Specialized treatment necessary for acne in skin of color

Racial and ethnic differences in acne presentation necessitate specialized therapeutic options for skin of color populations, according to a study.

“A national United States-based ambulatory medical care survey showed that acne was the leading dermatologic diagnosis in all non-white populations studied, including African Americans, Asians and Hispanics,” Andrew F. Alexis, MD, MPH, of Weill Cornell Medical College, and colleagues wrote.

Using a modified Delphi process, six skin of color dermatologists met to discuss racial and ethnic differences in clinical presentation and sequela of acne, racial and ethnic differences in acne treatment therapeutic endpoints and patient expectations, and any possible needs for specialized skin care options for patients with skin of color.

The panel also conducted a literature review of 60 papers regarding acne prevention, treatment and maintenance in skin of color.

Six consensus statements were drafted by the group addressing different aspects of clinical representation and treatment.

Post-inflammatory hyperpigmentation, often a common sequela of acne in skin of color, was addressed first, with the authors pointing out that treatment regimens must be aggressive enough to reduce inflammation in these populations while also being well tolerated to avoid irritation.

Second, dry skin can be more visible on skin of color, and clinicians should be cognizant of this fact when prescribing topical retinoids, alpha and beta hydroxy acids, and benzoyl peroxide.

“More tolerable formulations such as creams, lotions and aqueous gels with hydrating ingredients may decrease the risk of dry skin and irritation,” the authors wrote.

Researchers also addressed decreased ceramide levels in the skin of African Americans, the irritation of acne-related inflammation, and the role of adjunctive skin care in acne treatment, including cleansers and moisturizers designed for acne-prone skin.

Finally, the group outlined how skin of color populations require special considerations for acne treatment and how over-the-counter products can be used to treat acne in these populations.

“Preferred OTC products are cosmetically elegant (texture), non-irritating, well-tolerated, anti-inflammatory and should help restore the skin barrier function,” the authors wrote. “Hydrating cleansers may be the most appropriate type of cleanser for [skin of color] acne-prone skin or those with acne as they are associated with a low risk of irritation.”