Millions suffer from rosacea, but for people with darker skin tones, getting diagnosed can be a frustrating battle. That's because the telltale signs of rosacea often manifest differently on skin of color, leading to missed diagnoses and delayed treatment. At the 2025 Elevate-Derm Fall Conference, renowned dermatologist Hilary Baldwin, MD, shed light on this crucial issue, offering invaluable insights into recognizing and treating rosacea in this underserved population. And this is the part most people miss: it's not about different treatments, but about recognizing the subtle clues that often go unnoticed.
(https://www.dermatologytimes.com/authors/hilary-baldwin-md) Baldwin, director of the Acne Treatment and Research Center in Brooklyn, NY, emphasized that the core challenge lies in identifying rosacea in darker skin tones. “We're not dealing with a fundamentally different disease,” she explained to Dermatology Times. “The issue is that we're simply not recognizing it due to the way it presents in skin of color.”
The Hidden Signs: Beyond the Obvious
The classic redness (erythema) associated with rosacea can be far less pronounced in darker skin, Baldwin explained. Similarly, the tiny blood vessels (telangiectasias) that are another hallmark of the condition can be incredibly difficult to see without specialized tools. This makes relying solely on visual inspection a recipe for missed diagnoses.
But here's where it gets controversial: Baldwin argues that we need to shift our focus from purely visual cues to a more holistic approach. She encourages clinicians to “think beyond what meets the eye” and pay close attention to patient-reported symptoms. Itching, burning, stinging, and episodic warmth are all red flags that could point to rosacea, even if the skin appears relatively clear.
Tools and Techniques for Unmasking Rosacea
Baldwin offered several practical strategies to enhance diagnostic accuracy. Using a glass slide for compression can help blanch surrounding blood vessels, making subtle erythema more apparent. Dermoscopy, a handheld microscope, is another invaluable tool for visualizing telangiectasias that might otherwise be invisible.
Treatment: A Delicate Balance
Once diagnosed, Baldwin assures us that treatment principles for rosacea in skin of color are largely the same as for lighter skin tones. However, a crucial caveat exists: the potential for irritation from topical treatments. “We need to be mindful of iatrogenic postinflammatory hyperpigmentation,” she cautioned. This means choosing gentler formulations and avoiding overly aggressive treatments.
Baldwin favors newer, branded topical rosacea treatments designed with skin of color in mind. For systemic therapy, she recommends options like modified-release doxycycline, low-dose minocycline, or low-dose isotretinoin, which are effective against papules and pustules.
A Call to Action: Seeing Beyond the Surface
Baldwin's message is clear: by increasing our awareness of the unique presentation of rosacea in skin of color and utilizing the right tools and techniques, we can significantly improve diagnostic accuracy and patient outcomes.
What do you think? Is enough being done to address the challenges of diagnosing rosacea in skin of color? Share your thoughts in the comments below.
References:
- Baldwin H. Diagnosing & Managing Rosacea in Patients with Skin of Color (https://www.dermatologytimes.com/conference/elevate-derm-conference) . Presented at the 2025 Elevate-Derm Fall Conference; November 12-16, 2025; Tampa, Florida.
- Lim HW, et al. International Expert Consensus on Knowledge Gaps in Care for Dermatologic Disorders in Skin of Color. (https://pubmed.ncbi.nlm.nih.gov/41195756/) Int J Dermatol. 2025 Nov 6. doi: 10.1111/ijd.70101. Epub ahead of print. PMID: 41195756.
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