Why rosacea is so often misdiagnosed on Black skin

As skin issues go, few are as poorly understood as rosacea on Black skin. Flare-ups of rosacea, a skin condition that causes chronic inflammation, can be a source of discomfort and self-consciousness for many, but fake news has kept it flying relatively under the radar. Misinformation about rosacea constantly circulates – it’s just blushing or it’s an allergic reaction – that can negatively impact how we treat it. But the most crucial myth to debunk? Only white people get rosacea. 

According to the Journal of the American Academy of Dermatology, up to 40 million people of colour struggle with rosacea. It’s a lucrative market to tap, yet most brands still don’t represent anyone of colour in mainstream beauty advertisements and communications. Worse still, despite being far from rare, there is a shocking lack of information about rosacea in Black and brown skin, often resulting in it being misdiagnosed.

Be it erythematotelangiectatic rosacea (aka flushed cheeks) or papulopustular rosacea (the bumpy, spotty kind), the exact cause of it is still unknown. But as Nada Elbuluk, M.D., a board-certified dermatologist based in Los Angeles, explains, the symptoms are universal regardless of skin colour or ethnicity. “Rosacea is basically an inflammatory condition that most commonly presents on the face,” Elbuluk says. “It consists of tiny broken blood vessels, most prominently on the cheeks and nose area. Certain triggers can cause these broken blood vessels to dilate so the person looks flushed and red.” Other symptoms include sensitivity, swelling, and changes in skin texture.

But that’s where the similarities end and darker skin tones face a new set of challenges. The signs of rosacea are far more nuanced in Black skin because the obvious telltale redness does not present the same way. “Melanin in the skin tends to mask the redness, which we medically call erythema,” Elbuluk says. “That’s really the reason rosacea gets missed [on Black skin] so often, as it’s a more subtle presentation.” And that’s just the tip of the iceberg, say the experts.

Why is Rosacea on Black skin misdiagnosed?

There’s no denying that it’s easier to spot redness and broken capillaries more clearly on pale skin. But that doesn’t mean that Black skin automatically gets a free pass from rosacea. Contrary to popular belief, explains Ryan Turner, M.D., a board-certified dermatologist in New York, the inflammation is there, “it can present as a violet, purple, or a dusky brown hue” instead.

Likewise, as New York City board-certified dermatologist Rose Ingleton, M.D., explains, some types of rosacea can look remarkably similar to other skin conditions, especially acne. “In darker-skinned individuals, rosacea often appears as inflamed bumps and pustules; skin is also more reactive to various skin-care products so patients may experience stinging,” she tells Allure. 

Cue confusion and patients trying — and failing — to manage their symptoms with the wrong over-the-counter products. In other words, throwing petrol on a once extinguishable fire. “Someone may just be diagnosed with acne, but the background rosacea part is missed,” says Elbuluk, noting that this can be problematic because “the way [dermatologists] approach people with acne and rosacea is slightly different.”