Acne can affect anyone. People with black skin and acne may face a few additional concerns about the issue.
Severe acne can cause keloid scarring or hyperpigmentation, both of which are more common among people with darker skin.
Also, healthcare providers recommend that people of color use certain acne treatments with more caution.
Here, we look at treatment options, home remedies, tips, and when to see a dermatologist or another doctor.
Many over-the-counter and prescription acne treatments can be safe for people with black skin. Factors such as age, sex, and the severity of the acne will help determine the most suitable option.
It is worth noting, however, that it can take months for treatments to work.
Topical creams, gels, and lotions
Topical treatments can work well for people with mild to moderate acne. The following are safe and available without a prescription:
The American Academy of Dermatology (AAD) assure people of color that although benzoyl peroxide can bleach clothing and bed linen, it cannot bleach the skin.
The AAD recommend starting with a 2.5% benzoyl peroxide gel or cream to ensure the skin does not become dry or irritated. After cleaning the area, apply the product once or twice a day. Use sparingly, especially at first, to prevent irritation.
People who use benzoyl peroxide tend to see improvement only after 6 weeks.
Retinoids, such as adapalene 0.1%, work by removing dead cells from the surface of the skin, which may help unclog pores and hair follicles.
A 2013 review found retinoids to be effective and safe for people of color, and these products may also help reduce complications from acne, such as hyperpigmentation.
However, retinoids are not safe to use during pregnancy. They can also cause irritation and stinging, and they increase sensitivity to sunlight, so it is important to use sunscreen.
A person applies topical retinoids at night, after cleansing the affected area.
Always use caution with this treatment and consider consulting a dermatologist or another healthcare provider before beginning, to prevent adverse reactions.
A person typically only sees improvement in their acne after 6 weeks of using a retinoid.
Antibiotics and other topical acids
Salicylic acid may help unclog pores and prevent new breakouts, as the AAD report.
The British Association of Dermatologists also recommend azelaic acid and nicotinamide, which is also known as niacinamide. Still, a 2020 review of these treatments found little evidence that they are more effective than benzoyl peroxide or retinoids.
Females with acne may benefit from using the combined oral contraceptive pill, particularly if their acne flares up around periods. However, it may take up to 1 year for the pill to improve acne.
A doctor may prescribe oral antibiotics, such as doxycycline or minocycline, in combination with topical treatments. A course of antibiotics may last 3–6 months. Some, however, are unsafe to use during pregnancy.
Also, keep in mind that taking an antibiotic while taking birth control pills can reduce the effectiveness of the contraception. A person may need to use a secondary form of birth control, such as condoms, while taking an antibiotic.
Meanwhile, isotretinoin (Accutane) is a highly effective treatment for severe or persistent acne — but its side effects can be serious, including skin sensitivity, pregnancy complications, and suicidal thoughts.
Anyone taking isotretinoin in the United States is required to sign up for iPLEDGE, a distribution program approved by the Food and Drug Administration (FDA).
For this reason, the AAD advise people to see a dermatologist experienced in treating acne on skin of color and avoiding any at-home versions of these treatments.
Tea tree oil may help kill bacteria that can cause mild to moderate acne.
A person might lightly apply a small amount of tea tree oil to a pimple, using a cotton swab. Tea tree oil-based cleansers and moisturizers are also available for daily use.
However, be careful to take zinc supplements exactly as directed.
The AAD recommend that people with oily skin and acne use blotting papers to absorb excess oil. Press a sheet of this paper against the face for a moment or two and throw it away.
Meanwhile, some small studies have found that a low-glycemic diet may help reduce acne.
A person may benefit from avoiding foods such as white bread, potato chips, and fries, and eating more low-glycemic foods, such as fresh fruit and vegetables, when possible. Leveling out blood sugar in this way may reduce the amount of sebum, or oil, that the body produces.
The AAD recommend the following strategies for people with acne:
- Do not pick, pop, or squeeze pimples, which can increase the risk of scarring and infection.
- If acne only appears on the forehead and temples, it may be “pomade acne.” Switch to a water-based hair product and use hair oil only at the ends of the hair and on the length toward the middle of the scalp.
- Use water-based skin cleansers.
- Choose products labeled “noncomedogenic,” which means that they will not clog pores.
- Avoid using cocoa butter, which can clog pores and cause acne.
- Cleanse the skin gently, using a mild cleanser and a clean towel to lightly pat the skin dry.
- Wash hats and sports equipment frequently to remove the buildup of sweat, dirt, and oil.
- Always remove makeup before going to sleep.
Acne occurs when the sebaceous glands in the skin produce excess sebum, or oil, blocking pores and hair follicles. Bacteria can also play a role. The result may be blackheads, whiteheads, pustules, nodules, or cysts.
The following factors make acne more likely:
- Puberty: Increased levels of testosterone during puberty can lead to an excess production of sebum.
- Genetics: Teenage and adult acne can run in families. If one or both parents had teenage or adult acne, their children are more likely to develop it.
- Hormones: Females are more likely to have adult acne than males, due to changing hormone levels during periods and pregnancy.
- Medications: Certain medications can trigger acne flare-ups, including steroids, antidepressants, and some epilepsy drugs.
- Smoking: People who smoke are more likely to have adult acne.
Often, home care techniques over-the-counter products can control and reduce acne. However, a person with acne should see their healthcare provider or a dermatologist if:
- At-home techniques and over-the-counter products are not effective.
- Acne regularly affects self-esteem.
- Nodules or cysts develop — these need professional care to prevent permanent scarring.
- Severe acne runs in the family, in which case earlier treatment may be necessary.
Anyone can experience acne and its complications, but some, such as keloid scarring and hyperpigmentation, are more common in people with darker skin.
Many acne treatments, including topical creams and gels, oral contraceptives, and antibiotics, are safe for people of color. There are also some home care strategies to consider.
It may be especially important for people of color to avoid at-home versions of chemical peels, microdermabrasion, and laser therapy, as these can cause dark marks or light spots. For these treatments, see a dermatologist who has experience working with skin of color.
If other over-the-counter treatments, home remedies, and care techniques are not effective, see a dermatologist or another healthcare provider. This is especially crucial if acne is affecting self-esteem.