, a thorough physical examination of clean bare skin needs to be conducted in high light. The eyes can also be a clue to rosacea, as rosacea can gradually affect the eyes, leaving them itchy, dry, or watery.

It is essential to diagnose rosacea on black skin as early as possible because if diagnosed later, there is a higher chance of additional complications such as hyperpigmentation or thickening of the skin on the nose. Late diagnosis can also lead to issues with vision.

Treating Rosacea on Black Skin

Regardless of the patient’s skin color, there is no definitive cure for rosacea. Symptoms tend to come and go. And rosacea treatment involves combining skin care, medications, and lifestyle adjustments (such as avoiding certain known triggers).  But the good news is that rosacea is manageable in people of all skin tones and colors under a specialized doctor’s care.

Skin Care Products for Black Rosacea Patients

A skin care regimen incorporating hydrating and replenishing ingredients such as niacinamide, hyaluronic acid, and ceramides can help restore the skin’s compromised barrier – while avoiding abrasive scrubs and over-cleansing. Daily application of an SPF 30 or higher is important, too.

These products should be medically developed clinical grade products like those offered in our office by EltaMD and in our online stores by Zo Skin Health and Alastin. EltaMD Barrier Renewal Complex, Alastin HydraTint Pro Mineral Broad Spectrum Sunscreen SPF 36 and Zo Skin Health Rozatrol® are a few of the products we offer our rosacea patients. We can help you determine the right skincare products during your consultation.

In Office Treatments for Black Rosacea Patients

Carefully selected in-office treatments can also reduce the inflammation and pustules of rosacea. However, treatments for Black patients must be carefully chosen – because not all treatments are safe for melanin-rich skin.

For example, Fraxel laser can be used to reduce rosacea flareups in light skinned patients – but are not safe for darker skin tones. Lasers like Fraxel and CO2 can be dangerous for dark skin because they are “ablative” (take off the top layer of skin) which can result in permanent hyperpigmentation when used on darker complexions.

However, at AMAE in the Detroit area we offer non-ablative treatments that are safe for darker skin – including Gentle but powerful “DiamondGlow” that uses the power of water pressure to clear out pores and infuse customized serums. Certain specially formulated medical-grade facials can also be applied to sooth the inflammation and eliminate the pustules of rosacea.

Rosacea Treatments for Black Skin

Renowned Detroit area plastic surgeon Dr. Ali has been successfully treating people of color for decades. In fact, Dr. Ali is of middle eastern decent himself and his own skin is brown. He understands the unique needs and concerns of Black skin and help you choose the rosacea products and treatments that are ideal for your unique skin.

At AMAE in the Troy, MI area each appointment begins with a professional skin consultation. Rosacea treatments and products are then carefully selected and customized to meet the specific needs of each client’s unique skin.

Dr. Ali and our nurses and aestheticians offer the absolute best technologies in skin care – including state-of-the-art rosacea products and treatments. Schedule a consultation to see which treatment is best for your skin’s color, type and condition. Then relax in our Troy, MI area Med Spa, while we make you look and feel younger and even more beautiful!

Rosacea Treatments for Black Skin: 248.335.7200