What acne treatment works best on dark skin?

Keep in mind that the goal is to get acne under control. The most important thing is that you are using products that treat, but also care for your skin. Some over the counter products can actually be harder on your skin than clinical treatment products. Also, you don't want to strip your skin because it then wants to start producing more oil.

La Roche Posay/Biomedic has a good acne line (Effaclar) which treats but also results in getting your skin in good condition. Depending on the type of acne, your clinician may want to prescribe topical (Neobenz micro, Finacea) or oral medications to boost your homecare.

I would suggest researching a clinic (plastic or derm) who has a skincare department. They can get you on a good program including homecare and clinical treatments to safely treat your condition.

The risk of lightening the skin with acne treatments is very small. The pigmentation that is much more common and problematic is darkening of the skin. Racial differences do not affect the causes of acne, which are:

1. Excess oil production
2. Blocked or clogged pores
3. Bacteria
4. Inflammation

However, people with darker skin tones usually have more inflammation than those with lighter complexions. Even something that seems as minor as a clogged pore may have a lot of inflammation. And whenever there is inflammation in the skin, the pigment cells may become hyperactive, leading to a dark mark that may persist for months after the acne spot has gone away. This is why it is important to treat the acne early, and aggressively.

At the same time, it is important to pay attention to whether the acne treatment itself is causing irritation, because if it is, that may lead to patchy darkening of the skin. The treatments themselves are the same among all racial groups. These include topical medications (creams, lotion) like antibiotics, benzoyl peroxide, and retinoids (Retin-A, Differin), and oral medications ranging from antibiotics, to hormonal treatment, to Accutane. Darker skin types should avoid high concentrations of benzoyl peroxide, which can be quite irritating.

It is very important to remember sunblock. Many people with darker skin tones think they do not need sunblock. These people may have a lower risk of skin cancer, but don’t forget that the sun causes tanning, even in darker skin tones. So sun exposure will make any dark marks even darker.

In my experience one of the main problems with acne in darkly pigmented skin is the discoloration that is left behind after the acne lesions resolve. The most effective way to combat this problem is, of course, to prevent new acne from forming, and to do so using the modalities that are the least irritating to skin.

Oral antibiotics are an effective option for many patients with acne, and do not cause the drying of skin that we see from gels, creams, and solutions. Patients need to be aware about potential sun hypersensitivity with some oral antibiotics, which can worsen the discoloration that darkly pigmented individuals can experience as a result of their acne.

Effective topical medications include combinations of benzoyl peroxide with either clindamycin or erythromycin. Azelaic acid, which is available as either a gel or a cream, is mildly effective for acne, but has the added benefit of reducing pigment formation. For more severe acne, topical (e.g. Retin-A) or oral (e.g. Accutane) retinoids may be necessary to get the acne under control, although these medications can be more drying than others.

For particularly large or cystic acne lesions, receiving injections of steroids into the lesions will help them resolve quicker and may decrease the chance of long-term pigment changes.

The four main problems to address in acne care are:

1. Blocked pores - skin debris on the surface can block pores. Acne starts with a blocked pore.
2. Excess oil production - oil gets trapped beneath the surface when skin pores are blocked. Acne-prone skin makes more oil than normal.
3. Inflammation - Acne patients often have red, thickened skin even when no pimples are there.
4. Excess acne-causing bacteria - The bacteria builds up in the areas of inflammation, causing a pimple or nodule.

Acne is treated best when these four major problems are addressed. When treating patients with dark skin, it’s always important to minimize the possibility of pigmenting skin, light or dark, due to treatment.

 Many treatments are appropriate for patients with dark skin. Treatments that are best for you may include:

• Microdermabrasion, which decreases surface skin cell debris and unblocks pores

• Chemical peels, which decrease surface skin cell debris that blocks pores. Alpha hydroxy acids such as glycolic acids are a good choice. For darker complexions, concentrations of alpha hydroxy acids of less than 45% should be used. I sometimes use salicylic acid in my practice, as it not only decreases surface skin debris, but also decreases inflammation. However, I am cautious about using this on dark skin. If salicylic acid is used on dark skin, the concentration should be no higher than 10%.

• Photodynamic therapy (PDT), which kills off acne bacteria. I am concerned about the risk of hyperpigmentation with dark-skinned patients. As a result. I do not recommend PDT for these individuals.

• Blue Light therapy, which also decreases acne bacteria. This is safe for use on all skin types.

• Red Light therapy, which decreases inflammation. This also is safe for all skin types.

• Laser treatment for sebaceous gland hyperplasia, which decreases oil gland size and oil production. I agree that several lasers, such as the Quantel Aramis II, work well for all skin types.

I often combine prescription medications and a home skin care plan with office treatments to maximize results. Two prescription medications I often use are retinoids (e.g., Retin-A, Differin, Tazorac) and topical antibiotics (e.g., clindamycin). Dr. Schlessinger makes a great point: Retinoic acids may cause more dryness in acne patients with dry skin. As a result, I may use a gentler retinoic acid compound, such as Differin, and I may prescribe it for use only once a week at first.

Which treatments are best for you? Remember - It’s Your Face! Discuss this with an experienced Medical Doctor who treats acne regularly for best results!

This is a very good question as skin type/color is an important factor when seeking treatment.
In our practice, we achieve good, consistent outcomes for acne patients that have darker skin types. We use a combination of the Aramis Quantel and the QYag technology. Both are very safe. For those patients that do not want to have a treatment plan of non-ablative lasers, we offer Aminolevulinic Acid with Photodynamic Therapy. Both modalities have proven safe and effective for acne conditions. It should be noted that ALA(Aminolevulinic Acid) may cause a temporary discoloration of the skin in medium to darker skin types called post-inflammatory hyperpigmentation. Usually, this is a small percentage of our patients and is transient. As always, do your research, schedule a consultation, and make certain the practitioner is knowledgable with how to treat a variety of skin types for your particular condition.