Treatment of Acne-Induced Macular Hyperpigmentation in Fitzpatrick Skin Types V – VI: A Scoping Review
June 2025 | Volume 24 | Issue 6 | 579 | Copyright © June 2025
Published online May 29, 2025
Courtney A Smith MSa, Marcia Hogeling MDb, Carol E Cheng MDb
aDavid Geffen School of Medicine at UCLA, Los Angeles, CA
bDivision of Dermatology, Department of Medicine, University of California Los Angeles, Los Angeles, CA
Abstract
Acne-induced macular hyperpigmentation (AMH) is a common issue among patients with highly melanated skin, particularly those with Fitzpatrick Skin Types (FST) V - VI, which includes nonwhite patients with 'brown' and 'black' skin types. Despite the significant physical, emotional, and social harm caused by AMH, many clinical trials either fail to report FST data or do not include patients with FST V to VI. This scoping review summarizes current research on AMH treatment for patients with FST V to VI. Our review underscores the need for more data on the efficacy, safety, and tolerability of AMH treatments for patients with FST V to VI. Dermatologists who treat AMH should routinely collect data on patient FST, race, and ethnicity. Clinical trials should enroll more patients with FST V to VI from diverse racial and ethnic backgrounds to generate data that better informs clinical practice. This approach will ensure that treatment strategies are based on data relevant to the patient populations most in need of effective AMH care.
Citation: Smith CA, Hogeling M, Cheng CE. Treatment of acne-induced macular hyperpigmentation in Fitzpatrick skin types V to VI: a scoping review. J Drugs Dermatol. 2025;24(6):579-584. doi:10.36849/JDD.8703
INTRODUCTION
Acne-induced macular hyperpigmentation (AMH) refers to post-inflammatory hyperpigmentation in acne and is common in patients with highly melanated skin.1 The Fitzpatrick Skin Type (FST) system categorizes patients based on skin sun-reactivity. FST V-VI includes patients with skin of color, or skin described as 'brown' or 'black.'2 Phototype distribution varies across racial groups, as 87.3% of Black/African American patients are FST V-VI compared to 29.7% of Hispanic patients.3 AMH prevalence is higher among patients with skin of color compared to those with FST I- III, and among Black/African American patients (65%) compared to Caucasian patients (25%).4,5
Patients with skin of color prioritize AMH clearance as their chief goal.6 Individuals with AMH are more likely to experience social stigmatization compared to those with clear skin.7 AMH causes emotional distress for skin of color patients worsened by the chronicity, visibility, and co-occurrence with acne.8,9 AMH co-occurrence with acne predicts lower quality of life ratings compared to isolated acne.10 Limited studies investigate AMH treatment outcomes among FST V-VI. We aim to provide a scoping review of the current literature on AMH treatment among patients with FST V-VI.
MATERIALS AND METHODS
We performed a literature review using keywords to search titles and abstracts within PubMed, Embase, and Web of Science (Figure 1). Included studies involve AMH treatment for patients with FST V-VI. We excluded studies if: A) less than or equal to 50% of participants were FST V or VI, and B) data was not grouped by FST. We manually reviewed the full texts of the remaining articles to confirm they met the inclusion criteria.
Treatments
Overview
AMH clearance relies on the treatment of underlying dermatoses to prevent recurrent or worsening hyperpigmentation.1 Early incorporation of anti-hyperpigmentation treatments may improve pigmentary outcomes and patient satisfaction. However, skin susceptibility to ultraviolet radiation (UVR)-induced sun damage may increase on topicals.11 Clinicians should advise patients to routinely apply sun protection and educate patients on minimizing sun exposure.
Topical Treatments
Topical Retinoids
Retinoids activate retinoic acid receptors and simultaneously treat acne and AMH.12 Daily tazarotene 0.1% cream treated AMH
