Racial/Ethnic Variations in Acne: Implications for Treatment and Skin Care Recommendations for Acne Patients With Skin of Color

July 2021 | Volume 20 | Issue 7 | Original Article | 716 | Copyright © July 2021


Published online June 29, 2021

Andrew F. Alexis MD MPHa, Heather Woolery-Lloyd MD FAADb, Kiyanna Williams MD FAADc, Anneke Andriessen PhDd, Valerie D. Callender MD FAADe, Sewon Kang MD FAADf, David Rodriquez MDg, Jerry Tan MD FRCPCh

aWeill Cornell Medical College, New York, NY
bSkin of Color Division, Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, FL
cSkin of Color Section, Department of Dermatology, Cleveland Clinic, Cleveland, OH
dRadboud UMC, Nijmegen and Andriessen Consultants, Malden, The Netherlands
eHoward University College of Medicine, Washington DC; Callender Dermatology & Cosmetic Center, Glenn Dale, MD
fDepartment of Dermatology, Johns Hopkins School of Medicine, Baltimore, MD
gDermatology Associates & Research/ Dadeland Dermatology Group, Department of Dermatology & Cutaneous Surgery at the University of Miami, Miami, FL
hRoyal College of Physicians and Surgeons of Canada, Schulich School of Medicine and Dentistry, Department of Medicine, Western University, Windsor, ON, Canada

Abstract
Background: Acne vulgaris is among the most common dermatologic diagnoses observed, including skin color (SOC) populations. This project sought to help clarify the existing published data and provide consensus statements on acne presentation, prevention, treatment, and maintenance in SOC populations to help improve patient outcomes.
Methods: Six SOC dermatologists convened for a virtual meeting and used a modified Delphi process to address: 1) Are there racial/ethnic differences in the clinical presentation and sequela of acne? 2) Are there racial/ethnic differences in the therapeutic endpoint of acne treatment and patient expectations? 3) Is there a need for specialized approaches to therapeutic options and skincare in acne patients with SOC? The results of a literature review and the outcome of discussions, coupled with the panel's expert opinion and experience, are intended for health care providers caring for acne patients and clinician-researchers.
Results: Racial/ethnic differences in the clinical presentation, sequelae, and desired treatment outcomes for acne have been reported. Notwithstanding limitations in the number, size, and methodologies of studies to date, the available data suggest that strategies that improve outcomes in acne patients with SOC include: Early initiation and maintenance of treatment regimens and careful consideration of tolerability of active ingredients, vehicles, and dosing. Using pH-balanced, non-irritating cleansers and non-comedogenic ceramides containing moisturizers help minimize irritation or dryness.
Conclusions: There a need for specialized approaches to therapeutic options and skincare in acne patients with SOC. OTC skincare products are recommended before and during prescription therapy and as part of a maintenance regimen.

J Drugs Dermatol. 2021;20(7):716-725. doi:10.36849/JDD.6169

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INTRODUCTION

The Global Burden of Disease Project ranks acne vulgaris (acne) as the eighth most prevalent dermatologic disease worldwide.1,2 Global acne prevalence is estimated at 9.4% affecting 650 million adolescents and adults.1-4

Acne vulgaris is also among the most common diagnoses observed in skin of color (SOC) populations.5,6 A national United States (US)-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.6 In a four-city community-based study, involving a review of one-sided facial photographs of women