Commentary

Blog: Treating Acne, PIH in Dark Skinned Patients


 

The growing diversity of the U.S. population has highlighted the importance of being able to properly treat skin of color patients.

The topic was the focus of a presentation by Dr. Wendy E. Roberts during the American Academy of Dermatology's Summer Academy Meeting in New York. She is in private practice in Rancho Mirage, Calif.

When it comes to treating skin of color, dermatologists should keep three main points in mind, said Dr. Roberts: recognition of the skin disease, treatment, and procedural safely. (Dr. Roberts explains each point in the video below.)

For instance, acne, which is the most common skin condition, can affect dark skin differently than in patients with light skin. Postinflammatory hyperpigmentation (PIH) is one of the unique characteristics of acne expression in ethnic skin.

Patients may not visit the dermatologist because of the primary lesions such as papules and postules, said Dr. Roberts. Rather, they may come in because of the brown spot on their skin.

Based on the patients' skin type and severity of acne, dermatologists have access to several treatment options for PIH, which include the gold standard hydroquinone and retinoids that help lighten the affected areas. Other options include chemical peels, microdermabrasion, and fractional lasers.

A 2010 review of acne in skin of color patients showed that clinical features such as PIH and potential irritation, "should influence the choice of anti-acne agents used when designing a treatment regimen" (J. Clin. Aesthet. Dematol. 2010;3:24-38).

The study, however, pointed out the paucity of clinical studies that evaluate the safety and efficacy of acne medications in skin of color. "Future areas of exploration should examine the use of combination or new therapies in skin of color, the roles of hormones and genetics, and the contribution of possible differences in the skin biology characteristics of darker ethnic groups to the development of acne," the study authors wrote.
Meanwhile, a 2008 survey of program directors and chief residents at 109 dermatology programs concluded that there is a need for "increased exposure, educational sessions, and overall training in diseases pertaining to skin of color in U.S. dermatology residencies." (J. Am. Acad. Dermatol. 2008;59:615-8). In the meantime, Dr. Roberts stressed that peer-to-peer education and expanded residency training in skin of color are critical.

-By Naseem Miller

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