Acne In Persons with Colour By Gay Wardle

Acne in people with skins of colour is an enigmatic entity. Acne is one of the most common skin conditions for people that have darker skin worldwide. This is possibly due to the fact that the global population is much higher with darker skin than lighter skin.

Considering Asian populations, Hispanic populations, and people of African origin. The skin disorder for these people is a double insult because of the hyperpigmentation that usually accompanies the condition. The hyperpigmentation is caused from scar tissue and is much higher in skins of colour than those with lighter skin because of less pigmentation in lighter skins.

On the subject of post-inflammatory hyperpigmentation, it is caused by the inflammatory comedonal acne, the inflammation of non-inflammatory acne and the inflammatory lesions that occur and is more obvious in darker populations.

The studies between the skin colours demonstrate that lighter skins have a higher incidence of severe cystic acne than darker skins do. This means that slight inflammation to darker skin is a high risk for postinflammatory pigmentation.

The skin disorder that darker skins have where there is post-inflammatory pigmentation and is caused by lesions is known as acne hyperpigmented macule. It seems to occur in younger people than it does in older generations, and this is probably caused by frequently picking their acne lesions. When you look at the demographics and populations of these people, the use of sunscreens is almost a non-event and, there are often high levels of pollution, especially in younger generations that ride scooters and motorcycles. These are all risk factors for PIHP. Often the major concern for these people is the PIHP and not the acne. Many of these people live in countries such as India, Africa, and Asia, where they can purchase without a script topical steroids and depigmenting creams. These products use incorrectly can add to and exasperate an acne skin disorder with increased risk of further hyperpigmentation. Retinoids and salicylic acids work by removing corneocytes from the apical layer of the skin. The user is hoping to remove any congestion that is in their skin, but the risk is an increase in inflammation.

There is another risk factor pertaining to darker skin that does have nodulocystic acne and that is keloid scarring, a condition that is very hard to remove and treat. This poses another problem that is often seen in darker skin colours.

The Indian populations love to and commonly use hair products that contain oil. With these populations is very common to see acne lesions on the forehead and temple area, the oil tends to gravitate downwards that could cause irritation and inflammation.

The overall manifestations of acne do not significantly differ in darker skin from those with lighter skin. The treatments also generally remain the same in this population but all the topicals, especially the gel-based ones, that are irritant can result in varying degrees of post-inflammatory hyperpigmentation. It is always advisable to treat darker skin people with a little more love and care so that risks of further acne lesions and post-inflammatory pigmentation is reduced.

A very valid reason topicals such as retinoids and benzoyl peroxide should not be used on darker skin is that you cannot see the erythema. The risk of this is that the person tends to overuse the products and without noticing causes irritation that leads to hyperpigmentation and post-inflammatory pigmentation. inflammatory hyper-pigmentation risk and that may lead to post-inflammatory pigmentation or what is called acne pigmented macule.

People with darker skin face more challenges when treating their acne. This does not mean that they cannot have treatments and can use products to help with acne. It just means that the consultation needs to be thorough and the treatments and actives that are used will not cause further inflammation and add to the skin disorder they already have. When there is inflammation, melanocyte cells are stimulated to increase more pigment. The pigment then becomes as much an issue as the acne lesions.

Acne is always a challenge regardless of skin colour, when you achieve those results, the challenge is rewarded.