Leading dermatology expert Dr. Hilary Baldwin, Medical Director of Atlantic Health's Acne Treatment & Research Center, has challenged long-held assumptions about rosacea, highlighting its significant prevalence among patients of color and emphasizing the need for improved diagnostic approaches.
Recent epidemiological data reveals that rosacea affects approximately 10% of the US population, with notable presence across diverse ethnic groups. According to US National Ambulatory Medical Care Survey data from 1993 to 2010, 2% of rosacea patients were Black, 2.3% were Asian or Pacific Islander, and 3.9% were Hispanic or Latino. Global statistics indicate an even more substantial impact, with an estimated 40 million patients of color affected worldwide.
"I've practiced my whole life in the heart of Brooklyn, and if it only happened in women of Northern European descent, I wouldn't be here talking about rosacea," Dr. Baldwin emphasized, directly challenging traditional perspectives.
Diagnostic Challenges in Darker Skin Tones
The primary challenge in diagnosing rosacea in patients with darker skin stems from the difficulty in detecting erythema (skin redness). This has led to systematic underdiagnosis and delayed treatment. Dr. Baldwin advises clinicians to focus on other characteristic symptoms, including:
- Burning sensation
- Stinging
- Itching
- Skin sensitivity
- Ocular symptoms
"Bottom line, a diagnosis not considered is a diagnosis not made, so we really need to do a better job in this regard," Dr. Baldwin stated, highlighting the critical need for improved diagnostic awareness.
Treatment Approaches and Considerations
Treatment strategies remain consistent across all skin types, though special attention must be paid to product selection. The three most recently approved treatments showing particular promise include:
- Ivermectin cream 1%
- Minocycline foam 1.5%
- Microencapsulated benzoyl peroxide 5%
For patients facing access barriers to newer treatments, alternative options include over-the-counter 0.5% ivermectin lotions, skin barrier repair protocols, and oral medications such as sub-antimicrobial dose doxycycline or isotretinoin.
Essential Role of Skincare
Dr. Baldwin emphasizes the fundamental importance of proper skincare in rosacea management. Research demonstrates that appropriate skincare regimens can improve symptoms even without medication. Key recommendations include:
- Using non-alkaline, fragrance-free, emollient cleansers (pH 4-6)
- Applying quality silicone-based, fragrance-free moisturizers
- Utilizing tinted physical sunblock
- Avoiding heavy cosmetics requiring aggressive removal
"The bottom line is no acne and no rosacea visit is complete until you discuss very good quality skincare," Dr. Baldwin concluded, underscoring the holistic approach needed for effective management.
This evolving understanding of rosacea's prevalence in diverse populations highlights the urgent need for increased awareness among healthcare providers and improved diagnostic protocols to ensure timely intervention across all patient groups.
