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Chapter 19: Acne

INTRODUCTION

KEY POINTS

  • Comedonal, inflammatory, and nodulocystic acne occur in all skin types.

  • In darker skin, comedones and inflammatory papules may be skin colored and lack erythema in contrast to lighter skin where they can be skin colored or pink with significant erythema.

  • The sequalae of acne can vary significantly across skin colors with postinflammatory pigment alteration occurring in darker skin.

  • Atrophic, hypertrophic, and keloidal scarring may also occur in those who are prone, and the latter is more common in skin of color.

  • Certain types of acne including pomade acne and steroid-induced acne may occur more commonly in skin of color.

image

FIGURE 19-1.

Skin-colored closed comedones along the temple and lateral cheek secondary to hair oil use and consistent with pomade acne in a dark-skinned person. (Reproduced with permission from Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color, 2nd ed. New York, NY: McGraw Hill; 2016, Figure 42-5.)

A patient with dark brown skin with skin colored papules along the lateral check and temple.
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FIGURE 19-2.

Open and primarily closed skin-colored comedones along the lateral cheek and jawline. (Reproduced with permission from Baumann L, Saghari S, Weisberg E. Cosmetic Dermatology: Principles and Practice, 2nd ed. New York, NY: McGraw Hill; 2009, Figure 12-2.)

A photograph shows close view of right cheek of a male patient depicting comedones that appear as numerous small raised eruptions.
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FIGURE 19-3.

Pink inflammatory papules and white pustules on the cheek surrounded by pink-brown macules signifying postinflammatory erythema, which is more easily visible in lighter skin. (Reproduced with permission from Baumann L, Saghari S, Weisberg E. Cosmetic Dermatology: Principles and Practice, 2nd ed. New York, NY: McGraw Hill; 2009, Figure 12-1.)

A photograph shows close view of right cheek of a female patient with acne appearing as inflammatory pustules.
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FIGURE 19-4.

Pink inflammatory papules scattered diffusely on the face, with background atrophic scarring and brown macules consistent with postinflammatory hyperpigmentation. (Reproduced with permission from Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color, 2nd ed. New York, NY: McGraw Hill; 2016, Figure 91-11.)

A patient with light brown skin with pink papules, atrophic scarring and hyperpigmented brown macules on the face. Some papules have erosions.
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FIGURE 19-5.

Bright-pink to red inflammatory papules, nodules, comedones, pustules, and cysts, with surrounding background scarring and pink macules signifying postinflammatory erythema. (Reproduced with permission from Wolff K, Johnson RA, Saavedra AP, et al. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology, 8th ed. New York, NY: McGraw Hill; 2017, Figure 1-5.)

A patient with severe pink to deep red papules, nodules, pustules and cysts on the face. Scarring, dark pink macules and yellow crusts are also found.
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FIGURE 19-6.

Brown to violaceous papules and nodules along with comedones and pustules and areas of background erythema most visible along the mid-inferior border of the photo. The patient also has background icepick scarring and violaceous to brown macules signifying postinflammatory pigmentation and chronic acne changes. (Reproduced with permission from Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color, ...

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