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 MPH,a Heather Woolery-Lloyd MD FAAD,b Kiyanna Williams MD FAAD,c Anneke Andriessen PhD,d Valerie D Callender MD FAAD,e Sewon Kang MD FAAD,f David Rodriquez MD,g 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

8. Davis EC, Callender VD. A review of acne in ethnic skin: pathogenesis, clinical manifestations, and management strategies. J Clin Aesthetic Deramtol. 2010;4:24–38. [PMC free article] [PubMed] [Google Scholar]
9. Shah SK, Alexis AF. Acne in skin of color: practical approaches to treatment. J Dermatol Treat. 2010;21:206–211. [PubMed] [Google Scholar]
10. Alexis AF. Acne in patients with skin of color. J Drugs Dermatol. 2011; 10:sl3–sl6. [Google Scholar]
11. Trevelyan EG, Robinson N. Delphi methodology in health research: how to do it? Eur J Integrative Med. 2015;7(4):423-428.
12. Brouwers M, Kho ME, Browman GP, et al.; AGREE Next Steps Consortium. AGREE II: advancing guideline development, reporting and evaluation in healthcare. Can Med Association J. 2010,182:E839-42.
13. Nayak CS, Ansari SMM, Salve V, Patil S. Effectiveness of a combination of anti-pigmentary products in facial post-inflammatory hyperpigmentation. Int J Res Dermatol. 2020 Jan;6(1):1-8. http://dx.doi.org/10.18203/issn.2455-4529.IntJResDermatol20195199
14. Falder, Rebat M., et al. "A clincohistopathological study of acne vulgaris in black females." Journal of Investigative Dermatology. 4.106 (1996): 888. Halder RM, Rodney IJ. Why are there so few effective treatments for pigmentary disorders of the skin?. Expert Rev Dermatol. 2012;7(2):109-112. https://doi.org/10.1586/edm.12.9
15. Hayashi N, Miyachi Y, Kawashima M. Prevalence of scars and mini‐scars, and their impact on quality of life in Japanese patients with acne. J Dermatol. 2015;42: 690– 696.
16. Abad‐Casintahan F, Chow SK, Goh CL et al. Frequency and characteristics of acne‐related post‐inflammatory hyperpigmentation. J Dermatol. 2016; 43(7): 826–828.
17. Morrone A, Franco G, Valenzano M, et al. Clinical features of acne vulgaris in 444 patients with ethnic skin. J Dermatol. 2011;38:405–408. [PubMed] [Google Scholar]
18. Del Rosso JQ. Clinical relevance of skin barrier changes associated with the use of oral isotretinoin: the importance of barrier repair therapy in patient management. J Drugs Dermatol. 2013 June 1;12(6):626-31.
19. Yamamoto A, Takenouchi K, Ito M. Impaired water barrier function in acne vulgaris. Arch Dermatol Res. 1995;287(2):214–218.
20. Pappas A, et al. Seasonal changes in epidermal ceramides are linked to impaired barrier function in acne patients. Experimental Dermatol. 2018;27(8):833-836.
21. Kompaore F, Marty JP, Dupont C. In vivo evaluation of the stratum corneum barrier function in blacks, Caucasians and Asians with two noninvasive methods. Skin Pharmacol. 1993;6(3):200-207.
22. Berardesca E, Maibach HI. Racial differences in sodium lauryl sulphate induced cutaneous irritation: black and white. Contact Dermatitis. 1988;18(2):65-70.
23. Sugino K, Imokawa G, Maibach H. Ethnic differences of stratum corneum lipid in relation to stratum corneum function. J Invest Dermatol. 1993;100: 587.
24. Wilson D, Berardesca E, Maibach HI. In vitro transepidermal water loss: differences between black and white human skin. Br J Dermatol. 1988;119(5):647-652.
25. Berardesca E, Pirot F, Singh M, Maibach H. Differences in stratum corneum pH gradient when comparing white Caucasian and black African-American skin. Br J Dermatol. 1998;139(5):855-857.
26. Pinnagoda J, Tupker RA, Agner T, Serup J. Guidelines for transepidermal water loss (TEWL) measurement. A report from the Standardization Group of the European Society of Contact Dermatitis. Contact Dermatitis. 1990;22(3):164-178.
27. Grimes P, Edison BL, Green BA, Wildnauer RH. Evaluation of inherent differences between African American and white skin surface properties using subjective and objective measures. Cutis. 2004;73(6):392-396.
28. N. Luther M.E. Darvin W. Sterry J. Lademann A. Patzelt. Ethnic Differences in Skin Physiology, Hair Follicle Morphology and Follicular Penetration. Skin Pharmacol Physiol. 2012;25:182–191
29. Young, MM, Franken A, and du Plessis JL. Transepidermal water loss, stratum corneum hydration, and skin surface pH of female African and Caucasian nursing students. Skin Res Technol. 2019;25:88–95
30. Reed JT, Ghadially R, Elias PM. Skin type, but neither race nor gender, influence epidermal permeability barrier function. Arch Dermatol. 1995;131(10):1134-1138.
31. Berardesca E, de Rigal J, Leveque JL, Maibach HI. In vivo biophysical characterization of skin physiological differences in races. Dermatologica. 1991;182(2):89-93.
32. De Luca R, Balestrieri A, Dinle Y. [Measurement of cutaneous evaporation. 6. Cutaneous water loss in the people of Somalia]. Boll Soc Ital Biol Sper. 1983;59(10):1499-1501.
33. Muizzuddin N, Hellemans L, Van Overloop L et al. Structural and functional differences in barrier properties of African American, Caucasian and East Asian skin. J Dermatol Sci. 2010;59:123–128.
