significantly reduced noninflammatory acne lesions, improving QoL compared to vehicle. The lotion was well-tolerated in the Asian population, with no reported skin dryness, irritation, or PIH.49 Another study including Hispanic acne patients with moderate-to-severe acne using 0.05% tretinoin lotion showed good efficacy and safety.50 A subgroup analysis of self-identified Black subjects from data of three studies involving 3,855 patients with moderate acne showed that ADAP 0.3%/ BPO 2.5% gel was safe and more effective than vehicle in reducing both inflammatory and noninflammatory acne lesions.51
Topical antibiotics such as clindamycin in combination with BP or a retinoid are shown to be effective and safe for SOC patients for acne and acne-induced PIH.52-54
Both topical dapsone 5% and 7.5% gel are effective and safe in treating moderate acne in extensive studies including SOC patients.55-57 Topical dapsone is an option as it is well-tolerated and effective for both inflammatory and noninflammatory lesions.55-57
A pooled, post hoc analysis of data from two phase III studies included subsets of participants that self-identified as White (n=1191) or Black (n=262) and Hispanic (n=352) or non-Hispanic (n=1262). The analysis showed that tazarotene 0.045% lotion was effective, safe, and well-tolerated in all ethnic groups and resulted in decreased incidence of PIH in Black acne patients.58
Statement 5: Adjunctive skincare can play an essential role in preventing, treating, and maintaining acne. When selecting a cleanser and moisturizer for acne and acne-prone skin, individual and/or cultural variations in skincare preferences should be considered. Some skincare and haircare products that are commonly used in communities of color, such as cocoa butter and petrolatum, may exacerbate acne.
When recommending prevention, treatment, and maintenance approaches, acne guidelines from the US and Europe do not distinguish between skin phototypes or ethnic groups.40-43 However, Canadian guidelines recommend considering skin type and tolerance and applying creams and lotions for sensitive skin versus gels that may be more suited for oily skin.42
The Ibero-Latin American acne algorithm discusses the risk of PIH for darker phototypes. It incorporates skincare and sunscreens as an essential part of acne prevention, treatment, and maintenance care and recommends using it combined with medical treatment.44
The Japanese acne guidelines recommend preventing skin irritation and carefully choosing lowâ€irritant and noncomedogenic products based on clinical trials in acne patients.45 The guidelines recommend combining skincare with topical drugs to reduce skin irritation from the drugs, improve treatment effect, and help treatment adherence.45
In contrast, a South African acne guideline recommends avoiding skincare products to prevent acne exacerbation (Table 3).47
Daily application of fragrance-free, nonâ€irritating, and noncomedogenic cleansers, moisturizers, and sunscreen may reduce adverse events such as dryness, erythema, photosensitivity, and PIH resulting from topical drugs.44-46 Special consideration should be applied to SOC patients prone to PIH. Using the appropriate skincare is prudent in this population to minimize irritation.
Skincare products, such as non-comedogenic cleansers and moisturizers, have been successfully used to reduce skin irritation and can be especially useful in sensitive skin acne patients.59-63
Pomade acne is a clinical variant that is primarily seen in individuals of African descent. This is due to the use of comedogenic hair care products that can affect the margins of the scalp and facial skin. This type of acne is characterized by closely packed, closed comedones, and small papules on the forehead and temples (Figure 3).
Additionally, over-the-counter skin lightening products used by specific subpopulations with SOC can cause occult steroid acne as some of these products contain class I corticosteroids.
Statement 6: Special considerations when treating SOC individuals with acne:
• Dry skin and irritation commonly result from topical acne treatment or systemic retinoid therapy.
• Non-comedogenic cleansers and moisturizers can improve dryness and irritation resulting from acne treatment. Favor aqueous gels, lotion, or cream vehicles.
• Acne-affected skin has shown lower levels of ceramides, with profound reductions compared to healthy individuals of all ethnicities. Ceramide-containing moisturizers may enhance adherence and complement existing acne therapies.
