Rosacea in Dark Skin: Recognition and Treatment

Rosacea is a chronic inflammatory skin condition, particularly visible on the face. Typical symptoms are redness, visible blood vessels, bumps, and pimples. Although rosacea is often associated with light skin, it also occurs in people with dark skin. Recognizing and treating rosacea in dark skin brings specific challenges.

What is meant by a ‘dark skin’?

In dermatology, the skin is often classified according to the Fitzpatrick scale, which distinguishes six skin types based on skin color and reaction to sunlight:

• Type I: Very light skin, always burns, never tans.
• Type II: Light skin, burns easily, tans minimally.
• Type III: Lightly tinted skin, sometimes burns, gradually turns brown.
• Type IV: Moderately brown skin, rarely burns, easily tans.
• Type V: Dark brown skin, rarely burns, tans very easily.
• Type VI: Very dark or black skin, never burns, tans very easily.

A ‘dark skin’ usually refers to skin types IV to VI.

Challenges of Rosacea on Dark Skin

In people with dark skin, recognizing rosacea can be difficult. The typical redness that is often seen as the first symptom is less visible on pigmented skin. As a result, rosacea is less noticeable and the diagnosis can be missed or confused with another skin condition.

Instead of visible redness, rosacea in darker skin is more often characterized by a burning sensation, increased sensitivity, or dry skin. The symptoms can strongly resemble other skin conditions such as acne, seborrheic eczema, or lupus erythematosus, increasing the risk of misdiagnosis.

In addition, post-inflammatory hyperpigmentation (PIH) — dark discolorations that remain after inflammation — occurs more often in a dark skin during inflammations. These pigment spots can obscure the underlying skin image, making rosacea even more difficult to recognize.

Dermatological treatments for rosacea on dark skin

The treatment of rosacea in a dark skin requires a cautious and thoughtful approach, taking into account the risk of pigment changes.

Creams and gels for external use

Remedies such as metronidazole and ivermectin are often used to reduce redness, inflammation, and bumps in rosacea. They are generally well tolerated, even by people with dark skin.

Azelaic acid is also regularly mentioned because of its dual action: it inhibits inflammation and helps fade pigmentation spots – such as post-inflammatory hyperpigmentation (PIH). That sounds beneficial, especially for people with a pigmented skin, who may be more prone to dark discoloration after inflammation.

Caution is advised. In practice, I see that azelaic acid can cause irritation more quickly on dark skin, such as a burning or tingling sensation, redness, or flaking. That irritation can in turn cause pigment shifts – the opposite of what you want to achieve. Its use must be carefully matched to the skin type and sensitivity of the user.

Medication

In cases of more severe or long-term forms of rosacea – especially when there are signs of inflammation such as bumps, pimples, or diffuse redness – treatment with oral antibiotics may be considered. In dermatological practice, drugs such as doxycycline or minocycline are often prescribed.

Although they are officially antibiotics, these agents are primarily used in rosacea for their anti-inflammatory effects, that is, for suppressing inflammation, rather than fighting bacteria. In low doses, they have anti-inflammatory effects without a classic antibiotic effect, reducing the risk of resistance.

This treatment can be particularly useful for:

• papulopustular rosacea (the variant with inflammation and bumps)
• rosacea that does not respond well to local therapies
• inflammation due to hormonal fluctuations or external stimuli

The duration of the treatment varies, but is usually kept limited (for example 6 to 12 weeks), after which it is evaluated whether maintenance with local means is sufficient. Sometimes a maintenance dose of 40 mg doxycycline is used, specifically formulated for rosacea, which keeps the inflammation under control without heavily burdening the microbiome of the intestines.

Light and Laser Treatments

Laser and light treatments can be a valuable addition in the treatment of rosacea or pigment problems, but with a dark skin, this requires extra care. Since there’s naturally more melanin present, there is a greater risk of unwanted pigment changes – such as hyperpigmentation (dark spots) or hypopigmentation (lighter spots).

Treatments such as IPL are used less often on darker skin, as this light source is less specific and can cause pigment reactions more quickly. Pico-lasers (such as the picosecond laser) offer a more suitable option in this regard. They work with ultra-short pulses that can specifically target pigment, with less heat development in the surrounding skin, making it safer for skin types with more pigment.

