Acne Treatments in Skin of Color

Post-inflammatory hyperpigmentation - Photo © A.D.A.M.

Post-inflammatory hyperpigmentation is common in skin of color.  Photo © A.D.A.M.

Updated February 25, 2013.

As the landscape of America changes, more dermatologists are becoming aware of the differences in the skin of those of African, Asian, Latin/Hispanic, and Native American heritage. According to the American Academy of Dermatology, 35% of the U.S. population is persons of color. That figure is expected to rise to nearly 50% by 2050. For those with beautiful brown skin, acne presents unique challenges.

The Characteristics of Ethnic Skin

Ethnic skin varies in tone from light to very deep brown, depending on the amount of

melanin found. Melanin is the protein pigment responsible for coloring the skin, hair, and eyes. It is also the pigment that darkens the skin as it tans. Darker skin contains higher amounts of melanin than lighter skin.

When treating acne in skin of color, special care must be taken. It is often (wrongly) believed that darker skin is tougher than it’s lighter counterparts. Actually, brown skin can be very sensitive, and must be treated very gently.

Discoloration and Scarring is Common

While all skin colors are at risk for developing discolorations, brown skin is especially susceptible because of the higher amount of melanin found. Skin of color is more prone to dark spots or patches (hyperpigmentation), loss of skin color (hypo-pigmentation), and scarring. Acne and certain acne treatments can exacerbate discolorations.

It is especially important to avoid picking, squeezing, or otherwise irritating acne blemishes. Doing so can easily scar any skin color, but especially ethnic skin. Dark skin tones are prone to developing keloid scars. Keloids are large masses of tissue that develop after a wound heals. Keloid scars grow larger than the original wound.

More commonly, acne causes post-inflammatory hyperpigmentation. Post-inflammatory hyperpigmentation (PIH) is the natural response of the skin to a wound, such as a cut, scratch, or acne blemish. After the wound heals, a darkened spot or patch remains. This patch can range from very light and faint to very dark and obvious.

It is important to note that certain acne treatment products can cause skin discolorations in persons of color. Any product that causes dryness or irritation puts the user at risk for hyperpigmentation, or darkening of the skin. Special care must be taken when using retinoids such as Retin-A or Differen gel, benzoyl peroxide, and other such topical treatments. If excessive dryness, burning, or irritation occurs, tell your doctor right away.

What Can I Do About Discoloration?

Hyperpigmentation is the most common complaint among people of color who suffer from acne. The discoloration can be quite pronounced and widespread. While most hyperpigmentation will gradually fade over time, it can be severe enough to cause embarrassment and affect the self-esteem of sufferers.

There are many over-the-counter and prescription lightening creams available to help fade discolorations more quickly. Some prescription acne creams can also help lighten hyperpigmentation while healing breakouts. You best solution is to talk to your doctor. He or she will be able to suggest appropriate products to make post-inflammatory hyperpigmentation disappear.

People with brown skin often forgo sunscreen; however, regular sunscreen use may help dark spots to fade more quickly. Many dermatologists find sun exposure increases fading time. If you have hyperpigmentation spots, daily application of a noncomedogenic sunscreen with SPF of at least 15 may be helpful.

The Effects of Hair and Skin Care Products

Surveys have shown nearly half of all acne patients with ethnic skin use pomade, or other oils and ointments, for their hair. More than 70% of these patients developed acne on the forehead. Oil-based hair products can easily block pores, creating acne breakouts. Pomade-induced acne, or acne cosmetica , consists of blackheads , whiteheads , and general “bumpiness” along the forehead, temples and hairline.

Once the use of oil-based hair products is stopped, acne readily clears. However, many people find hair pomades are a necessity because of dry scalp, dry hair, or to help make hair manageable. If this is the case, avoid applying the product where it can come in contact with the forehead or temples. Doctor Susan Taylor, author of “Acne Vulgaris in People of Color,” recommends applying pomade at least one inch behind the hairline, or applying only to the ends of the hair. Use as little product as possible to get desired result.

Dry or “ashy” skin is common among dark skin tones. If you are prone to acne, choose your moisturizing products carefully. Certain creams and lotions, such as cocoa butter, can clog pores and make acne worse. Always choose light, oil-free moisturizers that are labeled noncomedogenic.

Source: Taylor SC, Cook-Bolden F, Rahman Z, Strachan D. “Acne vulgaris in skin of color.” Journal of the American Academy of Dermatology (2002); 46 (2): S98-S105.