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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and acne vulgaris in darker skin: a double-blind, randomized, vehiclecontrolled
study. Cutis. 2006;77(1):45-50.
- Czernielewski J, Poncet M, Mizzi F. Efficacy and cutaneous safety of adapalene
in black patients versus white patients with acne vulgaris. Cutis. 2002;70(4):243-248.
- Jacyk WK. Adapalene in the treatment of African patients. J Eur Acad Dermatol
Venereol. 2001;15 Suppl 3:37-42.
- Callender VD, Preston N, Osborn C, Johnson L, Gottschalk RW. A meta-analysis
to investigate the relation between Fitzpatrick skin types and tolerability
of adapalene-benzoyl peroxide topical gel in subjects with mild or moderate
acne. J Clin Aesthet Dermatol. 2010;3(8):15-19.
- Tanghetti E, Dhawan S, Green L, et al. Randomized comparison of the safety
and efficacy of tazarotene 0.1% cream and adapalene 0.3% gel in the treatment
of patients with at least moderate facial acne vulgaris. J Drugs Dermatol. 2010;9(5):549-558.
- LaVoo EJ. Tretinoin for hyperpigmentation in black patients. N Engl J Med. 1993;329(20):1503.
- Taylor SC. Utilizing combination therapy for ethnic skin. Cutis. 2007;80(1
- Callender VD, Young CM, Kindred C, Taylor SC. Efficacy and safety of clindamycin
phosphate 1.2% and tretinoin 0.025% gel for the treatment of acne and
acne-induced post-inflammatory hyperpigmentation in patients with skin of
color. J Clin Aesthet Dermatol. 2012;5(7):25-32.
- Kircik LH. Efficacy and safety of azelaic acid (AzA) gel 15% in the treatment
of post-inflammatory hyperpigmentation and acne: a 16-week, baseline-controlled
study. J Drugs Dermatol. 2011;10(6):586-590.
- Lowe NJ, Rizk D, Grimes P, Billips M, Pincus S. Azelaic acid 20% cream in
the treatment of facial hyperpigmentation in darker-skinned patients. Clin Ther. 1998;20(5):945-959.
Heather C. Woolery-Lloydwoolerylloyd@yahoo.com