According to the American Academy of Dermatology (AAD), acne is the most common skin condition among children and adults in the United States.
Acne presents as various types of blemishes, or “pimples,” that break out on the skin. These lesions can range from mild to severely inflamed.
Anyone can get scarring and hyperpigmentation from acne, regardless of their skin color. However, for Black people, scarring and hyperpigmentation may be more pronounced.
In this article, we will discuss how acne affects Black people, treatment options, and the importance of finding acne care catered to dark skin.
Acne is a skin condition characterized by inflammatory and noninflammatory skin lesions. Blackheads, whiteheads, papules, pustules, nodules, and cysts are all different types of acne lesions.
There are many causes of acne, including hormones, hygiene, diet, and more.
While acne affects any skin color, Black people are more susceptible to a condition called post-inflammatory hyperpigmentation.
Hyperpigmentation happens when certain areas of the skin appear darker than others. Post-inflammatory hyperpigmentation occurs as a side effect of inflammatory skin conditions, such as acne.
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Treatment for acne begins by visiting a healthcare professional who can review your symptoms and medical history to determine what kind of treatment you need. This can be your primary care doctor or a skin specialist called a dermatologist. For more severe acne cases, your primary doctor will likely refer you to a dermatologist.
According to the AAD, seeking early treatment for acne is especially important for Black people and can help prevent complications from acne, like scarring and dark spots.
Acne treatment is generally the same for all skin types. It typically includes topical, oral, or combination therapy, depending on the severity of the acne. However, some of these treatment options are also beneficial for fading acne scars on dark skin.
Treatment options for acne in Black people include:
Salicylic acid is a popular acne treatment option because it chemically exfoliates the skin to keep the pores clear. Chemical exfoliation is an important treatment for acne in dark skin because it reduces the chance of acne lesions developing in the first place.
Many people with dark skin wonder whether benzoyl peroxide will bleach or change the color of their skin. According to the AAD, this is a myth. Benzoyl peroxide will not cause light patches or change the color of skin.
Retinol and retinoids
Retinoids are vitamin A derivatives that can be used as a treatment option for acne. They improve the overall health of the skin, thus reducing the appearance of scars and blemishes.
Retinol is commonly found in over-the-counter (OTC) products. Prescription-strength retinoids may be prescribed by a primary care doctor or dermatologist for more severe acne and scarring.
Oral medications are often prescribed if topical treatments are not effective. These medications may be prescribed with other treatment options and include:
- Antibiotics. Generally, antibiotics to help treat acne are taken daily. They include antibiotics like tetracyclines (minocycline, doxycycline) and macrolides (erythromycin, azithromycin). You may also be prescribed a topical cream or gel as well.
- Hormone therapy. Addressing hormone levels can help prevent or control acne flare-ups, especially those that occur around mensuration. Birth control pills may help prevent flare-ups that occur during periods, but it may take up to a year to see results. Spironolactone, another hormone medication, may help women with acne that hasn’t improved with other therapies. It’s important to use birth control while taking spironolactone because it can cause birth defects.
- Isotretinoin. Also known as Accutane, isotretinoin helps improve acne by reducing the size of the glands in your skin that produce oil and by helping prevent skin cells from blocking pores. It’s usually prescribed for people with severe cystic acne. It can have significant side effects. It’s important not to become pregnant while taking isotretinoin because it can cause birth defects in a developing fetus. People prescribed isotretinoin must participate in the iPledge program to help prevent birth defects from isotretinoin.
Other treatment options
There are other treatments that may also help reduce acne scarring, especially for Black people, including:
- Other topical acids. Acids, such as azelaic acid, ascorbic acid, and linoleic acid, have been
shown to reducehyperpigmentation from acne.
- Chemical peels. Under the care of a skilled dermatologist with experience treating people with dark skin, chemical peels can be helpful for hyperpigmentation. A chemical peel uses acids at stronger concentrations to remove the epidermis and, in some cases, deeper layers of the skin to treat hyperpigmentation.
- Light therapy.Using pulses of various wave lengths of light, light therapy can target specific layers of the skin to help improve acne and hyperpigmentation.
No matter what treatment options you choose, they should aim to treat the acne while also reducing the development of hyperpigmentation.
Researchers have found potential disparities in care and treatment for Black people with acne. One
A 2017 study found that Black people who have acne are less likely to visit a dermatologist for acne treatment. But researchers found that when Black people with acne were treated by a dermatologist, they were more likely to receive a variety of treatment options, including topical and oral antibiotics and isotretinoin.
