Acne may be a universal problem – every blemish starts out more or less the same way — but not all skin is exactly the same. Just as some are born with oily skin and large pores and others never experience a breakout in their lives, there are some differences between races and ethnicities when it comes to how acne tends to appear and what its consequences are. One of the most common problems for many African Americans is so-called “ashy skin,” another term for xerosis, or extremely dry skin. If you have ashy skin and you’re dealing with acne as well, beware: Some acne-fighting products, such as benzoyl peroxide, which works by killing the bacteria that lead to breakouts, can be even more drying to skin.
The American Academy of Dermatology (AAD) cautions, too, that benzoyl peroxide can “decolorize skin,” affecting pigmentation; so proceed carefully and stop using benzoyl peroxide products immediately if you notice a problem. A better choice for treating your acne may well be a retinoid product, which fights acne and inflammation – and perhaps most important for dark skin – the discoloration too often left behind by a pimple in those with darker skin. Also effective for moderate-to-severe acne: antibiotics such as erythromycin and tetracyclines and oral contraceptives (for women), among other products.
And while a natural response to dry skin is to moisturize more to compensate, that may backfire if you don’t choose the right product (and sometimes no product at all). The AAD recommends using a moisturizer specifically labeled “non-comedogenic,” which means it won’t cause acne, but if you do try one and you’re still seeing whiteheads, blackheads and more severe papules, pustules, and cysts, stop using that, too. You can also look for lines of black skin care products – those formulated specifically for the needs of African Americans and others who have dark skin.
Black skin care for acne should prioritize treating both semi-permanent “dark spots” and permanent scarring from breakouts, if either appears. Dark spots are caused when too much melanin – the part of skin that gives it its color – is produced at the site of a pimple that’s in the process of healing, resulting in a much more visible spot. You may be tempted to encourage “fading” of dark spots by spending more time in the sun, but resist the urge; people of all skin types and tones should be wary of skin cancer and protect skin by regularly applying an SPF 30 sunscreen.
African American skin care products for treating dark spots (what are called “post inflammatory hyperpigmentation,” by your dermatologist) typically include bleaching or lightening creams that contain hydroquinone and other ingredients; these are applied topically and your doctor may prescribe a stronger product than what you can find over-the-counter if your skin requires it. Other options for lightening dark spots and treating scarring (as well as preventing future discoloration) include laser therapy and chemical peels.
When it comes to scarring, African Americans are at higher risk than Caucasians of developing keloid scars, in which extra tissue develops as a zit heals, the result of an over-buildup of collagen outside the confines of the zit. Scarring and serious residual discoloration from past pimples can easily become the most emotionally difficult part of having acne, so if you’re noticing dark spots or scarring that aren’t going away, that’s reason enough to see a dermatologist. The sooner you treat both problems, the greater the likelihood you can prevent either from becoming permanent.