Acne in patients with skin of color: practical management.

Acne vulgaris is a prevalent and non-discriminatory condition affecting individuals of all races and ethnicities. As people with skin of color make up a rapidly expanding segment of the US population, dermatologic care must evolve accordingly to address their distinct concerns. Patients with skin of color with acne can be particularly challenging, given their potential for cosmetically disturbing complications, including post-inflammatory hyperpigmentation and keloid development. A variety of treatments have been shown to be effective in preventing or treating these complications. Topical retinoids are considered first-line therapy for acne in patients of color; topical alternatives include azelaic acid, dapsone, and antimicrobials. Hydroquinone may be used in combating post-inflammatory hyperpigmentation, specifically. For more severe acne, oral agents, including oral antibiotics or isotretinoin, may be used. Most recently, various lasers and phototherapies have been suggested for their safety and efficacy in patients with skin of color with acne. Ultimately, recognizing the clinical and histologic differences, as well as the variations in treatment regimens for darker skin types will allow for better care and patient satisfaction.

Treatment of acne scarring.

BACKGROUND: Post-acne scarring remains a common entity despite advances in the treatment of acne. This represents limitations in our quality of therapy and a failure of public education. The level of severe scarring remains as much an ongoing challenge to prevent as well as manage. METHODS: This review will concentrate on the methods by which acne scarring may be improved and the available evidence for their utility. It will also rely on a grading scale of disease burden to classify patients and their ideal therapy. New therapies allowing treatment of scarring in areas other than the face will also be highlighted. RESULTS: Tabulated treatment planning will present algorithms summarizing best practice in the treatment of post-acne scarring. CONCLUSION: Post-acne scarring is being better managed. Grade 1 scars with flat red, white, or brown marks are best treated with topical therapies, fractionated and pigment or vascular-specific lasers and, occasionally, pigment transfer techniques. Grade 2 mild scarring as seen primarily in the mirror is now the territory of non-ablative fractionated and non-fractionated lasers as well as skin rolling techniques. Grade 3 scarring, visible at conversational distance but distensible, is best managed by traditional resurfacing techniques or with fractional non-ablative or ablative devices, sometimes including preparatory surgical procedures. Grade 4 scarring, where the scarring is at its most severe and non-distensible, is most in need of a combined approach.