Improving Rosacea Outcomes in Skin of Color Patients: A Review on the Nuances in the Treatment and the Use of Cleansers and Moisturizers
June 2022 | Volume 21 | Issue 6 | 574 | Copyright © June 2022
Published online May 31, 2022
Andrew F. Alexis MD MPHa, Heather Woolery-Lloyd MD FAADb, Anneke Andriessen PhDc, Seemal Desai MD FAADd, George Han MD FAADe, David Rodriguez MDf
aClinical Dermatology, Weill Cornell Medical College, New York, NY
bSkin of Color Division, Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, FL cRadboud UMC Nijmegen, Andriessen Consultants, Malden, The Netherlands
dDepartment of Dermatology, The University of Texas Southwestern Medical Center, Innovative Dermatology, PA, Dallas, TX
eDepartment of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
fResearch Dadeland Dermatology Group, Department of Dermatology & Cutaneous Surgery, University of Miami, FL
*Dr Alexis and Dr Woolery-Lloyd are both first authors
Abstract
Background: While rosacea is a common inflammatory condition that affects diverse populations, published data in skin of color (SOC) are limited. This review explored nuances in clinical presentation and treatment considerations in SOC patients with rosacea and the role of cleansers and moisturizers in the management of rosacea in these populations.
Methods: A panel reviewed and discussed aspects of rosacea in SOC and possible implications for treatment and maintenance. The outcome of these discussions, coupled with the panel's expert opinion and experience was used to define draft statements. After group discussions and an online review process, the panel agreed on the inclusion and wording of five statements.
Results: Studies and anecdotal clinical experience suggest that rosacea is more common in SOC populations than previously reported. The clinical presentation of rosacea across diverse skin types includes the spectrum of clinical subtypes observed in other populations; however, clinical features may be less conspicuous in individuals with higher skin phototypes and the index of suspicion may be lower in SOC populations. To avoid underdiagnosis, dermatologists should consider rosacea in the differential diagnosis of any patient presenting with a history of skin sensitivity, central facial erythema, papules, and pustules. The compromised barrier in rosacea contributes to skin sensitivity. Studies including Chinese rosacea patients showed that using a moisturizer and sunscreen negatively correlated with rosacea development.
Conclusions: The use of skincare could improve rosacea symptomatology. These products are recommended before and during prescription therapy and as part of a maintenance regimen as adjuncts.
J Drugs Dermatol. 2022;21(6):574-580. doi:10.36849/JDD.6838
INTRODUCTION
Rosacea is an inflammatory dermatosis with at least a ten percent prevalence reported among White adults and limited data in nonwhite populations.1–5 Although rosacea is less frequently described in patients with darker skin types, there is increasing awareness that the condition occurs in all racial/ethnic groups, including people of African descent, Asian, and Latino populations.5-16 The clinical presentation of rosacea across diverse skin types varies widely, and clinical features may be less conspicuous in individuals with richly pigmented skin5-8 rosacea deserves more attention from clinicians, especially in darker skin tones where erythema may be more challenging to detect.5-8 Frequently, this population is misdiagnosed, leading to advanced disease, suboptimal treatment, and greater morbidity.5-8,18-21
This review explores rosacea in skin of color (SOC) patients and the potential role of over-the-counter (OTC) skincare in improving treatment outcomes.