This study illustrates the importance of seeing a dermatologist for treatment of acne, especially for people with dark skin.
The Skin of Color Society can be one resource for help finding a dermatologist with experience treating People of Color.
How to find a healthcare professional with experience treating Black people with acne
It’s important to find a professional who has experience with acne treatment options that benefit people with darker skin. Here’s how you can find one.
- What are their credentials? They should have a doctor’s board certification from the American Board of Dermatology.
- What conditions have they treated? They should have experience with conditions like hyperpigmentation to know how to treat it properly.
- What treatment options do they use? They should offer a wide variety of treatment options, including medications or procedures that can help reduce hyperpigmentation in dark skin.
- Are they familiar with research on skin care for Black people? If they haven’t published their own research, they should be aware of the importance of tailored treatment options for dark skin.
While chronic acne generally benefits from professional treatment, there are some things you can do at home to help reduce the risk or severity of a breakout:
- Apply sunscreen liberally. It’s a myth that people with dark skin don’t need sunscreen. In fact, frequently using
sunscreencan help prevent further hyperpigmentation from acne.
- Use OTC treatments early. Treating acne early greatly reduces the chance of scarring and hyperpigmentation.
- Check your hair products. Most hair care products designed for Black people contain oils to help keep hair soft and moisturized. Sometimes these oils can make acne breakouts worse.
- Wash your fabrics often. Oils and bacteria that seep into bedding and hair accessories can easily spread to the face and lead to more acne.
Acne develops when the pores of the skin become clogged with oil, bacteria, or shed skin cells. Acne can also develop during periods of hormonal change or even because of ingrown hairs. According to the AAD, common causes of acne include:
- Genetics. Studies on genetics and acne suggest that people who have a close relative with severe acne may be more at risk of developing acne.
- Hormones. Certain hormones, specifically androgens, lead to an increase in oil production in the skin and more clogged pores.
- Stress. Stress can greatly affect hygiene, sleep, and other factors that may lead to a worsening of existing acne breakouts.
- Sleep. Sleep is important for overall health and well-being, and getting too little sleep may increase your risk of an acne breakout.
- Skin care. An effective skin care routine plays a huge role in keeping the skin clear of bacteria, excess oil, dead skin, and other pore-clogging debris.
- Diet. Poor dietary habits can impair the health of the skin, especially for people with inflammatory acne.
Some studieshave suggested that people who smoke may be at a higher risk of developing acne lesions.
From changing your skin care products to visiting with a dermatologist, here are some of the ways you can prevent acne breakouts:
- Maintain a good skin washing routine to keep your skin clean and clear of bacteria, dead skin cells, and other debris.
- Choose noncomedogenic makeup and skin care products to limit the amount of oil that can clog your pores.
- Avoid popping pimples. Doing so can damage the skin and potentially lead to another outbreak, or scarring and hyperpigmentation.
- Apply OTC acne treatments if you feel a breakout coming on to help prevent the possibility of eventual dark spots and scars.
Sometimes changes like maintaining a good skin care routine, limiting your exposure to oils, and other interventions aren’t enough to prevent acne breakouts.
If these efforts don’t prevent an acne flare-up, visit a dermatologist as soon as possible to discuss your long-term treatment options.
When acne causes post-inflammatory hyperpigmentation in dark skin, it can take anywhere from 6 to 12 months for the pigmentation to fade without treatment. Hyperpigmentation that runs deeper may take longer to heal.
However, with treatment, post-inflammatory hyperpigmentation can be successfully treated.
Treatment of the underlying acne is crucial in reducing the severity of hyperpigmentation. Generally, this type of treatment requires a visit to a dermatologist for prescription medications and other treatment options.
The cost of a dermatologist visit varies depending on your location, the professional’s level of expertise, and whether you have insurance. The same applies to your treatment costs.
As mentioned above, it can help to find a dermatologist who has experience with treating acne in people with dark skin. Choosing a specialist with experience in treating Black people can help assure you that you are receiving the best treatment options for your skin type.
With the right treatment, you should notice relief from hyperpigmentation and other acne scarring within a matter of months.
Acne can affect anyone of any skin type or color, but people with dark skin are at a higher risk of developing hyperpigmentation from acne.
Generally, the best course of action to prevent acne scars on dark skin is to treat acne early. Wear sunscreen, keep the skin clean, and use OTC products when necessary.
If at-home treatment isn’t enough, just be sure to seek out a dermatologist who has experience treating acne in Black people.