Retinoids and Azelaic Acid to Treat Acne and Hyperpigmentation in Skin of Color

April 2013 | Volume 12 | Issue 4 | Original Article | 434 | Copyright © April 2013

Heather C. Woolery-Lloyd MD, Jonette Keri MD, and Stefan Doig MD

Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL

a 6-point scale, total lesion count, inflammatory lesion count, noninflammatory lesion count, and IGA for PIH on a 7-point scale.9 At week 16, 92% of patients had a 2-point improvement in the IGA for PIH.9
A multicenter, randomized, parallel-group study compared the efficacy, safety, and tolerability of AzA 20% cream to its vehicle for the treatment of facial hyperpigmentation in 52 patients with Fitzpatrick skin types IV to VI.10 The efficacy variables were pigmentary intensity, lesion area, and global assessment of improvement. Pigmentary intensity was measured by chromometer.10 Results at 24 weeks showed AzA produced significantly greater decreases in pigmentary intensity than did vehicle, as measured by both an investigator’s subjective scale (P=.021) and a chromometer analysis (P=.039).10 In addition, there was a significantly greater global improvement with AzA than with vehicle at week 24 (P=.008).10 The investigators concluded that AzA is an effective and well-tolerated treatment for hyperpigmentation in darker-skinned patients.10


PIH is an extremely common and distressing condition in patients with skin of color. A growing body of evidence suggests that retinoids are well tolerated in skin of color. Dermatologists should consider retinoids as first-line therapies to treat acne in this patient population. In addition, AzA is another acne treatment that can offer patients improvement in both acne and hyperpigmentation. Dermatologists should consider either agent when treating acne in patients with skin of color. Some of the limitations of the studies cited include most having small sample sizes, lack of colorimetric assessments in most studies, and variable measures of efficacy used. Based on this review of literature, retinoids and AzA offer excellent treatment options for acne patients with skin of color.


The authors have no relevant conflicts of interest to disclose.


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Heather C.