Acne affects all skin types, tones, and colors. An international study of nearly 3,000 people found that both comedonal acne (blackheads and whiteheads) and inflammatory acne (pimples) have similar prevalence among all different ethnicities;
- Black: 37%
- Hispanic: 32%
- Asian: 30%
- White: 24%
What causes acne in dark skin?
The way acne develops is the same in all racial and ethnic groups.
- First, there is a proliferation of cells that line the sebaceous glands, which leads to the formation of comedones, which plug and obstruct the flow of the sebum.
- Second, there is an overproduction of sebum caused by excess circulating androgens (male hormones).
- Third, Propionibacterium acnes (p. acnes bacteria) proliferation in the obstructed, enlarged sebaceous gland.
- Fourth, the resulting inflammation around the sebaceous gland then produces the infamous, painful pimple.
- Finally, for some, this inflammation later leads to post-acne dark spots and, sometimes, scaring.
For people with darker skin tones, it is even more crucial to prevent future breakouts as this skin is more prone to post-acne dark spots (also referred to as post-inflammatory hyperpigmentation, or PIH - which can be treated with a dark spot remover but are best avoided altogether) and atrophic scars, which were more common in Black and Hispanic skin than other ethnicities. For those with dark skin, this post-acne pigmentation was reportedly the main reason they sought acne treatment.
Products to avoid for people with dark skin and acne
Skincare Products: For people with dark, acne-prone skin, it’s important to discontinue toners, astringents, exfoliants, and rubbing alcohol, which often leads to skin dryness and irritation (particularly when combined with topical acne medications).
Cosmetics: While managing acne, it's also important to avoid other cosmetics, including makeup and hair care products that can lead to clogged pores, such as hair gel, hair spray, and oil-based makeup
The best acne treatment for people with dark skin and acne
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 skincare 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.
- In more severe cases, oral therapies should be considered in addition to a topical acne treatment program. These include oral antibiotics (Doxycycline, Minocycline, and others), Accutane (Isotretinoin), and hormonal modulators for women (oral contraceptives, Spironolactone).
How to treat post-acne scars and hyperpigmentation in dark skin
Hyperpigmentation: The best treatment for post-acne dark spots and hyperpigmentation in dark skin is with a medical-grade skin lightening agent such as the Advanced Dark Spot remover.
Scars: Depressed acne scars do not respond to topical solutions that 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 effects. It is more safe and effective than fractional laser and is commonly used in Asian and darker skin types. Treatment of hypertrophic scarring and keloids typically intra-lesional injection of triamcinolone acetonide 20, 30, or 40 mg/mL every 4 weeks until the lesion is flat.
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