Acne in Skin of Color

Skin of color has special qualities that affect not only the manifestations of acne, but also the treatment. One of the most important features of acne in skin of color is the darkening of the skin... or staining... called post inflammatory hyperpigmentation. In fact, it's often even more bothersome than the actual acne. I'll discuss both today.

Most of the acne studies in skin of color are in African American and Hispanic skin.

In African American skin, cystic acne is much less common than in Caucasian skin, which may be a result of racial differences in the structure of the hair follicle. In a study involving about 3,000 patients, in African Americans, 1/3 had active acne but 2/3 had dark staining from previous outbreaks. And that staining was more bothersome than the active acne to many patients. In the same study in the Hispanic patients, 1/3 again had active acne and 1/2 had dark staining.

In skin of color, post inflammatory hyperpigmentation occurs from almost all types of acne lesions, whether they're the inflammatory lesions of pus pimples, red pimples and cysts, or the non inflammatory blackheads and whiteheads. But in Caucasian skin, that dark staining usually only occurs from the inflammatory lesions.

It was found that in African Americans, the higher use of hair pomades strongly contributes to the increased occurrence of blackheads and whiteheads on the forehead at the hairline. As heat is normally lost from the head it melts the pomade coating the hair and scalp which then invisibly flows down the hair shaft and onto the forehead, causing clogs.

Treatment of acne in skin of color is similar to acne in Caucasian skin with two important exceptions. Retinoids and benzoyl peroxides, both staples of many types of acne treatment, are more often irritating in skin of color... and that irritation is another source of post inflammatory hyperpigmentation. Accordingly, those two treatments must be used at low dose initially to insure they don't cause irritation before increasing dosage.

And very importantly in skin of color is the treatment of the hyperpigmentation which requires the usual triad of:

First... strict sun protection, but the sunscreen must be water based or non-comedogenic to not aggravate the acne.

Second... exfoliation, and here the gentle nature and efficacy of buffered glycolics is superior in my opinion to retinoids and benzoyl peroxide which have a potential for irritation and subsequent hyperpigmentation.

And third, a bleach such as peptide based products which don't cause halo depigmentation of normal skin surrounding the darkened area.

But one more tip. Stay focused and get rid of your active acne which is causing your staining... before you treat your stains.

Regardless of your skin color, acne is very frustrating. Treat it early and regularly and consult a professional if necessary, for the best results.