Ethnic diversity in the United States demands that dermatologists learn more about a wider range of skin types. Numerous new studies are required so that the differences and similarities in skin structure and activity among various ethnic groups can be better understood.
A Changing Population
o Acne is one of the most common dermatologic presentations among all races and ethnic groups
Differences in Inflammatory Content
o Biopsies of comedonal acne in African-American patients have shown marked inflammation in a condition that is considered noninflammatory in whites
o Comedonal acne may need to be reclassified as inflammatory in patients of color
o In addition to a topical retinoid to resolve the hyperkeratosis in comedonal acne,
black patients may also require an anti-inflammatory agent.
o Hyperpigmented macules (HPMs) are evidence of previous inflammatory lesions and are usually the most pressing presenting complaint of black acne patients.
o HPMs can be treated with a topical retinoid, azelaic acid, and hydroquinone.
o Over-the-counter preparations to treat HPMs are at best ineffective and at worst dangerous, with some containing potentially toxic ingredients such as mercury or steroids.
o Dermatologists who are unaware of the inflammatory nature of comedones in black patients may not prescribe optimal treatment.
Etiology of Acne in Darker Skin
o The same three factors are probably involved in the pathogenesis of acne, no matter what the patient's ethnic or racial background.
o Hyperkeratosis, the presence of Propionibacterium acnes, and increased production of sebum are the three factors that must be addressed by acne therapy in all patients
o Patients with darker skin tend to be more sensitive to drying and irritation, and therefore, antiacne agents must be chosen with care.
o A cream-based topical retinoid, such as adapalene (Differin®) cream, is a good first-line treatment for comedonal or popular acne in patients with dark, sensitive skin
o Gel-based retinoids can be used without reservation in darkskinned patients with oily skin.
o Adapalene gel seems to be less irritating to darker skin than some of the other topical retinoid gels or creams
Pseudofolliculitis Barbae
o The prevalence of pseudofolliculitis barbae among African-American men seems to be high, with estimates ranging between 40% and 80%.
o Pseudofolliculitis barbae can be disfiguring, cause physical discomfort, and lower self-esteem in men who suffer from it.
o It can be treated with topical retinoids to loosen follicular plugging and topical antibiotics to quell inflammation
o Alpha hydroxy acids might also be effective.
More Education Is Needed
o To ensure that acne patients with darker skin receive the best and most appropriate care, dermatologists must become more comfortable with treating a range of skin types.
o Educational initiatives sponsored by the American Academy of Dermatology, the National Institutes of Health, and teaching hospitals across the country are responding with more symposia and lectures specifically geared toward disseminating information on acne in darker skin to dermatologists, primary care physicians, and industry scientists.
