I am worried that some acne treatments/medications might cause my skin to lighten. Is it possible for acne treatments to cause hypopigmentation in African Americans? Are there any acne treatments that are safe for all skin types or work particularly well on dark skin? Are there any acne treatments that people with darker skin tones should avoid?
Best Acne Treatment for African American?
Doctor Answers 14
Acne in darker complexions
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:
- Excess oil production
- Blocked or clogged pores
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.
Best acne treatments for African Americans
Post inflammatory hyperpigmentation (PIH)' which is skin darkening, occurs much more commonly that skin lightening as a result of acne or as a consequence of acne treatment. Steroid injections, used to quickly resolve deep, tender acne nodules, are the one exception--these may cause skin lightening in spot (this generally resolves over time. Regardless of skin color, the best treatment for your acne will depend on the type of acne lesions and their location, That being said, acne medications that exfoliate, such as retinoids, azeleic acid and chemical peels are particularly effective in acne patients with dark skin as they improve the post inflammatory hyperpigmentation simultaneously.
Treating ethnic skin
You bring up an important question. There are many acne products that may be too harsh to apply to skin of color, African American Skin, or ethnic skin. Some chemicals may be too drying or irritating which can lead to redness, peeling, inflammation and result in "post-inflammatory hyperpigmentation" or darkening of the skin. There is a fine balance to carefully skin typing each individual and knowing which products may be tolerable and which products will be too harsh for your skin.
I advocate effective acne treatment but sometimes will add in a treatment to help fade out dark spots from old acne scar without "lightening" the overall skin. The goal is to allow improvement of complexion and blending and fading of dark spots, not to give you a "Washed-out" faded look to your skin.
I have treated patients in steps (1. treat acne, then 2. blend complexion) and simultaneously depending on how aggressive they want to be, the time they want to dedicate to the treatment, and their skin tolerability. I recommend natural and pharmaceutical treatments depending on the patient's preference. It is important to find a dermatologist who is culturally-sensitive to your skin and doesn't approach your treatment as a "one size fits all" model.
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Acne treatment for African American skin
Retin A is a very common acne treatment that many people use. This can lighten your skin. For your type of skin, I would consider a sensitive skin cleanser this will help decrease your inflammation that you might be getting with other products. Having a skin cleanser with salicylic acid 2% is vitally important. This ingredient will kill off bacteria that causes acne. A topical antibiotic cream with clindamycin can really help when things get really bad for you in terms of pustules and infections. A toner with salicylic acid can help after cleansing your skin with the cleanser above.
Also there are creams that you can use with alpha and beta hydroxy acids that work synergistically to help fight off acne. You may still want to have a Retin A product, they help with Acne in different ways. But you can hold off on it until the other products don't work. Retin A helps break down the adhesion of the skin cells that can lead to your pores getting clogged up, etc.
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.
Acne treatments in dark skin
Treatments For Darker Skin Types
Acne in Dark Skin Types
Patients with dark skin can tolerate most of the currently prescribed acne medications without much concerns or worries, if they are used correctly. The biggest problem that we see in darker-skinned individuals is what is called post-inflammatory hyperpigmentation, or dark spots once the bumps settle down. This pigment, or residual inflammation, is best handled by a dermatologist to make the dark normal skin as fast as possible.
VI Peel for Acne
The VI Peel is what I would recommend for acne. It is highly effective in clearing acne and impurities. A series of treatments may also help to reduce acne scars. In my experience it works very well on African American skin.
Best Acne Treatments for Skin of Color
It is important for patients with skin of color to visit their dermatologist promptly for acne treatment. When left untreated, patients with darker skin types are much more likely to develop dark spots on their skin (called post-inflammatory hyperpigmentation) that can be just as noticeable as the acne lesions themselves. I often recommend prescription medications such as azeleic acid (Finacea) and tazarotene (Tazorac) for my patients, as these creams have been shown to lighten areas of post-inflammatory hyperpigmentation as they treat acne. Additionally, in-office acne treatments (such as the Isolaz and LED light therapy) are often safe for patients with skin of color.