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Review
. 2022 Jan;23(1):69-81.
doi: 10.1007/s40257-021-00643-2. Epub 2021 Nov 9.

Effects of Topical Retinoids on Acne and Post-inflammatory Hyperpigmentation in Patients with Skin of Color: A Clinical Review and Implications for Practice

Valerie D Callender  1   2 , Hilary Baldwin  3   4 , Fran E Cook-Bolden  5   6 , Andrew F Alexis  6 , Linda Stein Gold  7 , Eric Guenin  8
Affiliations
Review

Effects of Topical Retinoids on Acne and Post-inflammatory Hyperpigmentation in Patients with Skin of Color: A Clinical Review and Implications for Practice

Valerie D Callender et al. Am J Clin Dermatol. 2022 Jan.

Abstract

Acne is a common cause for post-inflammatory hyperpigmentation (PIH), particularly in patients with skin of color (SOC), and PIH is often more distressing to patients than the acne itself. Topical retinoids are approved for the treatment of acne and for pigmentation disorders such as melasma or mottled hyperpigmentation associated with photodamage; moreover, they have been shown to reduce hyperpigmentation in patients with SOC. Therefore, treatment with topical retinoids should be started as early as possible unless contraindicated. Use of novel formulations or application of commonly recommended moisturizers may help reduce irritation. Combining retinoids with other topical agents and procedures such as superficial chemical peels can help to improve hyperpigmentation. Primary acne lesions are likely to improve weeks before PIH resolves and helping patients manage their expectations may reduce frustration. Providing clinicians and researchers with more education about the presentation and management of dermatologic conditions in patients with SOC is also recommended.

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Conflict of interest statement

Valerie Callender has served as an investigator, consultant, or speaker for AbbVie, Beiersdorf, Eli Lilly, Galderma, InCyte, L’Oréal, Ortho Dermatologics, Pfizer, Revance, Sente Labs, UCB and Vyne. Hilary Baldwin has served as advisor, investigator, and on speakers’ bureaus for Almirall, Cassiopea, Vyne, Galderma, Ortho Dermatologics, Sol Gel, and Sun Pharma. Fran Cook-Bolden has served as consultant, speaker, investigator for Galderma, LEO Pharma, Almirall, Cassiopea, Ortho Dermatologics, Investigators Encore, Foamix, Hovione, Aclaris, Cutanea. Andrew Alexis has received grant/research support (funds to institution) from Leo, Novartis, Almirall, Bristol-Myers-Squibb, Amgen, Menlo, Galderma, Valeant (Bausch Health), Cara, Arcutis; has served as a consultant/advisory board member for Leo, Novartis, Menlo, Galderma, Pfizer, Sanofi-Regeneron, Dermavant, Unilever, Beiersdorf, Valeant, L’Oreal, BMS, Menlo, Scientis, Bausch Health, UCB, Vyne, Cassiopea, Arcutis, Janssen, Allergan, Almirall, Abbvie, Sol-Gel, Amgen; and has served as a speaker for Pfizer, Sanofi-Genzyme/Regeneron, Astra Zeneca. Linda Stein Gold has served as an investigator/consultant or speaker for Ortho Dermatologics, LEO Pharma, Dermavant, Incyte, Novartis, AbbVie, Pfizer, Sun Pharma, UCB, Arcutis, Vyne, Sol-Gel, and Lilly. Eric Guenin is an employee of Ortho Dermatologics and may hold stock and/or stock options in its parent company.

Figures

Fig. 1
Fig. 1
Hyperpigmented acne lesions (red circles) and hyperpigmented macules (green ovals) in two 27-year-old Black females (A and B) who participated in a phase III study of tazarotene 0.045% lotion.
Fig. 2
Fig. 2
Acne and hyperpigmentation improvements in a 15-year-old Black female patient who was treated with tazarotene 0.045% lotion once daily for 12 weeks. Clinical trial results: inflammatory lesion counts reduced by 80%; noninflammatory lesion counts reduced by 33%; EGSS scores at baseline (4 = severe) and week 12 (3 = moderate). Authors’ assessments: Fitzpatrick skin type V; PIH Severity Scale grading at baseline (4 = moderate) and week 12 (2 = mild). Individual results may vary. EGSS Evaluator’s Global Severity Score, PIH post-inflammatory hyperpigmentation
Fig. 3
Fig. 3
Acne and hyperpigmentation improvements in a 27-year-old Black female patient who was treated with tazarotene 0.045% lotion once daily for 12 weeks. Clinical trial results: inflammatory lesion counts reduced by 60%; noninflammatory lesions counts reduced by 46%; EGSS scores at baseline (3 = severe) and week 12 (2 = moderate). Authors’ assessments: Fitzpatrick skin type V; PIH Severity Scale grading at baseline (4 = moderate) and week 12 (0 = normal). Individual results may vary. EGSS Evaluator’s Global Severity Score, PIH post-inflammatory hyperpigmentation
Fig. 4
Fig. 4
Acne and hyperpigmentation improvements in a 50-year-old Black female patient who was treated with tazarotene 0.045% lotion once daily for 12 weeks. Clinical trial results: inflammatory lesion counts reduced by 90%; noninflammatory lesions counts reduced by 79%; EGSS scores at baseline (3 = severe) and week 12 (2 = moderate). Authors’ assessments: Fitzpatrick skin type VI; PIH Severity Scale grading at baseline (7 = marked/severe) and week 12 (4 = moderate). Individual results may vary. EGSS Evaluator’s Global Severity Score, PIH post-inflammatory hyperpigmentation
See this image and copyright information in PMC

References

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