It has been observed that in Fitzpatrick skin types IV, V and VI – that is, darker skin tones – there are some subtle differences in how acne looks and feels. What treatments work and the elements that exacerbate acne may be different, leading to different approaches in care.
One of the major differences in treatment outcomes in people with darker skin tones is the propensity of these skin types to develop post-inflammatory hyperpigmentation, which means areas of extra pigmentation appear on the skin. Acne treatments often include causing microtrauma to or inflaming the skin, which then stimulates the skin’s healing response, improving symptoms.
Hyperpigmentation spots can last for weeks or months, even longer than the acne, and can be a disappointing outcome to otherwise solid treatments for acne. Research has observed that about a quarter of women of colour with acne reported hyperpigmentation, which to them was worse than the acne itself.
How exacerbating factors may differ in darker skin tones
Hair care practices in particular may contribute to an initial acne outbreak, with oily hair products commonly to blame. Any hair care product that contains petrolatum, mineral oil or other pore-blocking ingredients can lead to what’s known as pomade acne, characterised by pimples on the forehead and temples, close to the hairline as the offending hair care product slips onto the face.
Bleaching creams may also contain illegal doses of corticosteroids, which when used long-term on the face, can cause what’s known as steroid acne. Signs of bleaching cream may be irregular areas of pigmentation or just one type of pimple on the face (as opposed to a variety, normally found in acne). Sudden acne flare-ups are a characteristic of steroid acne. Once you stop using the cream, you may experience a flare-up of acne while your dermatologist treats you in other ways.
If you are being treated for acne, take all products you have used on your hair and face in the past year into your dermatologist appointment so the ingredients can be checked.
How much acne treatment is too much?
Undertreating and over-treating acne in darker skin tones remains a risk: undertreating carries the risk of not solving the problem adequately, while overtreating can result in inflammation and pigmentation issues. This means your treatment needs to be tailored to your skin type and acne, with tests done to see what your skin will tolerate. Usually this will mean a collection of treatments.