Acne vulgaris accounts for one of the most common dermatologic diagnoses, including skin color (SOC) populations. A study helped to clarify the existing published data and provided consensus statements on acne presentation, prevention, treatment, and maintenance in SOC populations to help improve patient outcomes.

The study utilized the efforts of six SOC dermatologists gathered via a virtual meeting, using a modified Delphi process to address: 1) Existence of racial/ethnic differences in the clinical presentation and sequel of acne? 2) Existence of racial/ethnic differences in the therapeutic endpoint of acne treatment and patient expectations? 3) Need for specialized approaches to therapeutic options and skincare in acne patients with SOC? 

The results of a literature review along with discussions, coupled with the panel′s expert opinion and experience, were then summarized to aid health care providers caring for acne patients and clinician-researchers.

The panel agreed on six consensus statements after reviewing and discussing the drafted statements generated by the original literature search-

Statement 1: Post-inflammatory hyperpigmentation (PIH), a common sequela of acne in SOC, can also develop on irritation from topical acne treatments or procedural therapies. Since PIH can occur as a sequela of acne or as a complication of treatment, regimens must be aggressive enough to reduce inflammation from acne and well-tolerated to avoid irritation from treatment. Therefore, while treating and prescribing skincare regimens for SOC patients with acne, an individualized selection of a topical regimen to minimize irritation should consider tolerability characteristics of the active ingredients and vehicle.

Statement 2: Dry skin, a common concern among patients with SOC, may be more visible or stigmatizing in richly pigmented skin.

Statement 3: The skin of African Americans shows Decreased ceramide levels.

Statement 4: Acne-related PIH in the SOC individual can be equally bothersome as the acne lesions themselves. So, the therapeutic endpoint of acne treatment in SOC patients must comprise of resolution of PIH and long-term control of underlying acne vulgaris. 

Statement 5: Adjunctive skincare have shown an essential role in preventing, treating, and maintaining acne. The selection of cleansers and moisturizers for acne and acne-prone skin should be based on individual and/or cultural variations in skincare preferences. Some skincare and hair care products, commonly used in communities of color, like cocoa butter and petrolatum, may exacerbate acne. 

Statement 6: the Special considerations to be remembered while treating SOC individuals with acne: 

• Dry skin and irritation are a common result of topical acne treatment or systemic retinoid therapy.
• Dryness and irritation resulting from acne treatment can be improved by using Non-comedogenic cleansers and moisturizers. Prioritize aqueous gels, lotion, or cream vehicles.
• Acne-affected skin has lower levels of ceramides, with profound reductions compared to healthy individuals of all ethnicities. Thus, Ceramide-containing moisturizers may enhance adherence and complement existing acne therapies in these patients.

It was summarized as-

• There exist Racial/ethnic differences in the clinical presentation, sequelae, and desired treatment outcomes for acne.
• Early initiation and maintenance of treatment regimens and careful consideration of tolerability of active ingredients, vehicles, and dosing are the strategies that can improve outcomes in acne patients with SOC.
• Irritation or dryness can be minimized by using pH-balanced, non-irritating cleansers and non-comedogenic ceramides containing moisturizers.

Thus the study warranted specialized approaches to therapeutic options and skincare in acne patients with SOC. It also recommended the use of OTC skincare products before and during prescription therapy and as part of a maintenance regimen. 

Source: J Drugs Dermatol. 2021 Jul 1;20(7):716-725. doi: 10.36849/JDD.6169. PMID: 34232006.