Adult acne in women of colour
Adult acne in women of colour
Rates of adult acne in women increasing in Canada, especially in dark-skinned patients, increasing the need for effective Tx (1,200 words, 6 minutes)
Rates of adult acne are increasing in women, particularly in women with skin of colour, Dr. Renita Ahluwalia said during a talk at the 9th annual Skin Spectrum Summit. This increasing frequency and the social and psychological impact of acne sequelae, particularly among darker-skinned patients, means that it is important to provide patients with the correct, effective treatment for their acne as soon as possible, she said.
Dr. Ahluwalia is the founder of the Canadian Dermatology Centre in Toronto, a full-service dermatology, plastic surgery, and medical spa clinic.
Roughly 95% of acne patients will develop some form of scarring, with atrophic and keloidal scars especially common in patients with richly pigmented skin, Dr. Ahluwalia said. Since delayed treatment can be a major factor in the occurrence of scarring, it is urgent to treat acne quickly.
Post-inflammatory hyperpigmentation is also a consideration and affects patients with darker skin more frequently. Often, pigment change is the first complaint a patient will have, said Dr. Ahluwalia.
For more severe or extensive papulopustular acne, in addition to topical treatments, physicians should consider hormonal therapy or oral antibiotics, Dr. Ahluwalia said. For severe acne, the guidelines suggest oral isotretinoin, antibiotics, benzoyl peroxide or topical retinoids, and hormonal therapies. Patients need to be treated until they are clear or almost clear, and then maintenance therapy is also required, she said.
Bottom line: Acne in women is on the increase in Canada, particularly in women with richly pigmented skin. The psychosocial burden of acne is dramatic. Skin of colour patients are more likely to scar, so early treatment is important.
From the literature on acne in skin of colour
Decreased treatment of acne among adolescents in skin of colour populations: An examination through the perspective of the National College Health Assessment
The authors of this paper assessed acne care among young adults of different demographics, especially in skin of colour populations.
They analyzed a total of 195,965 responses surveyed by the American College Health Association-National College Health Assessment from 2019 to 2021 for acne trends. Incomplete questionnaires for the isolated questions were excluded from the analysis.
High observed rates of initial diagnosis, but low rate of treatment follow-up for acne among non-White populations may be attributed to access to dermatologic care, patient knowledge of available treatment, cost of treatments, or physician knowledge of treating acne in these populations, the authors write.
The authors say their findings further highlight the need in the field of dermatology to increase support for patients of diverse backgrounds, and increase access to treatment for acne, to decrease the negative physical and psychosocial impact of the condition. This may be accomplished by creating a bridge in care by pediatricians to family medicine practitioners to facilitate the referral to dermatologists. In addition, targeted patient outreach and education programs may further bridge the gaps in health conditions impacting the health of skin of colour populations, they write.
Acne: Unique considerations in skin of colour
In this case report physicians describe a 28-year-old woman of Nigerian ethnicity referred to a dermatology clinic for management of facial skin hyperpigmentation. The patient’s referral was based on the persistent nature of acne and post-inflammatory hyperpigmentation that had been present since her early 20s.
The authors discuss differential diagnosis and management of acne in the context of the patient's case. They mention the significance of the post-inflammatory pigment changes to the patient’s wellbeing and the contribution of cultural practices—specifically the use of hair oils and oil-based creams and conditioning treatments—to the patient’s acne.
The epidemiology of acne vulgaris in a multiethnic adolescent population from Rotterdam, the Netherlands: A cross-sectional study
To study the prevalence and determinants of acne in a multiethnic population at the start of puberty, researchers graded acne severity using the Global Evaluation of the acne Severity (GEA) scale using three-dimensional facial photos of patients approximately 13 years of age collected from a single centre between 2016 and 2019. This study was embedded in the larger Generation R population-based study from Rotterdam, the Netherlands.
A total of 4,561 children (51% girls) with a median age of 13.5 were included. The visible acne prevalence (GEA 2-5) for girls vs. boys was 62% vs. 45% and moderate-to-severe acne (GEA 3-5) 14% vs. 9%. The researchers found higher puberty stages (adjusted odds ratios: 1.38 [1.20-1.59] and 2.16 [1.86-2.51] for girls and boys, respectively) and Fitzpatrick skin types V and VI (adjusted odds ratios: 1.90 [1.17-3.08] and 2.43 [1.67-3.56]) were associated with more severe acne in both sexes, and being overweight in boys (adjusted odds ratio: 1.58 [1.15-2.17]).
