Black skin and acne
Treating acne in black skin
- Acne very common in both adolescents and adults of African descent
- Strong tendency for hyperpigmentation
- Very few studies
Acne is the most common skin disorder in black adolescents and black adults and is often the primary reason for a visit to a doctor or dermatologist.1-3 According to the Journal of the European Academy of Dermatology and Venereology, "Acne vulgaris is an extremely common dermatological problem in Africans and people of African descent worldwide."4 Acne is also the most common skin disease in people with black skin in the United States.5
A 2012 study published in Pediatric Dermatology found that African American adolescents suffer with acne at a slightly higher rate when compared to Asian American adolescents and a slightly lower rate when compared to Caucasian American adolescents.6
Another study published in 2011 in the Journal of the European Academy of Dermatology and Venereology researched women of all ages, and showed a higher level of acne in women of African descent when compared to Caucasians, Asians, or Indians, with only Hispanics showing overall higher levels. When looking specifically at what researchers deemed “clinical acne,” another term for the usual acne people experience during adolescence with clogged pores (non-inflammatory acne) and inflamed lesions (inflammatory acne), women of African descent had the highest levels of any subgroup. “Physiologic” acne, or acne which tends to show up in adult women and tends to be less severe, was also higher in women of African descent than in any other subgroup except for Hispanic women.7 What is clear is that there is a high prevalence of acne in people of African descent. Unfortunately, relatively few acne-related studies have been conducted specifically on people with black skin.
What is different about black skin
People with black skin tend to have inflammatory acne, the most common type of acne, which includes papules and pustules, the run-of-the-mill “pimples” or “zits” that many people experience. This is actually good news because inflammatory acne can be easier to treat than non-inflammatory acne, which includes whiteheads and stubborn blackheads. Black people also tend to have fewer nodules and cysts, the more severe types of acne lesions.
Despite the fact that people of African descent tend to have less severe lesions, there is a higher chance of keloid scarring, especially on the chest and back, making effective acne prevention paramount. However, people of African descent tend to have less scarring overall.8
Next, while all non-Caucasian skin types tend to have a higher incidence of post-inflammatory hyperpigmentation, a medical term for marks left after acne goes away, from the research we have thus far, people of African descent have the greatest incidence of post-inflammatory hyperpigmentation.8 Dermatologists often remark on how their black patients consider these marks worse than the acne itself.2,8-11 A study published in 2011 in The Journal of Dermatology (see table below) has shown that these marks are very common in black skin and last much longer than acne itself.5 The authors state, “These data confirmed that hyperpigmentation as a consequence of acne is a much more important problem for patients with skin of color than for white ones…The hyperpigmentation persists for months to years: much longer than the acne lesions themselves.”5 Picking at the skin can make these marks worse, so people with darker skin types are strongly urged to avoid picking. See the hyperpigmentation page of Acne.org to learn more about how to contend with these dark spots that acne leaves behind.
Finally, people of African heritage do not tend to suffer with rosacea.9
|Asian and Other
(n = 19)
(n = 239)
(n = 55)
How to treat acne in black skin
Luckily, acne develops and is treated the same way regardless of skin color, and with the right regimen is easy to clear. There are several options including topical treatment as well as Accutane (isotretinoin) for people with severe, widespread, and scarring acne. According to the International Journal of Dermatology, "benzoyl peroxide is particularly effective for the inflammatory component." Benzoyl peroxide is a mild drying and peeling agent, but people with black skin tend to have less flakiness and scaling of the skin and tolerate it well.13,14 There is a highly effective topical regimen here on Acne.org that is based on benzoyl peroxide and works extremely well on people with black skin.
What is most important is to treat acne early and aggressively, since black skin is prone to hyperpigmentation and keloid scarring.15
The bottom line
The foremost concern should be prevention. Preventing acne will prevent the hyperpigmentation that are often left behind and will also prevent scarring. Concentrate your efforts on clearing up your acne and getting it under complete control. Then, if you choose, you can try on one of the many methods of hastening healing of the dark spots that are left behind.
People of African descent should not take the antibiotic minocycline to treat acne symptoms. "Fatal cases of hypersensitivity" have been reported with this drug in people of African descent.”14
- Dunwell, P. & Rose, A. Study of the skin disease spectrum occurring in an Afro-Caribbean population. Int J Dermatol 42, 287–289 (2003).
- 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).
- Yahya, H. Acne vulgaris in Nigerian adolescents--prevalence, severity, beliefs, perceptions, and practices. Int J Dermatol 48, 498–505 (2009).
- Jacyk, W. K. Adapalene in the treatment of African patients. J Eur Acad Dermatol Venereol 15 Suppl 3, 37–42 (2001).
- Morrone, A. et al. Clinical features of acne vulgaris in 444 patients with ethnic skin. J Dermatol 38, 405–408 (2011).
- 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).
- 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).
- Taylor, S. C., Cook-Bolden, F., Rahman, Z. & Strachan, D. Acne vulgaris in skin of color. J Am Acad Dermatol 46, S98–106 (2002).
- Halder, R. M. & Nootheti, P. K. Ethnic skin disorders overview. J Am Acad Dermatol 48, S143–148 (2003).
- Shah, S. K. & Alexis, A. F. Acne in skin of color: practical approaches to treatment. J Dermatolog Treat 21, 206–211 (2010).
- Davis, E. C. & Callender, V. D. A review of acne in ethnic skin: pathogenesis, clinical manifestations, and management strategies. J Clin Aesthet Dermatol 3, 24–38 (2010).
- Bhate, K. & Williams, H. C. Epidemiology of acne vulgaris. Br J Dermatol 168, 474–485 (2013).
- Kane, A., Niang, S. O., Diagne, A. C., Ly, F. & Ndiaye, B. Epidemiologic, clinical, and therapeutic features of acne in Dakar, Senegal. Int J Dermatol 46 Suppl 1, 36–38 (2007).
- Poli, F. Acne on pigmented skin. Int J Dermatol 46 Suppl 1, 39–41 (2007).
- Yin, N. C. & McMichael, A. J. Acne in patients with skin of color: practical management. Am J Clin Dermatol 15, 7–16 (2014).