Managing hormonal acne in patients with skin of colour
This condition is common in individuals with darker skin and is associated with pomade acne in this population (1,190 words, 6 minutes)
Hormonal acne is quite common in women and even more common among women with skin of colour, said Dr. Renita Ahluwalia, speaking at the 7th annual Skin Spectrum Summit on Nov. 4.
“Acne in the adult female is on the rise—50 per cent of women in their 20s, 35 per cent of women in their 30s and 26 per cent in their 40s experience acne. And these numbers are even higher in the skin of colour population,” said Dr. Ahluwalia. She is the lead dermatologist and co-founder of the Canadian Dermatology Center in Toronto.
The higher incidence of hormonal acne seen in populations with skin of colour is well studied and is associated with a higher incidence of hormonal imbalances, Dr. Ahluwalia said. This greater rate of acne includes pomade acne and acne-related conditions such as acne keloidalis nuchae, which she said often go unrecognized.
Hormonal acne typically presents as cystic lesions along the jawline or cheeks which flare cyclically with menstruation, Dr. Ahluwalia said. Hormonal acne can also manifest as fine comedone lesions along the hairline—these lesions are very common in skin of colour patients, she said.
Dr. Ahluwalia provided the following recommendations for treating hormonal acne in skin of colour:
Address the hormonal flares that can occur irregularly around ovulation. This can be done by prescribing oral contraceptives approved for acne treatment.
For patients who do not respond acceptably to oral contraceptives or do not wish to be on birth control, spironolactone can be added to treatment.
Topical dapsone gel is suitable for sensitive skin, and Dr. Ahluwalia noted women more frequently achieve treatment success with it than men (48.6% vs. 34.0%).
Topical retinoids, particularly modern slow-release formulations, may also be added. These are particularly useful in skin of colour patients as they also address pigment changes.
Recommend gentle cleansers.
Bottom line: Hormonal acne is more common in patients with skin of colour, and some of its manifestations can be overlooked. Managing hormonal flares is an effective way to control this form of acne. Some treatments, such as topical dapsone gel and topical retinoids, can be particularly effective in this population.
From the literature on acne in skin of colour
Objective and long-term evaluation of the efficacy and safety of a 1064-nm picosecond laser with fractionated microlens array for the treatment of atrophic acne scar in Asians
In this study, 26 subjects with Fitzpatrick skin types (FSTs) III and IV and atrophic acne scars were treated with a 1064-nm picosecond laser (spot size of 8 mm, fluence of 1.0 J/cm2, a repetition rate of 10 Hz) in combination with a microlens array handpiece for an average of three passes, for 6 monthly sessions.
Investigators observed a significant reduction of the scar volume from baseline at 1, 3, and 6 months after the final treatment. At the 6-month follow-up, 50% (13 of 26) of the subjects were rated as having at least 50% improvement of the scars, with the rate of improvement significantly increasing from the 1-month follow-up to the 6-month follow-up. Skin roughness also improved from baseline to 6 months.
Effects of topical retinoids on acne and post-inflammatory hyperpigmentation in patients with skin of colour: A clinical review and implications for practice
This open-access review covers the research supporting early initiation of treatment with retinoids in patients with skin of colour and acne to prevent pigment changes. Recent improvements in retinoid formulations are discussed, including formulations more tolerated by patients with sensitive skin. The authors conclude by recommending providing further education to clinicians and researchers regarding the presentation and management of skin conditions in patients with skin of colour.
Racial/ethnic variations in acne: Implications for treatment and skin care recommendations for acne patients with skin of colour
This open-access paper reviews the existing published data on acne presentation, prevention, treatment, and the role of general skincare in improving acne outcomes in skin of colour populations. The authors also develop and provide consensus statements relating to three questions:
1) Are there racial/ethnic differences in the clinical presentation and sequela of acne?
2) Are there racial/ethnic differences in the therapeutic endpoint of acne treatment and patient expectations?
3) Is there a need for specialized approaches to therapeutic options and skincare in acne patients with SOC?
A neglected acne scar type: Papular acne scars and their correlations with keloid scars
The authors of this retrospective study of 416 individuals with acne scars classified the scars into three types—atrophic, popular, and keloid type.
They found that papular acne scars were significantly more prevalent in patients with keloid scars than those without them. The authors write that their findings may help improve understanding of papular acne scars, which they say have been under-recognized.
VIDEO: Dr. V - How to treat period-related acne for skin of colour
At the intersection of skin and society
In an interview with CTV News, Jacqueline Ottmann, president of the First Nations University of Canada, said that the university is working to organize a Canada-wide dialogue about ongoing issues surrounding Indigenous identity.
Self-declaration of Indigenous identity has been a problem for centuries, Ottmann said but has been prominent in the public attention in the past few weeks due to concerns around the identity of University of Saskatchewan professor Dr. Carrie Bourassa.
“One of the things that we’re considering is hosting a national dialogue on Indigenous identity. We are First Nations University of Canada. Our foundations are Indigenous knowledge systems and practices,” Ottmann said in the interview. “We have these resources, and it’s very important to engage Indigenous peoples in developing a framework or helping inform policies related to this. That’s where, I think, sustainable and respectful practices will emerge from.”
The CTV News report notes that with the systems that are currently in place, at some universities and professions applicants can self declare their background.
An official statement on Oct. 28, 2021, from Métis Nation—Saskatchewan (MN—S) notes:
“False or insufficient claims to Indigenous ancestry are a serious concern in the arts, academics, and public services where funding, employment, advisory positions, and other opportunities are targeted for Indigenous peoples. These kinds of ameliorative opportunities and programs are an important part of addressing the historical disenfranchisement and silencing of Indigenous peoples and their voices, including the Métis.”
“Indigenous culture cannot be reduced to a matter of Indigenous choice or self-identification alone. It is about shared culture, heritage and history.”
In the interview, Ottmann said false claims of Indigenous identity can cause non-Indigenous people to take voice and space away from First Nations, Métis and Inuit people.
“There’s limited resources and limited space and positions in academia or in other sectors for Indigenous peoples. So when a non-Indigenous person takes up that space and begins to speak for Indigenous peoples, then that is a significant issue,” Ottmann said.
This week
Nov. 20 is National Child Day in Canada
Nov. 22 is Love Your Freckles Day internationally
Nov. 26 is Native American Heritage Day in the US
Something to think about in the week ahead…
Next week
We report on Dr. Afsaneh Alavi’s presentation from the 7th annual Skin Spectrum Summit. Dr. Alavi discusses the characteristics of hidradenitis suppurativa in skin of colour and special considerations for managing this condition in marginalized communities.