Acne commonly causes post-inflammatory hyperpigmentation (PIH), particularly in patients with skin of color (SOC). PIH often remains more distressing to patients than the acne itself. Topical retinoids are approved for treating acne and for pigmentation disorders such as melasma or mottled hyperpigmentation associated with photodamage. Moreover, they can also reduce hyperpigmentation in patients with SOC. Thus, it is vital to initiate treatment with topical retinoids as early as possible unless contraindicated. 

Using novel formulations or applying commonly recommended moisturizers may help reduce irritation. Further, combining retinoids with other topical agents and procedures like superficial chemical peels can help to improve hyperpigmentation. 

Primary acne lesions tend to improve weeks before PIH resolves, and helping patients manage their expectations may reduce frustration. Clinicians and researchers must have thorough knowledge about diagnosing and managing dermatologic conditions in patients with SOC.

Source: Callender VD, Baldwin H, Cook-Bolden FE, et al. Effects of topical retinoids on acne and post-inflammatory hyperpigmentation in patients with skin of color: a clinical review and implications for practice. Am J Clin Dermatol. 2022;23(1):69-81.