Rosacea in Skin of Colour: What It Looks Like and Why It’s Often Missed
- Debora Tentiș
- Apr 17
- 4 min read
Rosacea is often labelled as a condition that primarily affects fair-skinned individuals of Northern European descent — and while it’s more commonly diagnosed in this population, it absolutely affects people with darker skin tones as well.
The problem? It’s frequently overlooked, misdiagnosed, or dismissed altogether in Black, brown, and Asian patients. This leads to delayed care, unnecessary discomfort, and worsening of symptoms that could have been managed earlier.
Let’s break down what rosacea looks like in skin of colour, why it’s so often missed, and how to get the right support and treatment no matter your skin tone.
🔍 What Is Rosacea?
Rosacea is a chronic inflammatory skin condition that affects the face. Symptoms include:
Persistent redness or flushing
Bumps or pustules (similar to acne)
Visible blood vessels (telangiectasia)
Burning, stinging, or heat sensitivity
Eye irritation or dryness
Skin thickening (especially around the nose in later stages)
There are four subtypes: erythematotelangiectatic (ETR), papulopustular, phymatous, and ocular rosacea. But here’s the catch: in skin of colour, rosacea often doesn’t appear textbook.
🧑🏽⚕️ Why Rosacea is Underdiagnosed in Skin of Colour
Redness is harder to see.Rosacea’s most well-known symptom — redness — is less visible in melanin-rich skin. Flushing and erythema may appear as warmth, darkness, or a dusky hue rather than a classic red.
Medical training biases.Most dermatology training and image databases have historically featured light-skinned patients. This means doctors, aestheticians, and pharmacists may not be taught what rosacea looks like on Black or brown skin.
Misdiagnosis is common.In skin of colour, rosacea is often mistaken for:
Acne vulgaris
Seborrheic dermatitis
Lupus
Contact dermatitis
Hyperpigmentation from past inflammationThese misdiagnoses can lead to the wrong treatments — some of which may actually make rosacea worse.
Less frequent flushing reports.Flushing may not be noticed or described in the same way in darker skin tones. It may feel like warmth or tingling without obvious colour change, making early detection more challenging.
👀 What Rosacea Looks Like in Skin of Colour
Let’s explore what to look for — even when typical redness isn’t obvious:
1. Darker patches or a “smudgy” appearance
Instead of bright redness, you might see areas of warmth, darkening, or uneven tone on the cheeks or around the nose.
2. Bumps or pustules that resemble acne
Red or skin-toned bumps often appear on the cheeks, chin, or forehead. Unlike acne, there are no blackheads or whiteheads — and breakouts often worsen with heat, stress, or spicy food.
3. Burning or stinging with skincare products
If your skin often reacts to cleansers, toners, or SPF, it could be related to a damaged skin barrier — a hallmark of rosacea, even when flushing isn’t obvious.
4. Eye discomfort
Ocular rosacea can occur in any skin tone. Dry, gritty, or itchy eyes may be the only symptom in some patients.
5. Skin thickening over time
In untreated cases, thickened, bumpy texture may develop — especially around the nose. This is more common in men but can affect anyone.
💡 Real Patient Example
A 35-year-old woman of Indian descent visits a pharmacy complaining of acne that’s getting worse with her salicylic acid face wash. Her cheeks feel hot in the evenings, her eyes are dry, and makeup now stings.
Diagnosis? Papulopustular rosacea — not acne.
Her treatment involved stopping all exfoliants, switching to gentle, barrier-repair skincare, daily SPF, and adding azelaic acid under pharmacist supervision. Within weeks, her symptoms were under control.
This scenario is far more common than people think.
🩺 Getting the Right Diagnosis
If you suspect rosacea but aren’t sure:
Track your triggers (heat, food, stress, skincare, sun)
Pay attention to sensations, not just appearance (burning, tingling, dryness)
Ask your pharmacist or GP about rosacea, even if you don’t see redness
Avoid acne products unless your healthcare provider confirms they’re appropriate
Request a referral to a dermatologist familiar with diverse skin tones if needed
🧴 Tailored Treatment for Skin of Colour
The principles of rosacea care are similar for everyone, but in skin of colour, extra care is needed to protect against:
Post-inflammatory hyperpigmentation (PIH)
Barrier disruption from over-exfoliation
Irritation from strong actives
Best practices:
Stick to fragrance-free, alcohol-free, and essential oil–free skincare
Use mineral or hybrid SPF to avoid irritation
Consider azelaic acid, which treats bumps, redness, and pigmentation
Be cautious with laser or light treatments — only see a practitioner trained in treating darker skin
Support the skin barrier first with ceramides, oat, niacinamide, or panthenol
Rosacea doesn’t look the same for everyone — and that’s especially true in skin of colour. If you’ve been dismissed, misdiagnosed, or told your symptoms “don’t look like rosacea,” you’re not alone. The medical community is still catching up in recognising and treating rosacea across all ethnicities.
You know your skin best. If something doesn’t feel right — if you’re sensitive, breaking out, or constantly reacting — it’s worth exploring whether rosacea could be the cause.
With the right diagnosis, calming care, and trigger awareness, your skin can thrive — no matter your skin tone.
Comments