In my experience one of the main problems with acne in...

In my experience one of the main problems with acne in darkly pigmented skin is the discoloration that is left behind after the acne lesions resolve. The most effective way to combat this problem is, of course, to prevent new acne from forming, and to do so using the modalities that are the least irritating to skin.

Oral antibiotics are an effective option for many patients with acne, and do not cause the drying of skin that we see from gels, creams, and solutions. Patients need to be aware about potential sun hypersensitivity with some oral antibiotics, which can worsen the discoloration that darkly pigmented individuals can experience as a result of their acne.

Effective topical medications include combinations of benzoyl peroxide with either clindamycin or erythromycin. Azelaic acid, which is available as either a gel or a cream, is mildly effective for acne, but has the added benefit of reducing pigment formation. For more severe acne, topical (e.g. Retin-A) or oral (e.g. Accutane) retinoids may be necessary to get the acne under control, although these medications can be more drying than others.

For particularly large or cystic acne lesions, receiving injections of steroids into the lesions will help them resolve quicker and may decrease the chance of long-term pigment changes.

The risk of lightening the skin with acne treatments is very small. The pigmentation that is much more common and problematic is darkening of the skin. Racial differences do not affect the causes of acne, which are:

1. Excess oil production
2. Blocked or clogged pores
3. Bacteria
4. Inflammation

However, people with darker skin tones usually have more inflammation than those with lighter complexions. Even something that seems as minor as a clogged pore may have a lot of inflammation. And whenever there is inflammation in the skin, the pigment cells may become hyperactive, leading to a dark mark that may persist for months after the acne spot has gone away. This is why it is important to treat the acne early, and aggressively.

At the same time, it is important to pay attention to whether the acne treatment itself is causing irritation, because if it is, that may lead to patchy darkening of the skin. The treatments themselves are the same among all racial groups. These include topical medications (creams, lotion) like antibiotics, benzoyl peroxide, and retinoids (Retin-A, Differin), and oral medications ranging from antibiotics, to hormonal treatment, to Accutane. Darker skin types should avoid high concentrations of benzoyl peroxide, which can be quite irritating.

It is very important to remember sunblock. Many people with darker skin tones think they do not need sunblock. These people may have a lower risk of skin cancer, but don’t forget that the sun causes tanning, even in darker skin tones. So sun exposure will make any dark marks even darker.

20 of 21 found this helpful

Helpful?

Contact the doctor