Would you treat acne in black skin any differently, such as use topical retinoids earlier?
The main problem with treating acne in black or pigmented skin is the risk of developing post-inflammatory hyperpigmentation. This may be disfiguring and in severe cases can persist for years, so systemic treatment is justifiable at an early stage in this group of patients. Azelaic acid is the preferred topical agent as it reduces pigment in post-inflammatory hyperpigmentation. A topical retinoid should generally be used in most patients with acne but in weaker concentrations, particularly where comedones are predominant. Retinoids are known to cause a degree of irritation in almost all patients which may worsen the post-inflammatory hyperpigmentation. Patients with pigmented skin are also at substantially increased risk of developing keloid scars. If this is thought to be a likely outcome, early referral for consideration of isotretinoin may be appropriate.
