identified through a 5-year retrospective, multi-institutional pooled analysis in 5 hospitals.14 They found a significantly (P<.05) increased risk of rosacea in patients with diabetes and dyslipidemia and in those treated with a β-blocker, α blocker, [beta]-hydroxy-[beta]-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor, and/or fibrates. However, patients taking an HMG-CoA reductase inhibitor who did not have dyslipidemia had a lower risk of rosacea (P=.034).14
Statement 2: Differences in Asian skin may be clinically relevant in selecting topical treatment and skincare for these patients with rosacea.
a. Asian skin may be more prone to irritation to specific topical agents compared with other skin types, most notably White skin.
b. Asian skin was reported to have an elevated neurosensory response to insults when compared with White skin and was more reactive than the skin of Black Americans.
c. East Asian skin has been found to have the least skin barrier strength, the lowest degree of maturation, and, consequently, the highest degree of skin sensitivity compared with White or Black skin.
Not only are differences in Asian skin relevant in selecting topical treatments, but they are also relevant to diagnosis. While studies have found that PPR is more common in people with darker phototypes and ETR is more common in lighter phototypes, this may be an artifact of the difficulty of seeing erythema in richly pigmented skin.15 "Because erythema and telangiectasia might be difficult to recognize in darker skin, a heightened awareness of other signs and symptoms is warranted when evaluating a patient with richly pigmented."7 Helpful findings are: flushing, redness/erythema, burning/stinging with skincare products, failed acne treatments, difficult to treat symptoms, the presence of typical rosacea triggers, dry appearing skin, facial edema, and hyperpigmentation. Richly pigmented skin is more susceptible to post-inflammatory hyperpigmentation, which could conceal the erythema of rosacea.7
To help overcome the difficulty of diagnosing rosacea in patients with darker skin, clinicians can: search the family history for rosacea (people of color may have mixed ancestry), attempt to blanch the skin, eg, with a transparent device -- if the skin blanches, erythema is present; photograph the patient in front of a dark blue background to make erythema easier to see; examine the patient in a well-lit space and use a dermatoscope to identify telangiectasia; look for papules and pustules without comedones to differentiate from acne; look for thickening of the nose and medial cheek.7
Once the diagnosis has been made, clinicians can keep in mind findings that people of Asian heritage may have more sensitive skin than other people as this may impact treatment. According to the advisors, “Rosacea patients tend to have hypersensitive skin and often complain that they cannot tolerate certain products. Flushing and redness are very common, especially in autumn and winter, as well as dryness and stinging. Moisturizers are needed that reduce irritation.
Asian skin may be more prone to irritation to specific topical agents compared with other skin types, most notably White skin.16 Asian skin was reported to have an elevated neurosensory response to insults when compared with White skin and was more reactive than the skin of Black Americans.17 Compared with White and Black skin, East Asian skin had the least skin barrier strength, the least maturation, and, consequently, the highest skin sensitivity.17
Statement 3: Non-prescription products and skincare recommendations, in addition to the use of prescription medications, are a crucial part of successful rosacea therapy in all ethnicities.
Patients with rosacea are known to have sensitive skin prone to burning, dryness, erythema, pruritus, scaling, and stinging.18 Furthermore, some studies suggest Asian people may have more sensitive skin than other people.16,17 Therefore it is crucial to select rosacea treatment that patients can tolerate.
In a retrospective case-control survey in China of 997 patients with rosacea and 1012 controls with healthy skin, the odds ratio (OR) of developing rosacea was increased in those with a history of allergic reaction to skincare products: OR = 5.110, 95% CI = 3.893–6.706, P<.001, and in those with a history of allergic reaction to skincare in beauty salons: OR = 3.002, 95% CI = 1.506–5.981, P=.002.19 A cross-sectional study of university students in China, including 310 patients with rosacea and 3,129 healthy controls, found that both frequent use of facial cleansers (P=.03) and extended baths (P=.02) were significantly associated with rosacea.20 A retrospective, multi-center case-control survey study in China of 1,245 patients with rosacea and 1,538 controls with healthy skin found an association between rosacea and certain behaviors including: using a foaming cleanser (OR = 1.45, P=.01), wearing makeup more than 6 times a week (OR = 2.839, P<.001), applying a facial mask more than 4 times a week (OR = 2.56–3.069, P<.001), visiting the beauty salon than once a week (OR = 4.946, P=.0018), and using products from a beauty salon (OR = 2.334, P=.0018).21
Finally, data analysis in China of 999 patients with rosacea and 1010 controls with healthy skin also found an association between rosacea and certain skin-cleansing habits. These habits included washing the skin more than once a day (OR = 1.450), using more than 5 pieces of cleanser a year (ie, a large amount) (OR = 1.612), using a cleaning tool more than 4 times a week (OR
Statement 2: Differences in Asian skin may be clinically relevant in selecting topical treatment and skincare for these patients with rosacea.
