Managing acne-related hyperpigmentation in Black and Brown skin
Halting inflammation and protecting the skin from the sun, including blue light, are key (365 words, 2 minutes)
In last Saturday's launch episode of the Skin Spectrum Summit's Summer of Dialogue podcast on dermatology concerns in Black and Brown skin, Drs. Renita Ahluwalia and Juthika Thakur spoke about some of their strategies for the prevention and management of post-acne hyperpigmentation in richly pigmented skin.
“The first step is treating the active acne because it is the active acne that is leading to those dark spots,” said Dr. Ahluwalia, who is the lead dermatologist at the Canadian Dermatology Centre in Toronto.
For managing acne in these patients, both clinicians said they typically use three agents: retinoids, azelaic acid, and dapsone gel.
“Retinoids are good for the mild to moderate acne group [that may not have hormone-driven acne],” said Dr. Thakur. “[Retinoid treatment] works on two fronts. The first is it reduces blackheads and whiteheads and prevents future recurrence of acne. It also inhibits the melanin production that contributes to post-inflammatory hyperpigmentation.”
Dr. Thakur, who practices at the Canadian Dermatology Centre with Dr. Ahluwalia, said that azelaic acid may be a good option for patients with a history of eczema or who otherwise have sensitive skin, and would benefit from a less-drying treatment approach. Azelaic acid also inhibits melanin production, she said.
Dapsone gel is Dr. Thakur's choice for managing acne in some of her older patients who may have a hormonal component. “It works well for papules or bumps around the mouth or on the jawline as well,” she said.
For dealing with existing hyperpigmentation and scarring, Dr. Ahluwalia recommends radio frequency (RF) microneedling. “Radiofrequency microneedling targets deep into the skin and stimulates collagen production. It resolves those deeper scars to improve texture, tone and a little bit of pigmentation as well. And it is safe in all skin types which is nice,” she said.
To prevent the worsening or return of hyperpigmentation, both doctors emphasized the importance of sun protection.
Their recommendations for sun protection in Black and Brown skin include:
Sunscreens with both UVA and UVB protection
Tinted formulations for better aesthetics and compliance
Mineral sunscreens containing iron oxide to block blue light that can also stimulate melanin production
Applying sunscreens as the last step in the skincare routine
Touching sunscreen up through the day, possibly with mineral-based powder sunscreens
Listen to the complete Summer of Dialogue podcast episode here:
Have questions about treating acne-related hyperpigmentation in Black and Brown patients? Send them to our experts, Drs. Ahluwalia and Thakur, for discussion during the upcoming live Colloquium on August 21, 2021. Send them to questions@skinspectrum.net
From the literature on acne and hyperpigmentation
Effective reduction of post-inflammatory hyperpigmentation with the tyrosinase inhibitor isobutylamido-thiazolyl-resorcinol (Thiamidol)
Studies of topical formulations containing Thiamidol in managing post-acne hyperpigmentation and hyperpigmentation induced through suction blistering showed the agent significantly improved pigment changes. The authors conclude the agent is a safe and effective ingredient for cosmetic products, for the reduction of hyperpigmentation.
Cosmeceutical aptitudes of azelaic acid
This article is a summary of the basic physiochemical properties of azelaic acid. It looks at the physiological role of the molecule, particularly in dermatology applications. The authors also explore some of the novel treatment approaches using this molecule that are being investigated.
Novel polymeric tazarotene 0.045% lotion for moderate-to-severe acne: Pooled Phase 3 analysis by race/ethnicity
This report on two phase 3, double-blind, 12-week studies included 1,614 participants, 262 of whom self-identified as Black. The objective was to evaluate tazarotene 0.045% lotion compared to vehicle for treating moderate-to-severe acne, by race and ethnicity. Not only were rates of treatment success higher in all sub-populations with the tazarotene 0.045% lotion, but the incidence of hyperpigmentation decreased in tazarotene-treated Black participants from baseline to week 12.
A case report on the use of topical cysteamine 5% cream in the management of refractory post-inflammatory hyperpigmentation (PIH) resistant to triple combination cream (hydroquinone, topical corticosteroids, and retinoids)
A woman with Fitzpatrick skin type V had hyperpigmented patches on her face since childhood. Treatment with topical adapalene 0.1% gel and triple combination cream (hydroquinone, topical corticosteroids, and retinoids) did not resolve the pigment change. However, she experienced significant improvement with four months of treatment with cysteamine 5% cream.
VIDEO: Study finds racial disparity in acne medication prescribing
At the intersection of skin and society
As more unmarked graves are discovered at the sites of residential schools in Canada, people want to better understand what happened and how the lives of survivors were impacted.
Danika Ellis, contributing editor at Book Riot—a large independent site of book reviews and commentary—has created a list of books that address the historical facts and personal impact of the residential school system.
“It is hard to overstate the pain and damage Canada’s long history of residential schools has done—in fact, even the word ‘history’ is misleading since it is only very recently that this practise has stopped, and generations of survivors are still alive,” Ellis writes. “From the late 1800s, and only officially ending in 1996 with the last residential school closure, children were taken from their homes and robbed of their family and culture.”
Her post begins with the reports from Canada’s Truth and Reconciliation Commission’s investigation into the schools and includes history books, memoirs, novels, and poetry collections.
Ellis emphasizes that the best way a reader can be respectful and be sure of finding accurate information is to make connections with their local Indigenous nations.
Her list can be found here: https://bookriot.com/indian-residential-schools-books/
For questions younger people might ask, Ellis has also created a list of picture books that can be used to start conversations about residential schools with children. That list is here: https://bookriot.com/residential-schools-picture-books/
This week
July is UV Safety Awareness Month in the U.S.
July is Sarcoma Awareness Month
July 18 is Black Leaders Awareness Day
Something to think about during the week ahead…
Next Week
Next week we will showcase the second episode of the Summer of Dialogue: Focus on Black Skin.
The Summer of Dialogue is a summer-long discussion series on Black skin health. In recognition of the persistent health gaps that BIPOC Canadians experience, this program will be dedicated to promoting and advancing medical knowledge and cultural competence. The series will conclude with a live colloquium to be held on Aug. 21, 2021.
Registration for the colloquium and more information on the Summer of Dialogue is available at https://www.skinspectrum.ca/summer.