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Acne can pose unique challenges in people with darker skin
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Acne can pose unique challenges in people with darker skin

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In darker skin, one pimple or breakout can cause dark marks, scars or even keloids.

Acne affects millions of Americans each year and affects people of all skin tones, yet acne can pose special challenges in people with darker skin.

In darker skin, one pimple or breakout can cause dark marks, scars or even keloids (scar tissue that continues to grow larger than the original scar) that last for months to years afterward. Those affected are left searching for the secrets to treatment — or better yet, prevention. In this post we discuss how acne and similar or related conditions may be treated, and sometimes prevented, in people with darker skin.

Acne triggers release of melanin

Melanin, the same molecule that pigments our skin and hair and protects us from the damaging ultraviolet rays of the sun, can also protect our skin from inflammation. When the skin gets inflamed from acne (or from harsh acne products), our skin releases melanin. This can result in dark spots, known as post-inflammatory hyperpigmentation (PIH), that can last longer than the acne itself and are more likely to occur in people with darker skin.

In more severe cases, textural scarring and even keloids can develop from the inflammation. Preventive measures and timely treatment can help improve, minimize or even prevent PIH, scarring, and keloids.

What if it’s not acne at all?

Before jumping into treatments, it is important to recognize that there are other conditions that can look like acne but are not. Individuals with darker skin may be more susceptible to ingrown hairs, for example, which can look remarkably similar to acne and cause the same dark spots. These bumps, however, are caused by hair growing out of the follicle in a tightly coiled way and may require treatments such as laser hair removal. In the beard region, this is called pseudofolliculitis barbae, and may be mistaken for acne, particularly in men of darker skin types.

A dermatologist experienced in treating darker skin can provide a proper diagnosis and customize an appropriate treatment plan.

Treating acne

True acne should be treated with gentle products because harsher treatments can cause severe dryness or irritation that can worsen dark spots and scarring.

Topical retinoid and retinol creams and gels can help to clear pores, reduce inflammation and speed up the process of skin cell turnover and regeneration, which helps in both the prevention and treatment of PIH and scarring. Starting with a milder retinoid product (such as adapalene 0.1% gel) and gradually increasing strength and frequency of use allows the body to adjust without excessive irritation. A benzoyl peroxide wash can also help eliminate bacteria on the skin that contribute to the development of acne.

Always avoid squeezing, popping or picking at your acne, which can cause acne to spread and delay healing. It may take several months to see the results you desire, so be patient.

Another potential cause of breakouts, particularly on the forehead: certain hair-styling products such as pomades, oil-based hair products, and thicker creams that are more frequently used by those with darker skin and textured hair. These can contribute to breakouts consisting of blackheads, whiteheads and general bumpiness of the forehead and temples. They can be prevented by applying these products only to the mid-scalp and ends of the hair, and avoiding contact with the face.

Finally, if you feel mask-wearing is contributing to your breakouts, you may be experiencing a form of acne caused by friction and pressure on the skin. Consider washing your face as soon as you remove your mask; change your mask frequently, and apply a thin layer of moisturizer under the mask to serve as a barrier against friction whenever possible.

Treating PIH and scarring

Once the underlying inflammation is under control, your PIH may fade away over time. However, you may be able to speed the process with an over-the-counter or prescription lightening cream. Choose a product carefully; some bleaching creams may contain unhealthy doses of corticosteroids, which can cause a variant of acne, called steroid acne, with long-term use. When choosing a skin-lightening product, look for ingredients such as retinoids or retinols, azelaic acid, glycolic acid, hydroquinone, or kojic acid. Be sure to follow the instructions on the package, and consult your dermatologist with questions to prevent excessive bleaching and irritation. In addition, protect your skin by applying sunscreen daily.

In-office procedures such as lasers, chemical peels, and microdermabrasion may offer more immediate treatment for PIH and scarring. These procedures should be performed by a board-certified dermatologist with expertise in treating darker skin types; if done incorrectly, they can result in injury to the skin and worsening of scarring and PIH.

(Arianne Shadi Kourosh, M.D., MPH, and Shauna Rice, BS, are contributors to Harvard Health Publications.)

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