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KEY POINTS
Acne vulgaris is a disorder that is seemingly common in skin of color populations, including those of African, Asian, and Latin descent.
Although few studies examine possible differences in the pathogenesis of acne vulgaris in racial groups, it is likely that the pathogenesis is similar in all groups.
Individuals with darker skin tones and acne frequently present with a chief complaint of hyperpigmentation, which is often referred to as dark marks, blemishes, scars, spots, discolorations, blotches, descoloracions, or Mecheta.
Hyperpigmented macules may be the predominant lesions found in the skin of color patient with acne.
Whereas comedonal acne occurs commonly in some skin of color individuals, nodulocystic acne is felt to occur less frequently in this population.
By and large, treatment regimens for acne vulgaris in skin of color patients are similar to those for fairer-skinned patients, but it is important to avoid topical medications that lead to dryness or irritation and subsequent postinflammatory hyperpigmentation.
Various methods can be used to improve tolerability to potentially drying topical agents for the skin of color patient.
Oral agents, including antibiotics and retinoids, are effective for skin of color patients with acne.
Procedural treatments including chemical peels, laser and light therapy, and surgical modalities can also be beneficial in providing adjuvant and/or combination therapy for acne vulgaris and its sequelae.
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The diagnosis and treatment of acne vulgaris are a frequent reason for visits by patients to the dermatologist’s office. This disease affects 40 to 50 million people in the United States, and it is commonly seen from the preteen years through age 50 in Caucasian patients [Figure 42-1].1,2 Acne often has a negative psychological impact on patients and has been associated with anxiety, depression, social isolation, interpersonal difficulties, lower self-esteem and self-confidence, dissatisfaction with one’s facial appearance, and fewer employment opportunities.3,4,5 Furthermore, it may lead to permanent scarring. The U.S. Census estimates that by 2050, the skin of color population will constitute half of the U.S. population.6 Given this demographic shift, dermatologists will be faced with increasing numbers of individuals of color with acne. Acne vulgaris patients with skin of color present with differences in the chief complaint, clinical presentation, precipitating and exacerbating factors, long-term sequelae, treatment, and subsequent adverse events [Table 42-1]. This chapter provides a comprehensive review and discussion of these differences.
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