Novel 1,726 nm laser demonstrates durable therapeutic outcomes and tolerability for moderate-to-severe acne across skin types
In this prospective, open-label, single-arm study, researchers assessed the tolerability and therapeutic outcomes of a novel 1,726 nm laser in 104 subjects with moderate-to-severe facial acne. Participants had Fitzpatrick Skin Types ranging from II to VI, and each received three laser treatments at 3 (-1/+2)-week intervals.
Investigators found at four weeks following final treatment, 32.6% pf participants had a ≥50% reduction in active acne inflammatory lesions. This increased to 79.8% and 87.3% at 12 and 26-weeks, respectively. The percentage of subjects clear or almost clear increased from 0% at baseline to 9%, 36.0%, and 41.8% at 4-, 12-, and 26-weeks follow-up. No serious adverse events were observed related to device or protocol; treatments were well tolerated, requiring no anesthetic. Therapeutic outcomes and discomfort were similar across all skin types.
VIDEO: Best and worst acne serums
London, U.K.-based Dr. Vanita Rattan, a physician and cosmetic formulator with a focus on skin of colour, provides her opinion for non-prescription serums to recommend to patients with acne and darker skin.
At the intersection of skin and society
Duncan’s First Nation, an Indigenous community in northern Alberta, recently celebrated the opening of their new water treatment plant, ensuring safe, clean, and reliable drinking water for the community now and for future generations.
The project was a collaboration between Duncan's First Nation and Indigenous Services Canada and replaces the community’s existing, outdated water treatment system. It includes the establishment of a new raw water supply, installation of modern water treatment equipment, and construction of a new treated water reservoir and building.
Indigenous Services Canada provided approximately $13 million to support this community-led project.
“Air, food, and water are the three necessities of life,” said Virginia Gladue, Chief of Duncan’s First Nation, in a press release. “We are a nation of people who were on this land when the water could be drank right out of the rivers and lakes. Today, with the overpopulation and pollution of our lands and waterways we are no longer able to eat the fish in most rivers or drink the water without filtration.”
Chief Gladue said water from the plant will not only supply safe drinking water to the community but will also provide adequate water for firefighting and to support planned trout farms and vertical farming facilities to support the community’s food security.
This week
March 11 to 15 is Healthcare Science Week in the U.K.
March 11 is Canadian Women Physician’s Day
March 15 is International Day to Combat Islamophobia
Something to think about in the week ahead. . .
—Victor Hugo, French author (1802 to 1885)
Next week
Dr. Mohannad Abu-Hilal, associate professor and the head of the dermatology division at McMaster University in Hamilton, discusses variations in the pathology of atopic dermatitis in patients with skin of colour.
If you like Skin Spectrum Weekly, why not check out Chronicle’s other publications, podcasts, and portal?
Established in 1995, The Chronicle of Skin & Allergy is a scientific newspaper providing news and information on practical therapeutics and clinical progress in dermatologic medicine. The latest issue features:
Drs. Lauren Lam (Calgary), Sam Hanna (Toronto), Benjamin Barankin (Toronto), and Renée A. Beach (Toronto) discuss many of the new therapeutic options that arrived in 2023.
Dr. Andrew F. Alexis (New York) details pigmentary disorders in patients with skin of colour.
An essay from Dr. Sheila Wang (Montreal) submitted to the 2022 Dermatology Industry Taskforce on Inclusion, Diversity and Equity (DiTiDE) short essay contest. Dr. Wang wrote about the development of new imaging technology to detect and assess ‘beneath-the-skin’ inflammation, perfusion, and tissue oxygenation in any skin phototype.
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The Women in Dermatology e-newsletter updates new findings concerning dermatologic issues that affect women and the female dermatologists who care for them. Read the current issue here.
Season three of the Vender on Psoriasis podcast with Dr. Ron Vender has begun. Listen to the new season here. In episode five, Dr. Vender discusses whether vitamin D impacts psoriasis severity, sex differences in psoriatic inflammation itch, and the risk of psychiatric disorders associated with acitretin.
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