Acne affects all skin types and colors. An international study of nearly 3000 people found that comedonal and inflammatory acne’s equally prevalent among black, Hispanic, white and continental Indian communities.
The breakdown for acne was this:
Post-acne brown spots (Post-inflammatory hyperpigmentation, or PIH) and atrophic scars were more common in black and Hispanic females than other ethnicities. For many people with dark skin, this post-acne pigmentation was the main reason they sought acne treatment.
The way acne develops is the same in all racial and ethnic groups: First, a proliferation of cells that line the sebaceous glands duct lead to the formation of comedones (That plug and obstruct the flow of the sebum). Then, there’s an overproduction of sebum by circulating androgens. Next, there’s a proliferation of Propionibacterium acnes in the obstructed, enlarged sebaceous gland, and then inflammation around the sebaceous gland that produces the infamous red and painful pimple. This inflammation will later lead to brown spots and possible scarring.
The first step in acne treatment for people with dark skin should be a revision of daily skincare and hair treatment routines. If you’re suffering from acne, ask yourself these questions:
Which skin and hair care products do I use?
What cosmetic products or makeup do I use?
Do I use sunscreen? Any skin lightening creams?
Do I have a history of keloids?
It’s important to discontinue use of toners, astringents, exfoliants and rubbing alcohol, which may lead to skin dryness and irritation (Particularly when combined with topical acne medications).
Treatment of acne in people with darker or Asian skin types is similar to fair skin patients with some special considerations:
Acne should be treated early and aggressively to prevent or minimize subsequent brown spots (PIH) and acne scarring.
To reduce the risk for PIH, topical skin care should be effective but non-irritating.
Patients should always use oil-free sunscreen each morning and avoid greasy hair products or peeling agents and exfoliators — that’s an absolute must
There are more options for treatment, too! Superficial chemical peels such Jessner’s peels as can be used to treat acne and PIH in SOC patients. Depressed acne scars are best treated non-invasively by microneedle radiofrequency devices. This procedure produces microscopic columns of thermal injury in the epidermis and dermis, sparing the surrounding tissue and minimizing downtime and adverse events. This technology has been shown to be more safe and effective than fractional laser and is commonly used in Asians and darker skin types. Treatment of hypertrophic scarring and keloids involves intra-lesional injection of triamcinolone acetonide 20, 30, or 40 mg/mL every 4 weeks until the lesion is flat.