with FST IV to VI, noted PIH in 56% of subjects treated for acne scars.78 However, similar to most other surgical procedures, caution must be utilized with lasers in SOC patients, given the risks of PIH and scarring.71,78
LIMITATIONS
Recommendations are based on expert opinion, which could potentially differ from patients' practices and cultural perspectives. Treatment and maintenance approaches to acne in SOC patients are similar; however, the available data suggest that strategies to improve outcomes in patients with acne should consider racial/ethnic differences. The clinical studies on SOC patients with acne have limitations in the number, size, and methodologies and do not allow for conclusive recommendations.
CONCLUSIONS
The management of acne in SOC patients involves special consideration of the risk of sequelae such as PIH and keloid or hypertrophic scarring. PIH is a common concomitant feature of acne in SOC that can be treated with specific skin lightening products/procedures. However, efficacious and well-tolerated acne-directed therapy used longitudinally is key to successful outcomes. Under-treatment can result in the ongoing development of acne-induced hyperpigmented macules, while irritation from topical therapy can induce iatrogenic PIH. Adjunctive skin care, including hypoallergenic and pH-balanced hydrating cleansers and non-comedogenic, ceramide-containing moisturizers, may improve outcomes for acne in SOC patients by reducing xerosis or irritation and increasing tolerability of prescription therapy. Skincare products are recommended before and during prescription therapy and as part of a maintenance treatment regimen.
DISCLOSURES
The authors disclose receipt of an unrestricted educational grant from CeraVe USA for support with the research of this work and also received consultancy fees for their work on this project. All the authors developed the manuscript, reviewed it, and agreed with its content.
Funding: The authors disclose receipt of an unrestricted educational grant from CeraVe USA for support with the research of this work and also received consultancy fees for their work on this project. All the authors developed the manuscript, reviewed it, and agreed with its content.
Funding: The authors disclose receipt of an unrestricted educational grant from CeraVe USA for support with the research of this work and also received consultancy fees for their work on this project. All the authors developed the manuscript, reviewed it, and agreed with its content.
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24. 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(2):123‑128. doi:
2. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease study 2010. Lancet. 2012;380(9859):2163-2196. doi: 10.1016/S0140-6736(12)61729-2.
3. Tan JK, Bhate K. A global perspective on the epidemiology of acne. Br J Dermatol. 2015;172(Suppl 1):3-12. doi: 10.1111/bjd.13462.
4. Hay RJ, Johns NE, Williams HC, et al. The global burden of skin disease in 2010: An analysis of the prevalence and impact of skin conditions. J Invest Dermatol. 2014;134(6):1527-1534. doi: 10.1038/jid.2013.446.
5. Rocha MA, Bagatin E. Adult-onset acne: prevalence, impact, and management challenges. Clin Cosmet Investig Dermatol. 2018;11:59- 69. doi: 10.2147/CCID.S137794.
6. Davis SA, Narahari S, Feldman SR, Huang W, et al. Top dermatologic conditions in patients of color: An Analysis of Nationally Representative Data. J Drugs Dermatol. 2012;11(4):466-73.
7. Perkins AC, Cheng CE, Hillebrand GG, et al. Comparison of the epidemiology of acne vulgaris among Caucasian, Asian, Continental Indian and African American women. J Eur Acad Dermatol Venereol. 2011;25(9):1054-60. doi: 10.1111/j.1468-3083.2010.03919.x.
8. Kaminsky A, Florez-White M, Bagatin E, Arias MI. Large prospective study on adult acne in Latin America and the Iberian Peninsula: risk factors, demographics, and clinical characteristics. Int J Dermatol. 2019;58(11):1277-1282. doi: 10.1111/ijd.14441.
9. Ho SG, Chan HH. The Asian dermatologic patient: review of common pigmentary disorders and cutaneous diseases. Am J Clin Dermatol. 2009;10(3):153-68. doi: 10.2165/00128071-200910030-00002.
10. Gieler U, Gieler T, Kupfer JP. Acne and quality of life - impact and management. J Eur Acad Dermatol Venereol. 2015;29(Suppl 4):12-4. doi: 10.1111/jdv.13191.
11. Abadâ€ÂCasintahan F, Chow SK, Goh CL et al. Frequency and characteristics of acneâ€Ârelated postâ€Âinflammatory hyperpigmentation. J Dermatol. 2016; 43(7): 826–828. doi: 10.1111/1346-8138.13263.
12. Callender VD, Alexis AF, Taylor SC, et al. Racial differences in clinical characteristics, perceptions and behaviors, and psychosocial impact of adult female acne. J Clin Aesthet Dermatol. 2014;7(7):19-31. PMCID: PMC4106354
13. Davis EC, Callender VD. A review of acne in ethnic skin: pathogenesis, clinical manifestations, and management strategies. J Clin Aesthetic Dermatol. 2010;3(4):24–38.
14. Shah SK, Alexis AF. Acne in skin of color: practical approaches to treatment. J Dermatol Treat. 2010;21(3):206–211. doi: 10.3109/09546630903401496.
15. Alexis AF. Acne in patients with skin of color. J Drugs Dermatol. 2011; 10(6):sl3–sl6.
16. Alexis AF, Woolery-Lloyd H, Williams K et al. Racial/ethnic variations in acne: Implications for treatment and skin care recommendations for acne patients with skin of color. J Drugs Dermatol 2021;20(7): doi:10.36849/JDD.6169
17. Trevelyan EG, Robinson N. Delphi methodology in health research: how to do it? Eur J Integrative Med. 2015;7(4):423-428. doi: 10.1016/j. eujim.2015.07.002
18. 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(18):E839- 842. doi: 10.1503/cmaj.090449.
19. Smith Begolka W, Elston DM, Beutner KR. American Academy of Dermatology evidence-based guideline development process: responding to new challenges and establishing transparency. J Am Acad Dermatol. 2011 Jun;64(6):e105-112. doi: 10.1016/j.jaad.2010.10.029.
20. Kircik LH. Re‑evaluating treatment targets in acne vulgaris: Adapting to a new understanding of pathophysiology. J Drugs Dermatol 2014;13(6):s57‑60.
21. Fisk WA, Lev-Tov HA, Sivamani RK. Epidemiology and management of acne in adult women. Curr Dermatol Rep. 2014;3(1):29-39. Doi: 10.1007/s13671-014-0071-4.
22. Yamamoto A, Takenouchi K, Ito M. Impaired water barrier function in acne vulgaris. Arch Dermatol Res. 1995;287(2):214–218. doi: 10.1007/ BF01262335.
23. 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. doi: 10.1111/exd.13499.
24. 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(2):123‑128. doi:
