Take a Thorough Medical History Including Cosmetics and Personal Care Products.
Cosmetic and personal care products can play an important
role in the formation of comedones. In patients
of color this issue is particularly relevant, as darkerskinned
patients will frequently use opaque and oil-containing
makeup to camouflage acne and hyperpigmentation that results
from acne.1
Cultural differences can play a role in the selection of personal
care products. For example, many African Americans believe
cocoa butter to be a superior moisturizer that helps in the reduction
of hyperpigmented macules. Cocoa butter use on the
face should be discouraged, as it can be extremely comedogenic
and even irritating to facial skin. A second example exists
in the Arab American community. One study found common
personal care products to include hair oils, pomades (to be discussed
in the next section), mixtures of pure honey and sugar
to exfoliate, natural lemon juice or a milk and honey blend to
wash the face and a mixture of herbs or Dead Sea clay to make
facial masks.1,2 It is important for the dermatologist to become
aware of cultural practices that may impede treatment.
As risk of irritation and subsequent post-inflammatory hyperpigmentation
(PIH) is much greater in this population, patients
should be encouraged to use very gentle cleansers and noncomedogenic
moisturizers. Astringents, toners, scrubs and
masks should be discouraged.
Don't Discount the Importance of Pomade Acne.
Recommend Silicone-Based Styling Products Instead
of Oil-Based Products in Patients Who Present With
Acne on the Forehead and Close to the Hairline.
Pomade use is very common among patients of color. Taylor et al. conducted a survey of patients at the Skin of Color Center in New York and found that 46.2 percent of patients reported hair oil or pomade use. This was correlated with the presence of forehead acne in 70.3 percent of patients.3 There are now many products available for hair that are light and moisturizing, without having the heavy oil base. Patients who desire a moisturizer with very light coverage of the hair shaft often prefer the silicone-derived moisturizers.4 Treatment of acne in skin of color is much more effective when pomades are removed.
Pomade use is very common among patients of color. Taylor et al. conducted a survey of patients at the Skin of Color Center in New York and found that 46.2 percent of patients reported hair oil or pomade use. This was correlated with the presence of forehead acne in 70.3 percent of patients.3 There are now many products available for hair that are light and moisturizing, without having the heavy oil base. Patients who desire a moisturizer with very light coverage of the hair shaft often prefer the silicone-derived moisturizers.4 Treatment of acne in skin of color is much more effective when pomades are removed.
Address Post-Inflammatory Hyperpigmentation as
Part of the Acne Treatment Regimen. Retinoids,
Hydroquinone, Azaleic Acid, Chemical Peels, etc.
Are an Important Adjunct to Acne Therapy in People
of Color.
In patients of color, the most disturbing feature of acne is not the acne lesion itself but the resulting PIH.1,3,5-7 Attention to agents that treat both acne and hyperpigmentation is important and should be instituted early in the course of therapy.3 Tretinonin, adapalene and tazarotene have a positive effect on PIH.3,8 Choosing creams over gels and beginning with lower concentrations and titrating upward minimizes the risk of irritant dermatitis from the use of retinoids.
In patients of color, the most disturbing feature of acne is not the acne lesion itself but the resulting PIH.1,3,5-7 Attention to agents that treat both acne and hyperpigmentation is important and should be instituted early in the course of therapy.3 Tretinonin, adapalene and tazarotene have a positive effect on PIH.3,8 Choosing creams over gels and beginning with lower concentrations and titrating upward minimizes the risk of irritant dermatitis from the use of retinoids.
