NEW YORK (FRONTLINE MEDICAL NEWS) – A middle-aged patient with Fitzpatrick type V skin comes to the office with a 10-year history of “breakouts” on her face. When asked about topical treatments, she reports that “everything burns or stings,” and says she just has very sensitive skin. What could this be?

The first thought might not be rosacea in this darker-skinned woman, who shows little appreciable erythema on her face. However, according to Andrew Alexis, MD, dermatologists should move rosacea a little higher up the differential list in such cases.

Rosacea may often be missed in skin of color, said Dr. Alexis, speaking at the summer meeting of the American Academy of Dermatology. “It’s reportedly rare in darker skin types, especially in blacks,” and as a result, dermatologists and patients alike have a low index of suspicion for the diagnosis, he noted.

Also, rosacea looks different on darker skin than it does on lighter skin, which is featured in much of the dermatology teaching material. “In richly pigmented [Fitzpatrick] type VI skin, the erythema of rosacea can be masked,” said Dr. Alexis , chairman of the department of dermatology at Mount Sinai St. Luke’s and at Mount Sinai West, both in New York.

Dermatologists, in this case, may have to do some detective work: looking at the distribution of the lesions, thinking about trigger factors from the patient history, and noting the lack of comedones – although the patient has “pimples.” Patient complaints that they are sensitive to almost all topical products and experience stinging with “everything” is another very good clue that the patient may have rosacea.

Keep rosacea on the differential for this picture, advised Dr. Alexis. In skin of color, “rosacea may not be as rare as previously thought – less common, maybe – but not rare.”

Dr. Alexis reported financial relationships with multiple pharmaceutical companies.

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