AcneNet Article
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

1. 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 number one 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.
    

2. 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 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.

    

3. 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:

   • 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 dermatologist.

4. 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.
    

5. 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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