Complexities of Rosacea: Inflammatory Response in Melanin Rich Skin

Wilson, Shanice

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Date Uploaded: 05/13/2026
Date Modified: 05/13/2026

Rosacea is a chronic inflammatory skin disorder commonly characterized by centrofacial erythema, papules, pustules, vascular instability, and ocular involvement. Although extensively studied in lighter skin tones, significant disparities remain in the diagnosis, detection, and treatment of rosacea in individuals with skin of color. This review examines current literature regarding rosacea in melanin-rich skin with emphasis on prevalence, biomarkers, pathophysiology, diagnostic challenges, Demodex folliculorum involvement, and treatment approaches. Current diagnostic standards rely heavily on visible erythema and telangiectasia, which are often less apparent in darker skin tones, contributing to underdiagnosis and delayed treatment. Research also suggests differences in inflammatory biomarkers, post-inflammatory hyperpigmentation, and vascular responses in skin of color. Treatment methods including topical therapies, lifestyle modifications, and laser-based thermal therapies are reviewed alongside their limitations and risks in melanated skin. Emerging diagnostic technologies, such as computer-aided imaging systems and biomarker-based approaches, demonstrate potential for improving diagnostic accuracy across diverse populations. Overall, this review highlights the need for more inclusive research, improved clinical education, and culturally competent diagnostic criteria to better address rosacea in underrepresented populations and reduce disparities in dermatologic care.

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