a. Asian skin may be more prone to irritation to specific topical agents compared with other skin types, most notably White skin.
b. Asian skin was reported to have an elevated neurosensory response to insults when compared with White skin and was more reactive than the skin of Black Americans.
c. East Asian skin has been found to have the least skin barrier strength, the lowest degree of maturation, and, consequently, the highest degree of skin sensitivity compared with White or Black skin.
Not only are differences in Asian skin relevant in selecting topical treatments, but they are also relevant to diagnosis. While studies have found that PPR is more common in people with darker phototypes and ETR is more common in lighter phototypes, this may be an artifact of the difficulty of seeing erythema in richly pigmented skin.15 "Because erythema and telangiectasia might be difficult to recognize in darker skin, a heightened awareness of other signs and symptoms is warranted when evaluating a patient with richly pigmented."7 Helpful findings are: flushing, redness/erythema, burning/stinging with skincare products, failed acne treatments, difficult to treat symptoms, the presence of typical rosacea triggers, dry appearing skin, facial edema, and hyperpigmentation. Richly pigmented skin is more susceptible to post-inflammatory hyperpigmentation, which could conceal the erythema of rosacea.7
To help overcome the difficulty of diagnosing rosacea in patients with darker skin, clinicians can: search the family history for rosacea (people of color may have mixed ancestry), attempt to blanch the skin, eg, with a transparent device -- if the skin blanches, erythema is present; photograph the patient in front of a dark blue background to make erythema easier to see; examine the patient in a well-lit space and use a dermatoscope to identify telangiectasia; look for papules and pustules without comedones to differentiate from acne; look for thickening of the nose and medial cheek.7
Once the diagnosis has been made, clinicians can keep in mind findings that people of Asian heritage may have more sensitive skin than other people as this may impact treatment. According to the advisors, “Rosacea patients tend to have hypersensitive skin and often complain that they cannot tolerate certain products. Flushing and redness are very common, especially in autumn and winter, as well as dryness and stinging. Moisturizers are needed that reduce irritation.
Asian skin may be more prone to irritation to specific topical agents compared with other skin types, most notably White skin.16 Asian skin was reported to have an elevated neurosensory response to insults when compared with White skin and was more reactive than the skin of Black Americans.17 Compared with White and Black skin, East Asian skin had the least skin barrier strength, the least maturation, and, consequently, the highest skin sensitivity.17
Statement 3: Non-prescription products and skincare recommendations, in addition to the use of prescription medications, are a crucial part of successful rosacea therapy in all ethnicities.
Patients with rosacea are known to have sensitive skin prone to burning, dryness, erythema, pruritus, scaling, and stinging.18 Furthermore, some studies suggest Asian people may have more sensitive skin than other people.16,17 Therefore it is crucial to select rosacea treatment that patients can tolerate.
In a retrospective case-control survey in China of 997 patients with rosacea and 1012 controls with healthy skin, the odds ratio (OR) of developing rosacea was increased in those with a history of allergic reaction to skincare products: OR = 5.110, 95% CI = 3.893–6.706, P<.001, and in those with a history of allergic reaction to skincare in beauty salons: OR = 3.002, 95% CI = 1.506–5.981, P=.002.19 A cross-sectional study of university students in China, including 310 patients with rosacea and 3,129 healthy controls, found that both frequent use of facial cleansers (P=.03) and extended baths (P=.02) were significantly associated with rosacea.20 A retrospective, multi-center case-control survey study in China of 1,245 patients with rosacea and 1,538 controls with healthy skin found an association between rosacea and certain behaviors including: using a foaming cleanser (OR = 1.45, P=.01), wearing makeup more than 6 times a week (OR = 2.839, P<.001), applying a facial mask more than 4 times a week (OR = 2.56–3.069, P<.001), visiting the beauty salon than once a week (OR = 4.946, P=.0018), and using products from a beauty salon (OR = 2.334, P=.0018).21
Finally, data analysis in China of 999 patients with rosacea and 1010 controls with healthy skin also found an association between rosacea and certain skin-cleansing habits. These habits included washing the skin more than once a day (OR = 1.450), using more than 5 pieces of cleanser a year (ie, a large amount) (OR = 1.612), using a cleaning tool more than 4 times a week (OR
