How Rosacea Can Appear Differently on Black Skin

Rosacea can present distinct signs and may need tailored care in individuals with darker complexions.

Rosacea is a long-term skin disorder where the skin — most often on the nose, cheeks, and forehead — looks flushed and red and can develop pus-filled bumps. There are several rosacea subtypes, and some produce symptoms beyond mere redness.

Below, we cover key information about rosacea in Black people and people of color, including possible causes, common signs, and treatment choices.

Can Black people get rosacea?

Yes. Although rosacea seems to be reported more frequently in people with lighter skin, experts believe it is often missed or underrecognized in Black individuals.

A major reason is that rosacea can manifest differently on darker skin tones, making it harder to identify.

How does rosacea appear on Black and Brown skin?

When describing skin conditions — including rosacea — medical literature has traditionally focused on lighter skin. For example, a common descriptor for rosacea is “red or flushed skin.”

However, inflammatory skin problems don’t always look pink or red on darker skin. In fact, rosacea is often underidentified in Black people because its appearance can differ on darker complexions.

Rather than pink or red patches on the nose or cheeks, rosacea in people of color may cause these areas to look dusky or darker. Flares can seem purplish or simply discolored compared with your normal skin tone.

Other signs of rosacea in Black skin and skin of color can include:

• facial flushing
• visible broken blood vessels
• dry, rough, or scaly patches
• sensitive, burning, or swollen skin
• subtype 2: acne-like pimples
• subtype 3: thickening of nasal skin
• subtype 4: eye irritation or swelling

Severity varies from person to person. Some studies even indicate that certain features might be more common in people of color.

A 2019 review reported that facial redness was less frequently noted among people of color with rosacea. Instead, lesions around the mouth, nose, and eyes and acne-like bumps (papules and pustules) were more commonly seen in these populations.

The review also found people of color were more prone to post-inflammatory hyperpigmentation. Hyperpigmentation causes darker patches of skin, which can further obscure other features of rosacea, such as redness.

What causes or triggers rosacea?

Medical professionals don’t yet know the exact cause of rosacea, but multiple contributors seem involved, including genetics and environmental exposures. These influences appear to be similar regardless of skin tone.

Beyond potential causes, there are specific factors that can provoke flares and affect symptom severity — these are called triggers.

According to the American Academy of Dermatology Association (AAD), common rosacea triggers include:

• sun exposure
• harsh weather conditions
• stress
• spicy foods
• alcohol
• coffee or tea
• personal care products
• makeup
• physical exertion
• certain medications
• microbial organisms

While triggers differ between individuals, skin color does not seem to determine what will trigger flares.

How is rosacea treated on Black or Brown skin?

Treatment for rosacea is largely the same across skin tones, although some approaches may be adjusted to lower the risk of hyperpigmentation in darker skin.

Medications

Topical, oral, and systemic drugs can help control rosacea symptoms like redness and lesions.

Medication choices usually depend on the specific signs being targeted, but may include:

• antibiotics
• acne treatments
• anti-inflammatory agents
• antihistamines
• beta-blockers

Keep in mind some rosacea medications can raise the chance of hyperpigmentation in Black skin and other skin of color. Discuss any concerns with your doctor or dermatologist.

Light and laser therapies

Phototherapy, which uses various wavelengths of light to reduce skin inflammation, is a common treatment. Laser treatments likewise use concentrated light to address redness, inflammation, and skin thickening.

Stronger light or laser procedures can carry a greater risk of scarring or hyperpigmentation in people with darker complexions. Consult a dermatologist to fully understand risks before undergoing any such procedures.

Lifestyle adjustments

One of the most effective ways to manage rosacea is adopting lifestyle measures that reduce flares. Helpful steps include:

• Identifying and avoiding triggers: Triggers vary by person, so pinpointing and steering clear of yours can lessen flare-ups.
• Maintaining a gentle skincare regimen: Steering away from harsh ingredients in personal care products can lower irritation while keeping skin clean and hydrated.
• Using sun protection outdoors: Sunlight is a frequent rosacea trigger; protecting your skin can cut this risk.

Culturally competent care for rosacea

Diagnosing and managing rosacea on Black and brown skin requires specific expertise. That’s why access to diverse, culturally aware clinicians matters. Although a small portion of U.S. physicians identify as Black, many groups are working to increase diversity in dermatology.

Ask your primary care provider for referrals or resources to find Black dermatologists or culturally competent specialists in your area.

Takeaway

Rosacea is a common inflammatory skin disorder but is frequently underrecognized in Black people and people of color. While redness and flushing are typical signs, other manifestations — such as acne-like lesions and hyperpigmentation — are common in darker skin.

If you notice new symptoms like darkened patches, acne-like bumps, or other skin changes, consult a healthcare professional to discuss evaluation and care.