INTRODUCTION
Rosacea is well recognized globally as a common dermatologic
disorder encountered in clinical practice. Although
prevalence estimates vary depending on the population
evaluated and the methodology used to capture the diagnosis for
demographic or epidemiologic purposes, there is little disagreement
that at least the major presentations that have been classified
as rosacea are commonly encountered in clinical practice.1-4 For the
purposes of having a reasonably accepted "diagnostic language"
for discussion, the common presentations of rosacea were first
designated as subtypes in 2002, and subsequently in other references.
2 Among the four major subtypes, the two most common
are erythematotelangiectatic rosacea (ETR) and papulopustular rosacea
(PPR). Although rosacea has long been recognized as being
most common in patients with very fair skin with a reported prevalence
of up to 10% in individuals of Northern European or Celtic
heritage (Fitzpatrick Skin Type I-II), it has also been reported to affect
approximately 4% of individuals with darker skin types.5-7 To add,
there is some evidence that African Americans are more likely to be
affected by rosacea if one of the parents is of Northern European
ancestry.8 Nevertheless, a thorough evaluation of the prevalence
of rosacea, including a breakdown of individual subtypes or specific
presentations, has not been completed in patients with skin
of color (Fitzpatrick Skin Types IV-VI) or among different ethnicities
where darker skin types than Fitzpatrick I-II are predominant.
Clinical Differentiation of Common Presentations of Rosacea
Clinical features that characteristically manifest in ETR that are also
observed in many patients with PPR include diffuse central facial
erythema, telangiectasias, and associated symptoms (ie, stinging,
burning) and signs (ie, scaling, flaking, redness) of "skin sensitivity"
and stratum corneum (SC) permeability barrier impairment.1-5,8 PPR
differs clinically from ETR by the presence of inflammatory lesions
in PPR. The inflammatory lesions of PPR are commonly papules
and pustules that are most pronounced on the central face with associated
perilesional erythema, although some patients with PPR
may have few or many inflammatory lesions with little to no diffuse
central facial erythema that is not perilesional in nature.1-3,8-11
