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AcneNet
Update
Treating Acne in Skin of
Color
Whether it’s a few pimples
or severe acne, there are five key factors that people with skin of
color, especially those of African descent, should know before they
begin acne treatment. Considering these factors can help individuals
with skin of color make informed decisions about their treatment options
and obtain better results.
Five Key Factors
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Dark skin prone to
developing “dark spots.”
These darkened spots on the skin, which dermatologists call
“post-inflammatory hyperpigmentation,” can occur at the site of a healed
or healing inflamed acne lesion. Caused by excessive
melanin production, this darkening
of the skin is a normal reaction when dark skin becomes inflamed, such
as after a rash, scratch or pimple. While these spots tend to gradually
disappear over time, they are the No.1 complaint among dark-skinned
patients with acne vulgaris.
Like acne, “dark spots” can diminish one’s self-esteem and affect a
person’s ability to function confidently in society.
How to treat “dark spots.” When these spots appear, they can be
treated with a topical skin-lightening product. Some skin-lightening
agents are available over-the-counter, and stronger forms can be
obtained from a dermatologist. Dermatologists can also recommend
cosmetic tips that will make the spots less apparent. Additionally, some
topical acne treatments used by dermatologists may help fade the
discoloration.
Sunscreen may help. Although there are no clinical studies to
confirm this, some dermatologists find that repeated sun exposure leads
to longer treatment time and that daily use of sunscreen (SPF of 15 or
higher) helps resolve the spots more quickly. Only sunscreen labeled
“noncomedogenic” should be used. “Noncomedogenic” means the product will
not clog pores.
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Acne treatments designed
to dry the skin should be use with caution.
Consumer Alert
Before trying a skin-lightening product that you have not used before, you
may want to consult a dermatologist. Several potentially harmful
skin-lightening products are entering the United States. These products have
the potential to worsen acne and can cause other skin conditions, such as
severe dermatitis and rosacea. |
Acne medications that can have a drying effect on the skin, such as
benzoyl peroxide, should only be used under the supervision of a
dermatologist as these medications may irritate the skin and prolong
post-inflammatory hyperpigmentation in some cases. Benzoyl peroxide can
also decolorize skin.
Topical acne medications for skin of color. Clinical studies show
that some topical medications, such as retinoids, safely and effectively
treat acne in skin of color without the drying effects when used
properly. Topical retinoids, which are only available by prescription,
include adapalene, tazarotene and tretinoin.
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Pomade may be the culprit.
A recent survey of acne patients with skin of color revealed that almost
half, 46.2%, use pomade (oil or ointment for hair) to style or improve
the manageability of their hair and that 70.3% of the patients using
pomade developed forehead acne. The acne that develops from using pomade
is called “acne cosmetica” or “pomade acne.” It occurs when pomade
blocks pores and acne develops on the scalp, forehead and/or
temples—places where pomade comes into contact with the skin. Pomade
acne usually consists of blackheads and whiteheads, with perhaps a few
papules and
pustules.
Treatment. For pomade acne, treatment consists of these
options:
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If using pomade to decrease scalp dryness, try applying pomade
one inch behind the hairline.
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If using pomade to style or
make hair more manageable, try applying pomade to the ends of the hair
only to avoid contact with the scalp and hairline.
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Stop using pomade.
Once use of pomade stops,
pomade acne should clear. If it persists, be sure to see a
dermatologist.
Folliculitis. Pomade
can also contribute to a bacterial infection of the scalp called “folliculitis,”
in which pus bumps and redness develop around the hair. Folliculitis can
cause hair loss and the spread of infection. If folliculitis is
suspected, discontinue using pomade and see a dermatologist.
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Moisturizers can worsen
acne.
Moisturizers relieve the dry or “ashy skin” that is common among
dark-skinned people. When using moisturizer, make sure the label
includes the word “noncomedogenic.” This means the product will not clog
pores. If acne gets worse after moisturizing with a product labeled “noncomedogenic,”
discontinue moisturizing and seek the advice of a dermatologist.
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Keloid may form after
acne outbreak.
When scarring occurs in a person with skin of color, there is a greater
tendency for a keloid (large raised scar that spreads beyond the size of
the original wound) to form. While uncommon in acne patients with skin
of color, keloids have been seen on the chest, back and jaw line. Early
and aggressive acne treatment is needed to prevent scarring because
keloids, unfortunately, tend to return even when treated.
Treatment. Scar treatment should be discussed with a
dermatologist or dermatologic surgeon before it is undertaken. Depending
on the location, treatment may involve pressure, silicone gels, surgery,
laser treatment or radiation therapy.
Before beginning any acne
treatment, be sure to consider these key factors and direct your
questions to a dermatologist. But, don’t delay treatment as
dermatologists recommend early and aggressive acne treatment in skin of
color to prevent scarring and darkened spots from developing.
References
Bates, B. “Illegal Skin-Lightening Steroids Wreak Havoc.” Skin and
Allergy News: December 2003. p. 5
Taylor, SC et al. “Acne
vulgaris in skin of color.” Journal of the American Academy of
Dermatology 2002: 46:S98-S105.
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