What you should know about treating rosacea in darker skin tones

ver the past few years, many of the myths about darker or Black skin have slowly been debunked by dermatologists and aestheticians. The creation of the Black Skin Directory, which works to 'Connect people of colour with expert skin care professionals' in 2018, plus the formation of the Black Aesthetic Advisory Board, (BAAB), in July, which investigates the experiences of Black practitioners in the industry, as well as those of patients and consumers, have further paved the way for a new awareness. This includes the way in which standard medical training has often failed to address the difference in the way common conditions appear on skin of colour, and, as such, to get effective treatment delivered to those who need it.

One common skin issue that has been long overlooked in darker skinned women is rosacea. Although less prevalent in those with Black skin, or those from an Asian or Minority Ethnic background, it is still far from rare. The effects of the condition meanwhile, can be extremely detrimental for the person in question's confidence, thanks to the aesthetic implications, as well as their overall quality of life: rosacea can cause a painful stinging or burning sensation, as well as patches of extreme dryness. The upshot? Correct, swift diagnosis and treatment really matters.

A review into rosacea, published in the Journal of American Dermatology, reported that 'Worldwide, the reported prevalence of rosacea in people with skin of colour has varied, with estimates as high as 40 million cases and rates up to 10%.' However, because rosacea is often misdiagnosed in darker skin, the exact figures for Black women, or those from an Asian or minority ethnic background in the UK living with the condition, remains unknown.

Rosacea on people with white or lighter skin tones often presents as ‘rosy cheeks’, a ‘flush’ or with overall uneven red skin. These indicators can be masked by higher pigmentation in skin of colour, making it harder to diagnose for some GPs and skin experts. According to Dr Kemi Fabusiwa, Aesthetician and Director of JoyFul Skin Clinic in Croydon, rosacea shows up in Black and brown skin in a few ways.

How does rosacea appear on Black skin?

'Darker-skinned individuals might notice pimples or pustules and hypersensitive skin,' she explains. Hypersensitivity also means that people impacted may notice that their skin 'is easily irritated by external aggressors such as UV radiation or the application of cosmetic products'. Just like on lighter skin tones, Dr Fabusiwa says that another indication of rosacea is persistent 'warmth rising from the cheeks'. When professionally identifying the redness of rosacea in dark skin, Dr Fabusiwa says she opts for a 'proper assessment of the skin under adequate lighting' in order to 'discern an underlying redness in skin of colour.'

The root reason as to why someone might develop rosacea is unknown, she adds, although flare-ups can be triggered by lifestyle factors – including alcohol, heat, stress and spicy food. These vary from person-to-person.

'Patients with rosacea typically come into the clinic first experiencing pimples and pustules on the cheeks,' says Dr Fabusiwa. She explains that her clients have been known to mistake these for acne, and come to her after trying over-the-counter ingredients to manage symptoms of that condition, which haven't worked. A recent rosacea client of Dr Fabusiwa, for example, came to the clinic complaining of irritation that started when she used some new make-up. This had, over time, given way to pimples that she believed to be acne. In turn, these left behind areas of hyperpigmentation and uneven skin. After consulting her GP and then Dr Fabusiwa, she was diagnosed with rosacea.

How is rosacea treated on darker skin?

Treatment-wise, Dr Fabusiwa believes that trying to prevent flare-ups is the best way to go. This involves identifying your triggers – noting down if you have visible rosacea after a period of extreme stress or lying in the sun, for example – and then trying to avoid these through relaxation techniques and using SPF. For a longer term solution, she also recommends focusing on strengthening the skin’s moisture barrier.

Why? Hypersensitivity caused by rosacea means that your 'skin barrier isn’t as effective at protecting itself from the outside world,' she says. So, building a protective one by moisturising every night – and avoiding irritating soaps or harsh exfoliators – can work wonders for mild cases of rosacea. A gentle, fragrance and soap-free cleanser, preferably with an emollient like glycerin, which can preserve moisture in the skin, can significantly reduce any added inflammation.

Swapping out exfoliators like glycolic acid for gentler methods of cleansing the skin can also reduce the appearance of rosacea in dark skin.

Dr Fabusiwa says that this is especially important because you should already be looking to 'reduce unnecessary irritation to the surface of your skin, as dark skin is much more prone to post-flammatory hyperpigmentation – and even minor irritation could cause lasting problems.'

Another crucial step for daily management of rosacea on darker skin is SPF. Dr Fabusiwa advises that people with rosacea 'use SPF every day, even when you're indoors'. She explains that this is particularly important as 'UV radiation can trigger flares but can also worsen hyperpigmentation.' For more severe cases that are not able to be managed at home, she advises that you should consult with your GP early doors, in order to help prevent some of the long-term consequences of rosacea, such as thickened skin. They might prescribe you certain gels or creams to help to lessen the appearance of rosacea, as well as any pain you're experiencing.

In some such cases, your GP might offer you a course of antibiotics, which could last from six to 16 weeks. These will likely be pretty weak, as the aim of the game is to use them for an anti-inflammatory effect, as opposed to nix harmful microbes. In some instances you might be prescribed a retinoid (a form of Vitamin A and a stronger, prescription alternative to retinol), which can reduce the appearance of red bumps on your skin. If your issues keep persisting, then you might be referred to a dermatologist for specialist help. Want to find one yourself? The Black Skin Directory is helpful for locating experts who specialise in diagnosing and treating skin of colour.