An Interview With Dr Thivi Maruthappu

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I am always trying to learn more about rosacea, especially when it comes to the aspects of rosacea I haven’t experienced first hand. So when I was planning my content for Rosacea Awareness Month 2022, I knew I wanted to write about rosacea in skin of colour as it’s a topic that is not spoken about enough, and often misunderstood and – worse – filled with mistruths. So when the incredible Dr Thivi Maruthappu got in touch with me and suggested we have a conversation about it, I was really excited.

I interviewed Dr Thivi over email and have included our full chat below. If there are any questions on this topic that you’d like to ask her, or any clarifications, please just let me know!

How does rosacea present in skin of colour?

Rosacea can present differently in skin of colour. The most common symptom of rosacea is flushing of the face, in darker skin tones the background melanin pigment can disguise the true redness of flushing. Redness may appear as a dusky tone instead.

The presence of [physical] symptoms can also be helpful in making a diagnosis of rosacea, such as burning or stinging after skincare products are applied. There may also be dryness and sensitivity. Breakouts – either bumps or whiteheads can also occur and easily be mistaken for acne. Eye symptoms such as dry, gritting eyes and inflamed eyelids are another sign of rosacea involving the eyes. 

A common phrase we hear is that rosacea is typically found in those with pale skin and light eyes. Do you think this is true or is it just easier to diagnose? Do we have any stats on how common rosacea is in darker skin?

Rosacea can easily be missed in skin of colour and awareness has only really increased over the last few years. There are approximate stats on how common it occurs in darker skin tones but it is likely that these are an underestimated. Studies suggest that around 5% of those with rosacea are darker skinned.

In lighter skin tones, sunlight is thought to be one of the triggers that can precipitate the onset of rosacea but we wonder whether this still holds true in skin of colour, where melanin affords natural SPF.

Do you think the media has a part to play in this (both the misdiagnosis and misinformation, and also any ongoing education)?

The portrayal of people with rosacea in the media has almost always referred to lighter skin tones. From my experience, people with skin of colour are also less likely to think that they have rosacea as a result, and often self-diagnose acne or eczema instead. Treatments for both of these conditions can actually make rosacea worse so increasing awareness and education is a key goal.

How is rosacea in skin of colour treated?

The management of rosacea doesn’t differ significantly between skintones, but there are some nuances. Nutrition and lifestyle advice in addition to skincare and prescription medical treatments are all important aspects of the holistic management of rosacea.

It can be tricky to find a broad-spectrum SPF suitable for sensitive skin that disappears into darker skin tones, from personal experience they can often leave a greyish/ashy hue.

Skin lightening creams can be a major trigger for rosacea, they can contain steroids which precipitate or worsen rosacea so stopping these is a priority.

Green-tinted creams are often suggested for rosacea to counteract the appearance of redness, in my experience this is less effective in skin of colour and I find yellow-tinted makeup more natural-looking.

What advice would you give to people wanting to discuss their rosacea with their doctor, particularly if their doctor doesn’t seem too knowledgeable about rosacea?

This is really important, particularly as some doctors may still not be aware themselves that rosacea affects people with skin of colour. I would make sure you have photos of flare ups on your phone and log your symptoms too. It may be that they cannot see the redness clearly but you know your skin better than anyone so explain that it is red for you.

Reading up on symptoms and signs is also helpful so you’re armed with the right information when you make your appointment. Opticians can also be helpful in picking up whether there are symptoms of rosacea in the eye – this can also help doctors with making the diagnosis.

Are there any sources or accounts you’d recommend people to look into if they would like more information on this topic?

American Academy Of Dermatology Association: https://www.aad.org/public/diseases/rosacea/what-is/skin-color

British Association Of Dermatologists: https://www.bad.org.uk/patient-information-leaflets/rosacea

Skin Of Color Society: https://skinofcolorsociety.org/patient-dermatology-education/rosacea/

FURTHER READING FROM LEX:

Black Skin Directory: https://www.blackskindirectory.com/bsd-learning-journal/2020/4/19/uxmvv9t8cwi20qh4xwwsu1exoqd8o2

Concealers and colour-correctors for skin of colour: https://www.byrdie.com/concealers-for-dark-skin

Yellow-toned make up recommendations: https://www.refinery29.com/en-gb/sunscreen-dark-skin

A huge thank you to Dr Thivi for her time and knowledge on this important topic. Rosacea Awareness Month is all about education, support, and (obviously!) awareness, so conversations like this are so necessary to make sure that all rosaceans are included in the conversation.

By the way, keep an eye on my instagram later this month as I’m going to be doing an Instagram Live with Dr Thivi which should be really interesting!

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Lex

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