areas lacking evidence. The reviewers reached a consensus on the grading of the 24 selected clinical studies on SOC patients with acne.19
The advisors subsequently convened to review the results and draft an algorithm for the treatment and maintenance, including skincare recommendations, for SOC patients with acne. The panel reviewed and adopted the algorithm using evidence coupled with the panel's expert opinion and clinical experience (Figure 1).
SOC Patients With Acne
Acne pathogenesis is multifactorial; it includes follicular hyperkeratinization, Cutibacterium acnes colonization, inflammatory mediators, and sebaceous gland activity. Dietary and other factors such as hormonal variations, occlusive skin care, mask-wearing, etc, may also contribute.20
Depending on disease severity, acne breakouts can consist of a range of lesions, including comedones, papules, pustules, nodules, and cysts that involve the face and/or the trunk.20 The pathogenesis of acne in SOC patients is similar to that of White patients with acne, despite studies evaluating potential differences in sebaceous gland size, activity, and sebum production between racial groups.13-16,20-24 PIH is a common sequela or associated feature of acne (Figure 2). In moderate to severe cases, acne can induce the development of keloids or hypertrophic scars in predisposed patients.
Stratum corneum barrier dysfunction in patients with acne may contribute to comedogenesis and inflammation.20,22,23 A study in Japanese patients with acne vs control subjects demonstrated a higher sebum secretion rate in patients with moderate acne; as well as higher transepidermal water loss (TEWL) and lower proportions of total ceramide and free sphingosine in patients with both mild and moderate acne.22,23,22,23
Population variations in skin sensitivity have been reported mainly in Asian patients, but robust data are lacking.12-16,25,26 People who are of East Asian descent may have lower skin barrier strength (defined as the number of tape strippings required to disrupt the barrier) and consequently a higher skin sensitivity as compared to those who are White or African American.24
Limitations of the research are that the Asian population is a diverse group of individuals with phototypes ranging from Fitzpatrick skin type III to IV in those of East Asian descent to types IV to VI in those of South Asian descent (Figure 3).24
It is unclear what implications the findings on differences in the stratum corneum barrier dysfunction in SOC patients with acne may have for prevention, treatment, and maintenance approaches for these patients.16
Haircare practices in SOC women, such as the use of potentially comedogenic products for managing Afro-textured or chemically/thermally treated hair, may contribute to acne (eg, pomade acne).13,26 This type of acne presents as closed comedones and papules along the frontal hairline, forehead, and temples (Figure 4).13,26
The advisors subsequently convened to review the results and draft an algorithm for the treatment and maintenance, including skincare recommendations, for SOC patients with acne. The panel reviewed and adopted the algorithm using evidence coupled with the panel's expert opinion and clinical experience (Figure 1).
SOC Patients With Acne
Acne pathogenesis is multifactorial; it includes follicular hyperkeratinization, Cutibacterium acnes colonization, inflammatory mediators, and sebaceous gland activity. Dietary and other factors such as hormonal variations, occlusive skin care, mask-wearing, etc, may also contribute.20
Depending on disease severity, acne breakouts can consist of a range of lesions, including comedones, papules, pustules, nodules, and cysts that involve the face and/or the trunk.20 The pathogenesis of acne in SOC patients is similar to that of White patients with acne, despite studies evaluating potential differences in sebaceous gland size, activity, and sebum production between racial groups.13-16,20-24 PIH is a common sequela or associated feature of acne (Figure 2). In moderate to severe cases, acne can induce the development of keloids or hypertrophic scars in predisposed patients.
Stratum corneum barrier dysfunction in patients with acne may contribute to comedogenesis and inflammation.20,22,23 A study in Japanese patients with acne vs control subjects demonstrated a higher sebum secretion rate in patients with moderate acne; as well as higher transepidermal water loss (TEWL) and lower proportions of total ceramide and free sphingosine in patients with both mild and moderate acne.22,23,22,23
Population variations in skin sensitivity have been reported mainly in Asian patients, but robust data are lacking.12-16,25,26 People who are of East Asian descent may have lower skin barrier strength (defined as the number of tape strippings required to disrupt the barrier) and consequently a higher skin sensitivity as compared to those who are White or African American.24
Limitations of the research are that the Asian population is a diverse group of individuals with phototypes ranging from Fitzpatrick skin type III to IV in those of East Asian descent to types IV to VI in those of South Asian descent (Figure 3).24
It is unclear what implications the findings on differences in the stratum corneum barrier dysfunction in SOC patients with acne may have for prevention, treatment, and maintenance approaches for these patients.16
Haircare practices in SOC women, such as the use of potentially comedogenic products for managing Afro-textured or chemically/thermally treated hair, may contribute to acne (eg, pomade acne).13,26 This type of acne presents as closed comedones and papules along the frontal hairline, forehead, and temples (Figure 4).13,26
