Why is Rosacea Often Misdiagnosed or Missed Altogether on Darker Skin?

As many as 40 million people with darker skin struggle with Rosacea. Still, it’s often misdiagnosed. Or missed altogether.

Whether it’s erythematotelangiectatic rosacea (flushed cheeks) or papulopustular rosacea (the bumpy, spotty kind), the exact cause is unknown. The symptoms, however, are universal, regardless of skin color or ethnicity.

Rosacea is an inflammatory condition that most often presents in the face. It’s the result of tiny broken blood vessels, most prominently around the cheeks and nose. Certain triggers can make these blood vessels dilate, which can leave you looking flushed and red. Other symptoms include swelling, sensitivity, and changes in skin texture.

The signs of rosacea are much more nuanced in Black skin because melanin in the skin tends to mask the telltale redness, which is one of the leading reasons why rosacea is often missed on Black skin.

Make no mistake, the inflammation is there – contrary to popular belief – but it presents more subtly as a violet, purple, or brown hue.

In those with darker skin tones, rosacea usually appears as inflamed bumps or pustules, which makes it easier to confuse with other skin conditions, especially acne. That can be problematic because dermatologists approach people with acne and those with rosacea in slightly different ways. For example, retinoids are strong enough to tamp down breakouts, but they can also agitate rosacea-prone skin.

With all of that in mind, so much hinges on the physical exam, which should be on clean, bare skin and in good light. The dermatologist should also be asking targeted questions.

Research is beginning to suggest that the gut microbiome may be linked to rosacea. More specifically, one study found that a very high carbohydrate intake could contribute to rosacea flareups in some people. We’re far from a definitive answer, but the early data is enough to warrant asking a patient what their diet’s like.

Another potential clue: Rosacea can increasingly affect the eyes, leaving them dry, itchy, or watery.

Diagnosing rosacea as early as possible is important because the longer it goes untreated, the higher the chance of additional complications like hyperpigmentation or thickening of the skin on the nose.

There’s no cure for rosacea, but it can be managed. Most treatments are comprised of skincare (both prescription and over-the-counter products) and lifestyle adjustments.