Dermatology Weekly

Failure to recognize rosacea in the skin of color population presents an important gap in dermatology practice. Beginning at 10:06, Dr. Vincent DeLeo talks with Dr. Susan Taylor about how dermatologists can improve diagnosis and treatment of rosacea in this patient population. “I think that rosacea is underrecognized because it’s often confused for other disorders that occur commonly in skin of color populations,” Dr. Taylor explains. She highlights various clinical clues distinguishing rosacea from mimickers such as connective tissue diseases, seborrheic dermatitis, cutaneous sarcoidosis, and acne vulgaris.

We also bring you the latest in dermatology news and research:

1. No increased risk of psychiatric problems tied to isotretinoin

Arash Mostaghimi, MD, of Brigham and Women's Hospital in Boston discusses the study's findings and their implications. 

2. FDA warning letters fall on Trump’s watch

The Food and Drug Administration sent out one-third fewer warning letters to marketers of problematic drugs, devices, or food during the Trump administration's first 28 months.

Things you will learn in this episode: 

• Overall, rosacea does not occur as commonly in skin of color patients as in white patients in the United States, but all types of rosacea can be observed in skin of color.
• The erythematotelangiectatic and papulopustular subtypes are most common in skin of color populations, with granulomatous rosacea occurring more frequently in black patients.
• Rosacea is underrecognized and underdiagnosed in skin of color patients because physicians often don’t appreciate that rosacea can and does occur in these populations. It also can be difficult to identify the erythema that is characteristic of rosacea in skin of color.
• Skin of color patients with rosacea often don’t present to dermatology for treatment because they have no awareness of the disease.
• Connective tissue diseases such as systemic lupus erythematosus and dermatomyositis can mimic rosacea in patients with skin of color.
• Seborrheic dermatitis and rosacea have similar clinical features and can occur concurrently in the same patient.
• Biopsy is needed to accurately distinguish between granulomatous rosacea and cutaneous sarcoidosis, as it can be a challenge to make the diagnosis clinically.
• Comedones, nodules, cysts, and postinflammatory hyperpigmentation are suggestive of acne vulgaris, as these findings are not observed in rosacea.
• Most of the same medications used in white patients with rosacea can be used for skin of color patients.
• The most important factor to keep in mind when treating rosacea in skin of color patients is that irritation from topical agents can lead to postinflammatory hyperpigmentation. “I don’t think you can go wrong being cautious and approaching therapy slowly in this patient population,” notes Dr. Taylor.
• Daily sunscreen use is important in all skin of color patients, particularly those with rosacea who may have facial skin that is more subject to burning or stinging or those who are photosensitive because of treatment with topical agents.
• Ultimately, dermatologists should rely on information garnered from patients when rosacea is suspected in skin of color. “I think the key here is you must think about rosacea when you see a skin of color patient who comes to you and complains of burning, tingling, stinging of the facial skin; sensitivity to products; redness of the skin; papules; and pustules. There are times when as clinicians you may not be able to appreciate the erythema, but rest assured that your patient can tell you if his or her facial skin is red.”

Hosts: Elizabeth Mechcatie; Terry Rudd; Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles)

Guest: Susan C. Taylor, MD (Perelman School of Medicine, University of Pennsylvania, Philadelphia)

References: 

• Establishing the Diagnosis of Rosacea in Skin of Color Patients
• Article PDF

Show notes by Alicia Sonners, Melissa Sears, and Elizabeth Mechcatie.

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