34. Warrier A, Kligman A, Harper RA, Bowman J, Wickett RR. A comparison of black and white skin using noninvasive methods. J Cosmet Sci. 1996;47:229- 240.
35. Hellemans l, et al. Characterization of stratum corneum properties in human subjects from a different ethnic background. J Invest Dermatol. 2005;124(S4):A62.
36. Jungersted JM, Høgh JK, Hellgren LI et al. Ethnicity and stratum corneum ceramides. Br J Dermatol. 2010;163:1169–1173.
37. Halder RM, Rodney IJ. Why are there so few effective treatments for pigmentary disorders of the skin?. Expert Rev Dermatol. 2012;7(2):109-112. https://doi.org/10.1586/edm.12.9
38. See Jo-Ann, Goh Chee Leok, Hayashi N, et al. Optimizing the use of topical retinoids in Asian acne patients. J Dermatol. 2018;45(5):522-528. https://doi. org/10.1111/1346-8138.14314
39. Alexis AF, Harper JC, Stein Gold LF, Tan JKL. Treating acne in patients with skin of color. Semin Cutan Med Surg. 2018;37(supp3):S71-S73
40. Thiboutot DM, Dreno B, Abanmi A, et al. Practical management of acne for clinicians: an international consensus from the global alliance to improve outcomes in acne. J Am Acad Dermatol. 2018;78(2S1):S1–23.
41. Zaenglein AL, Pathy AL, Schlosser BJ, Alikhan A, Baldwin HE, Berson DS, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74(5):945-73.e33.
42. Asai Y, Baibergenova A, Dutil M, et al Management of acne: Canadian clinical practice guideline. Can Med Ass J. 2016;188(2)118-126. DOI: https://doi. org/10.1503/cmaj.140665
43. Nast A, Dreno B, Bettoli V, Bukvic Mokos Z, Degitz K, Dressler C, et al. European evidence-based (S3) guideline for the treatment of acne - update 2016 - short version. J Eur Acad Dermatol Venereol. 2016;30(8):1261-8.
44. Bagatin E, Florez-White M, Bagatin E, Arias-Gomez MI, Kaminsky A. Algorithm for acne treatment: Ibero-Latin American consensus. An Bras Dermatol. 2017;92 (5) 1-10. https://doi.org/10.1590/abd1806-4841.20177003
45. Hayashi N, Akamatsu H, Iwatsuki K, et al. Japanese dermatological association guidelines: Guidelines for the treatment of acne vulgaris 2017. J Dermatol. 2018;45(8)898-935. https://doi.org/10.1111/1346-8138.14355
46. Acne Group, Combination of Traditional and Western Medicine Dermatology, Acne Group, Chinese Society of Dermatology, Acne Group, Chinese Dermatologist Association, et al. Chinese guidelines for the management of acne vulgaris: 2019 Update. Int J Dermatol Venereol. 2019,2(3):129-137. DOI: 10.1097/JD9.0000000000000043
47. Sinclair W. Guidelines for the Management of Acne Vulgaris. South African Fam Pract. 2017; 59(1):24-29. http://creativecommons.org/ licenses/by-nc-nd/4.0
48. Lain E, Day D, Harper J, Guenin J. Tretinoin 0.05% lotion for the once-daily treatment of moderate-to-severe acne vulgaris: impact of gender and race on efficacy and safety. J Drugs Dermatol. 2019 Nov 1;18(11):1128-1138. PMID: 31741356
49. Han G, Amstrong AW, Desai SR, Guenin E. Novel tretinoin 0.05% lotion for the once-daily treatment of moderate-to-severe acne vulgaris in an Asian population. J Drugs Dermatol. 2019 Sep 1;18(9):910-916.
50. Cook-Bolden FE, Weinkle SH, Guenin E, Bhatt V. Novel tretinoin 0.05% lotion for once-daily treatment of moderate-to-severe acne vulgaris in a Hispanic population. J Drugs Dermatol. 2019 January 1;18(1):32-38.PMID: 30681791
51. Alexis AF, Johnson LA, Kerrouche N, Callender VD. A subgroup analysis to evaluate the efficacy and safety of adapalene-benzoyl peroxide topical gel in black subjects with moderate acne. J Drugs Dermatol. 2014 Feb;13(2):170-4.
52. Alexis AF, Cook-Bolden F, Lin T. Treatment of moderate-to-severe acne vulgaris in a Hispanic population: A post-hoc analysis of the efficacy and tolerability of clindamycin 1.2%/benzoyl peroxide 3.75% gel. J Clin Aesthet Dermatol. 2017;10:36-43
53. 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. PMID: 22798973
54. Cook-Bolden FE. Treatment of moderate to severe acne vulgaris in a Hispanic population: a post-hoc analysis of efficacy and tolerability of clindamycin phosphate 1.2%/benzoyl peroxide 2.5% gel. J Drugs Dermatol. 2012 Apr;11(4):455-9.
55. Alexis AF, Burgess C, Callender VD, et al. The efficacy and safety of topical dapsone gel, 5% for the treatment of acne vulgaris in adult females with skin of color. J Drugs Dermatol. 2016;15:197-204.
56. Draelos ZD, Rodriguez DA, Kempers SE, et al. Treatment response with once-daily topical dapsone gel, 7.5% for acne vulgaris: Subgroup analysis of pooled data from two randomized, double-blind studies. J Drugs Dermatol. 2017;16:591-598.
57. Taylor SC, Cook-Bolden FE, McMichael A, et al. Effcacy, safety, and tolerability of topical dapsone gel, 7.5% for treatment of acne vulgaris by Fitzpatrick skin