Lifestyle Changes

Lifestyle habits also play an important role. Try to avoid triggers such as spicy food, alcohol, temperature changes, and stress, as these factors can aggravate rosacea. By paying attention to both skincare and lifestyle, flare-ups can be better managed.

Cosmetic product use for dark skin

In the care of rosacea, one standard approach is often followed, but there are important differences in how rosacea presents itself and should be treated in people with a light versus a dark skin. Although the general goals of skin care remain the same – namely, calming the skin, strengthening the skin barrier, and reducing inflammation – there are specific points of attention for pigmented skin that should not be overlooked.

Pigmentation Spots

People with darker skin naturally have a more active melanin production. This means that any form of inflammation or irritation, such as that which occurs with rosacea, can quickly lead to PIH: dark spots that often remain visible longer than the original redness or inflammation. Therefore, it is especially important to choose mild, non-irritating skincare products that are also pigment friendly. Ingredients like niaciamide, resveratrol, emblica are often suitable, as they work both anti-inflammatory and pigment lightening – provided they are applied correctly and gradually.

Being Extra Kind to the Skin

Not every ingredient labeled as ‘mild’ is automatically suitable for everyone. Especially with darker skin, the sensitivity to irritation and pigment shift can be greater. Strongly-acting acids such as glycolic acid, or high concentrations of retinol can upset the skin balance.

A gentler alternative are PHAs (polyhydroxy acids). Unlike their ‘big brother’ AHAs, they penetrate the skin less deeply and therefore cause less irritation. They exfoliate in a mild manner and help improve skin texture, without damaging the skin barrier.

Also bakuchiol, a plant-based alternative to retinol, is a suitable choice. It supports skin renewal and collagen production, but is more tolerable – even for people with sensitive or pigmented skin.

Sun Protection, But Just a Bit More

Sun protection is an important part of rosacea care, regardless of skin type. But with dark skin, there’s more at stake than just protection against UV rays. According to research , dark skin can also react sensitively to visible (blue) daylight, which contributes to pigment stimulation – factors that can cloud the complexion.

Therefore, it is especially important for dark skin to choose a sunscreen that not only provides broad-spectrum UV protection, but also protects against visible light. Products with mineral filters such as zinc oxide, titanium dioxide, and iron oxides are a good choice: they cause less irritation, are non-comedogenic (do not clog pores), and work immediately after application. These ingredients provide extra protection against visible light, especially in dark skin types where pigment shift occurs quickly.

Do you want to read more about: Visible light and its effect on the skin

Dark Skin, Different Hydration Needs

Hydration is also an important point of attention. Darker skin types often have a drier skin barrier, which makes the skin feel tight and sensitive faster. Creams with glycerine, ceramides and ectoine are extremely suitable: they hydrate deeply, strengthen the skin barrier and at the same time reduce sensitivity without feeling greasy or heavy.

Finally, makeup use plays a role, especially when pigment spots or papules are visible. Preferably use makeup products that are non-comedogenic, oil-free, and fragrance-free. Soothing water-based foundations are a good choice and can be safely combined with a skincare routine focused on rosacea.

FAQ – Rosacea in Dark Skin

Can rosacea occur on dark skin? Yes, rosacea can occur on all skin types, including dark skin types, although it is diagnosed less often.

How can I recognize rosacea on dark skin? Look for symptoms such as heating feeling, swelling, bumps, pimples, and visible blood vessels in the face, even if redness is less noticeable.

Are the treatments for rosacea the same for all skin types? The basic treatments are similar, but extra caution is needed with dark skin to avoid pigment changes.

Is laser therapy safe for dark skin? Laser therapy can be effective, but there is an increased risk of pigment changes. It is crucial to consult a specialist who has experience treating dark skin.

What role does the Fitzpatrick scale play in the treatment of rosacea? The Fitzpatrick scale assists dermatologists in assessing the risk of side effects and selecting the most suitable treatment options for different skin types.

Now that you’re here

Rosacea is more than just a skin condition. Although redness, bumps and visible blood vessels on the face are the most well-known characteristics, recent studies suggest that rosacea may also be linked to other physical conditions. Think of respiratory allergies, asthma, intestinal problems such as irritable bowel syndrome (IBS), hormonal disruptions, high blood pressure, or even autoimmune diseases such as type 1 diabetes and rheumatism. Psychological complaints such as anxiety and depression also occur more frequently in people with rosacea. Curious about the possible links? Click further and discover how rosacea is related to your overall health.