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INTRODUCTION
Rosacea was once thought to be a disease of northern European origin, but this view is now being disputed because individuals of any racial/ethnic group have been shown to be afflicted. 1, 2 The true incidence of rosacea in people with dark skin has yet to be identified. Some reports assert that approximately 4% of rosacea patients are of African, Latino, or Asian descents. 3, 5 Recently, Al-Dabagh et al analyzed the 1993-2010 data from the National Ambulatory Medical Care Survey (NAMCS) in the United States for visits associated with the diagnosis of rosacea in different racial and ethnic groups. 6 The data indicated 980 visits for rosacea per 100,000 whites in 2000 compared to 130/100,000 for blacks, 430/100,000 for Asians and Pacific Islanders, and 370/100,000 for Hispanics and Latinos. The prevalence of rosacea visits did not change over time. Fewer rosacea visits may denote that patients with darker-colored skin may not be bothered by subtle changes in their skin, leading to fewer physician visits, or they may not be diagnosed with rosacea even when they have symptoms suggesting it. 6
Arabs are part of the Caucasoid race that includes some or all of the population of Europe, North Africa, the Horn of Africa, Western Asia (including the Middle East), and South and Central Asia. The report of Khaled et al from Tunisia, North Africa, of 224 cases of rosacea and a hospital prevalence of 0.2% in a population mostly comprised of darker skin types establishes rosacea as a frequent dermatosis. 7 This study describes the clinical features of rosacea in dark-skinned people and highlights the peculiarities of the disease in the Caucasoid/Saudi ethnic group.
METHODS
This prospective study included patients diagnosed with rosacea at the Dermatology Clinic in King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia, who were seen between February 2010 and May 2011. The study included 50 patients of variable skin types, ranging from type 4 through 6. We adopted the skin phototype system for classifying the skin types: type 4 (light brown), type 5 (brown), and type 6 (dark brown or black). 8 A detailed history of rosacea was obtained from each patient, including the duration, exacerbating factors (including sunlight, heat, cosmetics, spicy food, and others), family...