Acne affects millions of Americans and people of all skin tones each year. However, acne can present particular challenges in people with darker skin. For darker skin, a pimple or breakout can cause dark spots, scars, or even keloids (scar tissue that continues to grow larger than the original scar) that last for months to years. Those affected are looking for the secrets of treatment – or, even better, prevention. In this post we discuss how acne and similar or related conditions can be treated and sometimes prevented in people with darker skin.
Acne triggers the release of melanin
Melanin, the same molecule that pigments our skin and hair and protects us from the sun’s harmful ultraviolet rays, can also protect our skin from inflammation. When the skin becomes inflamed from acne (or from harsh acne products), our skin releases melanin. This can lead to dark spots called post-inflammatory hyperpigmentation (PIH), which can last longer than the acne itself and are more common in people with darker skin. In more severe cases, the inflammation can develop structural scars and even keloids. Preventive measures and timely treatment can help improve, minimize, or even prevent PIH, scars, and keloids.
What if it’s not acne at all?
Before starting treatment, it is important to realize that there are other conditions that may appear like acne but are not. For example, those with darker skin are more prone to ingrown hairs, which look remarkably similar to acne and can cause the same dark spots. However, these bumps are caused by tightly coiled hair growing tightly out of the follicle and may require treatments such as laser hair removal. In the beard region, this is known as pseudofolliculitis barbae and can be mistaken for acne, especially in men with darker skin types. A dermatologist experienced in treating darker skin can make a correct diagnosis and adjust an appropriate treatment plan.
Real acne should be treated with gentle products, as harsher treatments can result in severe dryness or irritation that can make dark spots and scars worse. Topical retinoid and retinol creams and gels can help cleanse pores, reduce inflammation, and speed up the process of skin cell turnover and regeneration, which helps both in the prevention and treatment of PIH and scarring. Starting with a milder retinoid product (such as Adapalen 0.1% gel) and gradually increasing the strength and frequency of use, the body can adjust without undue irritation. A benzoyl peroxide wash can also help clear out bacteria on the skin that contribute to the development of acne. Always avoid bruising, popping, or pecking your acne as this can cause acne to spread and delay healing. It can take several months for the results you want to appear. So be patient.
Another possible cause of breakouts, especially on the forehead: certain hair styling products like pomades, oil-based hair products, and thicker creams, which are more commonly used by those with darker skin and textured hair. These can lead to breakouts consisting of blackheads, white heads, and general unevenness of the forehead and temples. They can be prevented by applying these products only to the middle scalp and ends of the hair, avoiding contact with the face.
Eventually, if you feel that wearing a mask is contributing to your breakouts, it can eventually develop into some form of acne caused by friction and pressure on the skin. Wash your face as soon as you remove your mask. Change your mask frequently and apply a thin layer of moisturizer under the mask to protect it as a barrier against friction whenever possible.
Treatment of PIH and scars
Once the underlying inflammation is under control, your PIH can go away over time. However, you may be able to speed up the process with an over-the-counter or prescription whitening cream. Choose a product carefully. Some bleaching creams may contain unhealthy doses of corticosteroids, which, with prolonged use, can cause a variant of acne called steroid acne. When choosing a skin lightening product, look for ingredients like retinoids or retinols, azelaic acid, glycolic acid, hydroquinone or kojic acid. Be sure to follow the directions on the package and consult your dermatologist with any questions to avoid excessive bleaching and irritation. Also, protect your skin by applying sunscreen every day.
In-office procedures like lasers, chemical peels, and microdermabrasion may offer more immediate treatment for PIH and scars. These procedures should be performed by a board certified dermatologist who has experience treating darker skin types. If done wrong, they can lead to skin injuries and worsening of scars and PIH.