Asian acne

Asian skin

  • Acne very common in Asians
  • While common, Asian adolescents may have less acne than other ethnicities
  • Tendency for hyperpigmentation
  • Asian skin may be more sensitive

Acne is a very common issue for people of Asian descent. Unfortunately, few studies have been performed specifically on people with Asian skin. According to an article in the British Journal of Dermatology, "There are very few studies on the prevalence of acne vulgaris among Asian teenagers."1 However, there is some evidence that Asian children and adolescents may suffer with acne less than other ethnicities.2-3 A study published in 2012 in the journal Pediatric Dermatology examined 31,153 children and adolescents up to 17 years of age in the United States and showed that Asian children and adolescents had less acne than their Caucasian or African American counterparts.3

Prevalence of acne in Asian skin

Another study, published in 2011 in the Journal of the European Academy of Dermatology and Venereology, examined 2,895 women of various ethnicities in the United States. Overall incidence of acne in Asian women was slightly lower compared to African American or Hispanic women, but slightly higher compared to Caucasians and Indians. When the researchers separated out types of acne, Asian women had the lowest amount of “comedonal” acne, which refers to non-inflammatory blackheads and whiteheads, than any other ethnicity. However, they had the highest amount of inflammatory acne, which refers to red pimples, sometimes with a white or yellow center. Asian women had more of a milder form of acne, called physiologic acne, than Indian women, but less physiologic acne than other ethnicities.

Acne skin of color
asian skin
Hyperpigmentation

Several features of Asian skin make it different from skin of other ethnicities and pose special challenges in treating acne. A study published in the Journal of the American Academy of Dermatology (see table below) in 2002 reported that Asian people had the least incidence of cystic lesions, the most severe type of acne lesion. The cohort of Asian people was small, however, so this report should be viewed as preliminary.5

Asian and Other
(n = 19)
Black
(n = 239)
Hispanic
(n = 55)
Papular Lesions 78.9% 70.7% 74.5%
Pustular Lesions 21.1% 26.4% 43.6%
Comedonal Lesions 52.6% 46.9% 50.9%
Cystic Lesions 10.5% 18.0% 25.5%
Post-inflammatory Hyperpigmentation 47.4% 65.3% 52.7%
Scarring 10.5% 5.9% 21.8%

People with Asian skin tend to have a bigger issue with marks left behind after acne lesions heal.6-9 These marks, scientifically referred to as post-inflammatory hyperpigmentation, can be stubborn, staying on the skin for a longer time in people with Asian skin and can be challenging to treat. See the hyperpigmentation page for more on these marks and treatment options. In addition to hyperpigmentation, people with Asian skin have a somewhat higher incidence of raised (keloid) scarring from acne. Next, Asians may respond differently to hormone therapy, but again, research is limited in this area.10 Lastly, Asian skin is thought to be thinner than other skin types, making it more sensitive, as outlined in this 2016 article in the Journal of Cutaneous and Aesthetic Surgery:

 It is generally believed that the Asian skin is more prone to irritation to certain topical agents compared to other skin types, most notably, Caucasian skin. This is generally thought to be a factor of the skin's ability to provide a barrier (i.e., thicker stratum corneum and higher eccrine gland sensitivity correlates with decreased somatosensory perception) against toxic, sensitizing, or irritating substances. Asian skin was reported to have an elevated neurosensory response to insults when compared to the skin of Caucasians, which were also observed to be more reactive than the skin of African-Americans. In particular, the East Asian skin has been found to have the least skin barrier strength, the lowest degree of maturation, and consequently, the highest degree of skin sensitivity as compared to whites or blacks.”11

Acne develops in the same way regardless of skin color, and acne is treated in the same way in people of every ethnicity. Acne can be effectively treated with topical medications, particularly with a properly applied benzoyl peroxide regimen. Doctors sometimes prescribe the oral medication Accutane (isotretinoin) to people with severe, widespread, and scarring acne as well.12-14 Because of the severe side effects of Accutane, including birth defects that Accutane can cause, authorities in Japan have banned its use in that country.

