Ten Tips for Treating Acne Vulgaris in Fitzpatrick Skin Types IV-VI

June 2011 | Volume 10 | Issue 6 | Original Article | 654 | Copyright © June 2011

Candace Thornton Spann MD

During the 21st century, people with skin of color will account for a large portion of the US population. According to race projections from the US Census Bureau, persons of African American, Hispanic, Asian and Native American descent will make up nearly half of the total US population by the year 2050. Because of our changing demographics, it is important that all dermatologists become comfortable in treating skin of color. This article provides 10 practical pearls for management of acne vulgaris in patients with Fitzpatrick skin types IV-VI.

J Drugs Dermatol. 2011;10(6):654-657.

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.
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.