Ten Tips for Treating Acne Vulgaris in Fitzpatrick Skin Types IV-VI
June 2011 | Volume 10 | Issue 6 | Original Article | 654 | Copyright © June 2011
Candace Thornton Spann MD
During the 21st century, people with skin of color will account for a large portion of the US population. According to race projections from the US Census Bureau, persons of African American, Hispanic, Asian and Native American descent will make up nearly half of the total US population by the year 2050. Because of our changing demographics, it is important that all dermatologists become comfortable in treating skin of color. This article provides 10 practical pearls for management of acne vulgaris in patients with Fitzpatrick skin types IV-VI.
J Drugs Dermatol. 2011;10(6):654-657.
Take a Thorough Medical History Including Cosmetics
and Personal Care Products.
Cosmetic and personal care products can play an important
role in the formation of comedones. In patients
of color this issue is particularly relevant, as darkerskinned
patients will frequently use opaque and oil-containing
makeup to camouflage acne and hyperpigmentation that results
Cultural differences can play a role in the selection of personal
care products. For example, many African Americans believe
cocoa butter to be a superior moisturizer that helps in the reduction
of hyperpigmented macules. Cocoa butter use on the
face should be discouraged, as it can be extremely comedogenic
and even irritating to facial skin. A second example exists
in the Arab American community. One study found common
personal care products to include hair oils, pomades (to be discussed
in the next section), mixtures of pure honey and sugar
to exfoliate, natural lemon juice or a milk and honey blend to
wash the face and a mixture of herbs or Dead Sea clay to make
facial masks.1,2 It is important for the dermatologist to become
aware of cultural practices that may impede treatment.
As risk of irritation and subsequent post-inflammatory hyperpigmentation
(PIH) is much greater in this population, patients
should be encouraged to use very gentle cleansers and noncomedogenic
moisturizers. Astringents, toners, scrubs and
masks should be discouraged.
Don't Discount the Importance of Pomade Acne.
Recommend Silicone-Based Styling Products Instead
of Oil-Based Products in Patients Who Present With
Acne on the Forehead and Close to the Hairline.
Pomade use is very common among patients of color. Taylor
et al. conducted a survey of patients at the Skin of Color
Center in New York and found that 46.2 percent of patients
reported hair oil or pomade use. This was correlated with the
presence of forehead acne in 70.3 percent of patients.3 There
are now many products available for hair that are light and
moisturizing, without having the heavy oil base. Patients who
desire a moisturizer with very light coverage of the hair shaft
often prefer the silicone-derived moisturizers.4 Treatment of
acne in skin of color is much more effective when pomades
Address Post-Inflammatory Hyperpigmentation as
Part of the Acne Treatment Regimen. Retinoids,
Hydroquinone, Azaleic Acid, Chemical Peels, etc.
Are an Important Adjunct to Acne Therapy in People
In patients of color, the most disturbing feature of acne is not
the acne lesion itself but the resulting PIH.1,3,5-7 Attention to
agents that treat both acne and hyperpigmentation is important
and should be instituted early in the course of therapy.3 Tretinonin, adapalene and tazarotene have a positive effect on
PIH.3,8 Choosing creams over gels and beginning with lower
concentrations and titrating upward minimizes the risk of irritant
dermatitis from the use of retinoids.