Rosacea underreported, underdiagnosed in patients with skin of colour

Rosacea management is similar in skin types, though under-diagnosed in patients with skin of colour. (868 words, 3 minutes)

The management of rosacea in light and dark skin types is very similar according to Dr. Monica K. Li, who presented strategies to manage rosacea symptoms at the 2019 Skin Spectrum Summit in Vancouver. 

“Unfortunately, because the entity itself is underreported and underdiagnosed in those with skin of colour, there is not a lot of data specifically looking at management, and the efficacy of management strategies for this patient population,” Dr. Li explained. 

With the increased risk of post-inflammatory hyperpigmentation in darker-skinned patients, physicians and clinicians need to be vigilant when implementing lasers and light-based therapies to ensure that this patient population does not experience potential adverse effects as much as possible. 

The goal of rosacea management is to reduce papules and pustules in patients, which can reduce the chronic inflammation occurring on the face, leading to potential scarring and post-inflammatory hyperpigmentation. 

When using laser and light therapies, the goal is to reduce superficial capillaries and to resurface the possible phymatous changes that can result as rosacea progresses. 

Dr. Li cautions practitioners to be careful when choosing laser and light therapies for darker skin phototypes because there is an increased risk of post-inflammatory hyperpigmentation that can result as a sequela of these interventions. 

“I use a long-pulse 1064 nm laser, Nd:YAG. We can also use a 595 nm pulsed dye laser to reduce the diffused redness that can be seen on the face,” said Dr. Li. 

“Because of the chronic nature of rosacea, usually a series of treatments are required every one to two years to improve some of the facial redness and symptoms experienced by darker-skinned patients.”

For supportive measures to help both fair- and dark-skinned patients, it is important to avoid triggers such as spicy foods, alcohol and sun exposure when possible.

Additionally, dermatologists should be advising and helping patients to use photoprotection, particularly with physical agents containing zinc oxide and titanium dioxide, consistently. The use of bland emollients and moisturizers is important because essentially all patients with rosacea have hypersensitive skin. 

When using a new skin-care product, patients should apply the product to a test-spot area for a week to determine tolerance prior to more generalized application of the product on the entire face. 

Patients should be counselled to use physical blockers as opposed to chemical blockers. Chemical blockers can be more irritating to rosacea patients with sensitive skin. Also, patients should avoid alcohol-based exfoliating products (astringents), which can further drive the redness and irritation on facial skin. 

Established options for rosacea management include an oral 40 mg subantimicrobial-dose doxycycline taken once daily. Studies show that this treatment method has similar efficacy and safety for skin phototypes I to III, as well as those with phototypes IV to VI. In the U.S., a topical oxymetazoline cream is available for the treatment of facial redness in both lighter and darker skin phototypes. 

The takeaway: Because there is a lack of data regarding rosacea in skin of colour, it can be a challenge to diagnose, but therapeutic results are similar across skin phototypes.

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FROM THE LITERATURE ON ROSACEA IN SKIN OF COLOUR

Establishing the diagnosis of rosacea in skin of color patients

  • Although clinical signs of rosacea may appear similar across all skin types, diagnosis may be more of a challenge for patients with skin of colour. In addition, physicians should be familiar with the wide range of presentations that may mimic rosacea in patients with skin of colour.

From "Cutis"

Characterization and analysis of the skin microbiota in rosacea: Impact of systemic antibiotics

  • A study of 12 Asian subjects with moderate rosacea skin found that after six weeks of oral doxycycline (100 mg, twice daily), the systemic antibiotics had an impact on skin microbiota. Study subjects had Fitzpatrick skin phototypes III and IV. 

    From "Journal of Clinical Medicine"

Consensus on the therapeutic management of rosacea

  • In a recent study, a group of researchers in Brazil came to a consensus on the therapeutic management of rosacea regarding epidemiology, pathophysiology, triggering factors, clinical condition, classification, quality of life, and comorbidities. Researchers said that following these management guidelines, improvement and long periods of remission are possible in people with a variety of skin phototypes.

    From "Anais Brasileiros de Dermatologia"

VIDEO: Caffeine consumption linked to decreased rosacea symptoms

AT THE INTERSECTION OF SKIN & SOCIETY

  • A recent article published by Hyperallergic explores the inherent biases and prejudices present in a new wave of artificial intelligence-driven apps. In the article categorizes these machine learning prejudices as “a New Jim Code” in reference to Jim Crow laws that once enforced racial segregation in the Southern United States. The article warns that what may seem like a scientific process working within many AI algorithms, is often an artistic process that comes complete with the biases and prejudices of the creator. Read the full article here.

This Week

Something to think about during the week ahead…

Next Week

A report on how sickle cell disease can complicate venous leg ulcers in patients of colour by Dr. Brian Kunimoto. Subscribe to Skin Spectrum Weekly and have each issue sent directly to your phone or inbox.

Thank you to our panellists and delegates for making Skin Spectrum Summit 2020 a great success. Conference highlights will soon be posted to the Skin Spectrum website.

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