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
Dark skin prone to developing
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
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
number one complaint among dark-skinned patients with
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 30 or higher) helps resolve the spots more
quickly. Only sunscreen labeled “noncomedogenic” should be used.
“Noncomedogenic” means the product will not clog pores.
Acne treatments designed to dry the
skin should be use with caution.
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
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
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
Treatment. For pomade acne, treatment consists of these
If using pomade to decrease scalp
dryness, try applying pomade one inch behind the hairline.
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.
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
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.
Keloid may form after acne
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.
Bates, B. “Illegal Skin-Lightening Steroids Wreak Havoc.” Skin
and Allergy News: December 2003.
Taylor, SC et al. “Acne vulgaris in
skin of color.” Journal of the American Academy of Dermatology
content solely developed by the American Academy of Dermatology
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.