A review of acne in ethnic skin: pathogenesis, clinical manifestations, and management strategies

Abstract

Acne vulgaris is one of the most common conditions for which all patients, including those with skin of color (Fitzpatrick skin types IV-VI), seek dermatological care. The multifactorial pathogenesis of acne appears to be the same in ethnic patients as in Caucasians. However, there is controversy over whether certain skin biology characteristics, such as sebum production, differ in ethnic patients. Clinically, acne lesions can appear the same as those seen in Caucasians; however, histologically, all types of acne lesions in African Americans can be associated with intense inflammation including comedones, which can also have some degree of inflammation. It is the sequelae of the disease that are the distinguishing characteristics of acne in skin of color, namely postinflammatory hyperpigmentation and keloidal or hypertrophic scarring. Although the medical and surgical treatment options are the same, it is these features that should be kept in mind when designing a treatment regimen for acne in skin of color.

Figures 1a–1c

Acne vulgaris in Fitzpatrick skin types IV (a), V (b), and VI (c). Note the postinflammatory hyperpigmentation, particularly in the higher skin phototypes.

Figures 1a–1c

Acne vulgaris in Fitzpatrick skin types IV (a), V (b), and VI (c). Note the postinflammatory hyperpigmentation, particularly in the higher skin phototypes.

Figures 1a–1c

Acne vulgaris in Fitzpatrick skin types IV (a), V (b), and VI (c). Note the postinflammatory hyperpigmentation, particularly in the higher skin phototypes.

Figure 2

Fitzpatrick skin type V patient with nodulocystic acne. Note the postinflammatory hyperpigmentation.

Figure 3

Comedonal acne. Note the presence of both open and closed comedones.

Figures 4a and 4b

Histological examination of an open comedo. Note the dilated, distorted, keratin-filled follicle and the presence of patchy chronic inflammation. There was no evidence of inflammation on clinical exam.

Figures 4a and 4b

Histological examination of an open comedo. Note the dilated, distorted, keratin-filled follicle and the presence of patchy chronic inflammation. There was no evidence of inflammation on clinical exam.

Figure 5

Patient with pomade acne eruption of closed comedones over the forehead and temple regions

Figures 6a and 6b

Postinflammatory hyperpigmentation in a patient with Fitzpatrick skin type V (a) and VI (b). Note the greater intensity of pigmentation with darker skin

Figures 6a and 6b

Postinflammatory hyperpigmentation in a patient with Fitzpatrick skin type V (a) and VI (b). Note the greater intensity of pigmentation with darker skin

Figures 7a and 7b

Keloid formation on the chest (a) and along the mandible (b) from acne vulgaris

Figures 7a and 7b

Keloid formation on the chest (a) and along the mandible (b) from acne vulgaris

Figure 8

Multiple areas of persistent erythema on the cheek after acne

Figures 9a, 9b, 9c

Erythema (a), hyperpigmentation (b), hypopigmentation (c) resulting from an irritant contact dermatitis in skin of color patients. Figures 9b and 9c are reprinted with permission from Dermatologic Therapy. 2004;17(2):184–195.© John Wiley & Sons, Inc.

Figures 9a, 9b, 9c

Erythema (a), hyperpigmentation (b), hypopigmentation (c) resulting from an irritant contact dermatitis in skin of color patients. Figures 9b and 9c are reprinted with permission from Dermatologic Therapy. 2004;17(2):184–195.© John Wiley & Sons, Inc.

Figures 9a, 9b, 9c

Erythema (a), hyperpigmentation (b), hypopigmentation (c) resulting from an irritant contact dermatitis in skin of color patients. Figures 9b and 9c are reprinted with permission from Dermatologic Therapy. 2004;17(2):184–195.© John Wiley & Sons, Inc.

Figures 10a and 10b

Skin of color patient with acne and PIH before (a) and after (b) 7 months of therapy with tazarotene 0.1% applied in the mornings and a fixed combination lightening agent (fluocinolone acetonide 0.01%, hydroquinone 4%, and tretinoin 0.05% cream) applied in the evenings

Figures 10a and 10b

Skin of color patient with acne and PIH before (a) and after (b) 7 months of therapy with tazarotene 0.1% applied in the mornings and a fixed combination lightening agent (fluocinolone acetonide 0.01%, hydroquinone 4%, and tretinoin 0.05% cream) applied in the evenings