Previously, medical professionals and dermatologists assumed people with darker skin tones didn’t experience rosacea. This was an incorrect assumption, of course, and it led to mis-diagnoses and unnecessary pain for rosacea-sufferers with skin of color.
Thankfully, doctors and medical professionals now understand that people of color can, in fact, have rosacea — it just looks a little different than it appears on lighter skin tones.
Based on a study in Social Science & Medicine, it’s estimated that only 4.5% of medical textbooks show images of skin conditions, like rosacea, on darker skin tones.
That’s why we want to shed light on how rosacea on black skin appears and how it affects those with darker skin tones. But first, let’s recap what rosacea is.
What Is Rosacea?
Rosacea is a chronic inflammatory skin condition characterized by facial redness, visible blood vessels, and small red bumps on the face. However, there are four distinct forms of rosacea that each cause varying symptoms.
Erythematotelangiectatic rosacea (ETR) is the type of rosacea most people are familiar with. ETR causes the most common symptoms of rosacea, including flushing and redness across the nose and cheeks, plus dilated blood vessels.
Papulopustular rosacea, also called “acne rosacea,” causes redness and visible blood vessels as well as pimples and acne-like symptoms. These blemishes can appear as small red bumps or pus-filled pimples.
The least common form of rosacea, phymatous rosacea occurs on and around the nose, causing thickening of the skin. As it worsens, the skin condition can resemble scar tissue and form large lumps on the nose.
Ocular rosacea causes inflammation and redness around the eyes and eyelids. You may also experience bumps, swelling, redness of the eyes, along with burning and watering of the eyes.
Prevalence of Rosacea in People of Color
Determining how many people of color suffer from rosacea is almost impossible. That’s because people with darker skin remain underdiagnosed still today. That means people are unknowingly suffering from rosacea and possibly experiencing decreased quality of life and a worsening skin condition — without receiving proper care.
What we do know is that according to the U.S. government, almost 14 million people have rosacea. One 2014 study found that, “Of all patients diagnosed with rosacea, 2.0% were black, 2.3% were Asian or Pacific Islander, and 3.9% were Hispanic or Latino of any race.”
However, it’s safe to assume that the percentage of those with darker skin tones dealing with rosacea is actually higher than these stats indicate.
How Rosacea Looks Against Darker Skin Tones
A key factor in being able to properly diagnose rosacea in people of color is to understand how the skin condition appears on darker skin tones. Often, you can’t see the redness or visible blood vessels of rosacea on dark skin, so you must instead look for:
- Discoloration of the skin
- Dryness or swelling
- Thickened patches of skin
- Small bumps that may or may not be pus-filled
Depending on the color of your skin, you may still be able to spot the visible blood vessels or redness commonly associated with rosacea. However, the appearance of the skin isn’t the only way to make a rosacea diagnosis. Non-visual symptoms of rosacea in people of color include:
- Stinging or burning sensation on the skin
- Feeling of warmth on the skin
- Pain in your eyes or the sensation that something is in your eyes
- Sensitivity to topical products
- Worsened symptoms after sun exposure
How to Treat Rosacea in People of Color
Treating rosacea on black skin or darker skin tones requires the same intervention it would on lighter skin tones. Treatment doesn’t vary. No matter your skin color, to manage your rosacea symptoms:
While the exact cause of rosacea remains unknown, researchers and doctors do know that various environmental and lifestyle factors cause rosacea to flare-up and worsen. Possible rosacea triggers include:
- Emotional stress and anxiety
- Spicy foods
- Hot beverages
- Extreme heat from weather, sauna, shower, etc.
- Extreme cold
- Strong winds
- UV rays
- Physical exertion
- High-histamine foods
Not everyone will respond to these factors the same, but once you identify which environmental triggers worsen your rosacea, avoiding them can be one of the easiest ways to reduce rosacea symptoms.
Try Prescription Creams
One of the most popular treatment methods for rosacea is topical creams that constrict the dilation of blood vessels. Oxymetazoline and brimonidine are the two topical creams currently approved for rosacea by the FDA.
Doctors typically suggest applying these creams in the morning, because they work quickly and can help keep rosacea symptoms at bay the entire day.
The downside of this treatment method, though, is that these creams only constrict the blood vessels when applied to the skin. That means when you’re not using them, they can’t benefit the skin and symptoms will likely reappear.
Use Laser Treatment
Although many rosacea sufferers with darker skin don’t experience visible blood vessels and redness, if you do, your doctor may include laser treatment in your treatment plan for rosacea. Laser treatment for rosacea uses yellow or green light to target the hemoglobin in your blood. The light converts to heat energy and works to eliminate visible blood vessels and facial redness.
This laser treatment process provides a more permanent solution compared to topical creams. Most rosacea patients using laser treatment will see a 50–75% reduction in visible blood vessels after one to three laser treatments, according to the American Academy of Dermatology Association.
Another bonus? Once a blood vessel has disappeared with laser treatment, it won’t reappear. If you start seeing dilated blood vessels again, they are new ones. A major downfall of this treatment method, though, is most insurance companies don’t cover the cost of this type treatment for rosacea. Also, if you don’t have visible blood vessels and redness, this treatment option won’t likely won’t benefit you.
Balance Your Skin Microbiome
Did you know that both good bacteria as well as bad bacteria live on the surface of your skin? It’s true! When these good and bad bacteria are in an ideal ratio, the bacteria work to keep skin healthy and happy. But if your bad bacteria overpopulates and throws off the delicate balance of these microorganisms, it can lead to the appearance of rosacea, as well as eczema and blemishes.
That means that by taking care of these bacteria that form the skin microbiome, you can help to manage skin issues such as rosacea. To care for your skin microbiome, you must restore balance if your bad bacteria has begun to outweigh the good, and then you can support and maintain that balance.
Gladskin’s Redness Relief Cream with Microbalance® can help calm skin prone to rosacea by restoring balance the skin microbiome. Many rosacea sufferers see results in as little as a week. This gentle, preservative- and fragrance-free cream also doesn’t have negative side effects like dryness and sun sensitivity like many other rosacea treatments.
Once you’ve restored balance to the skin microbiome, it’s important to maintain that balance. You can do this by avoiding harsh skincare products that strip the good bacteria in the skin microbiome. Instead, opt for gentle topical products that don’t affect these protective bacteria.
Historically, rosacea in people of color has been greatly misunderstood and unfortunately, in some ways, it still is today. Knowing the unique signs of rosacea to look for on darker skin tones can help to close the gap in properly diagnosing people of color with rosacea.
If you suspect you have rosacea, the good news is rosacea treatment remains the same whether you have a lighter or darker skin tone. Talking to a board-certified dermatologist–especially one that specializes in treating skin of color–is the safest bet to help you identify your rosacea triggers, choose the right topical cream, consider laser treatment, and restore balance to your skin microbiome.