In 2014, a group of leading dermatology experts from six Asian countries (SASA) assessed the differences between Asian and Caucasian skin and formulated guidelines for treating acne specific for Asian skin. Lending further credibility to the argument that all acne is treated similarly no matter the ethnicity, the guidelines for Asian skin bear a striking resemblance to those for any other ethnicity, with the possible exception noted that due to cultural norms, oral contraceptives may not be as acceptable to people of African descent.15

Prevention is key. Get yourself completely cleared up so you are actively preventing future acne lesions, hyperpigmentation, and scarring. Then, if you so desire, you may try one of the various methods to treat hyperpigmentation.

  1. Tan, H. H., Tan, A. W., Barkham, T., Yan, X. Y. & Zhu, M. Community-based study of acne vulgaris in adolescents in Singapore. Br J Dermatol 157, 547–551 (2007).
  2. Shen, Y. et al. Prevalence of acne vulgaris in Chinese adolescents and adults: a community-based study of 17,345 subjects in six cities. Acta Derm Venereol 92, 40–44 (2012).
  3. Henderson, M. D. et al. Skin-of-color epidemiology: a report of the most common skin conditions by race. Pediatr Dermatol 29, 584–589 (2012).
  4. Perkins, A. C., Cheng, C. E., Hillebrand, G. G., Miyamoto, K. & Kimball, A. B. Comparison of the epidemiology of acne vulgaris among Caucasian, Asian, Continental Indian and African American women. J Eur Acad Dermatol Venereol 25, 1054–1060 (2011).
  5. Taylor, S. C., Cook-Bolden, F., Rahman, Z. & Strachan, D. Acne vulgaris in skin of color. J Am Acad Dermatol 46, S98–106 (2002).
  6. Alexis, A. F. & Lamb, A. Concomitant therapy for acne in patients with skin of color: a case-based approach. Dermatol Nurs 21, 33–36 (2009).
  7. Shah, S. K. & Alexis, A. F. Acne in skin of color: practical approaches to treatment. J Dermatolog Treat 21, 206–211 (2010).
  8. Kim, S. & Cho, K. H. Treatment of facial postinflammatory hyperpigmentation with facial acne in Asian patients using a Q-switched neodymium-doped yttrium aluminum garnet laser. Dermatol Surg 36, 1374–1380 (2010).
  9. Ho, S. G. et al. A retrospective analysis of the management of acne post-inflammatory hyperpigmentation using topical treatment, laser treatment, or combination topical and laser treatments in oriental patients. Lasers Surg Med 43, 1–7 (2011).
  10. Yeung, C. K., Teo, L. H., Xiang, L. H. & Chan, H. H. A community-based epidemiological study of acne vulgaris in Hong Kong adolescents. Acta Derm Venereol 82, 104–107 (2002).
  11. Goh, C. L. et al. Meeting the Challenges of Acne Treatment in Asian Patients: A Review of the Role of Dermocosmetics as Adjunctive Therapy. J Cutan Aesthet Surg 9, 85–92 (2016).
  12. Ahn, H. H. & Kim, I. H. Whitening effect of salicylic acid peels in Asian patients. Dermatol Surg 32, 372–375; discussion 375 (2006).
  13. Lee, H. S. & Kim, I. H. Salicylic acid peels for the treatment of acne vulgaris in Asian patients. Dermatol Surg 29, 1196–1199; discussion 1199 (2003).
  14. Gan, E. Y. et al. Isotretinoin is safe and efficacious in Asians with acne vulgaris. J Dermatolog Treat 24, 387–391 (2013).
  15. Goh, C. L. et al. South-East Asia study alliance guidelines on the management of acne vulgaris in South-East Asian patients. J Dermatol 42, 945–953 (2015).