Supplement Individual Article: Racial Ethnic Variations in Acne: A Practical Algorithm for Treatment and Maintenance, Including Skincare Recommendations for Skin of Color Patients With Acne
November 2022 | Volume 21 | Issue 11 | SF3446083 | Copyright © November 2022
Andrew F. Alexis MD MPHa, Heather Woolery-Lloyd MD FAADb, Anneke E. Andriessen PhDc, Sewon Kang MD FAADd, David Rodriguez MDe, Valerie D. Callender MD FAADf
aWeill Cornell Medical College, New York, NY
bSkin of Color Division Dr Phillip Frost Department of Dermatology and Cutaneous Surgery University of Miami, Miller School of Medicine Miami, FL
cRadboud UMC Nijmegen, Andriessen Consultants, Malden, The Netherlands
dJohns Hopkins School of Medicine, Baltimore, MD
eDadeland Associates & Research/Dadeland Dermatology Group, Miami, FL
fHoward University College of Medicine, Washington, DC; Callender Dermatology & Cosmetic Center, Glenn Dale, MD
Abstract
Background: Racial/ethnic differences in the clinical presentation, sequelae, and desired treatment outcomes for acne have been reported. Post-inflammatory hyperpigmentation (PIH) frequently occurs in patients with richly pigmented skin complexions and can frequently be the most bothersome aspect of acne in this population. Methods: The project used a modified Delphi hybrid process comprising face-to-face discussions followed by an online follow-up. A structured literature search was conducted to identify publications on racial/ethnic differences in the clinical presentation, sequelae, and desired treatment outcomes for skin of color (SOC) patients with acne . The advisors subsequently convened to review the results and draft an algorithm for the treatment and maintenance, including skincare recommendations, for SOC patients with acne. Online, the panel reviewed and adopted the algorithm using published evidence coupled with the panel's expert opinion and clinical experience. Results: Studies suggest that strategies for improving outcomes in patients with acne who have SOC include: the early initiation and maintenance of treatment regimens; careful consideration of the tolerability of active ingredients, vehicle formulations, and dosing; and the use of skin care (eg, pH balanced, non-irritating cleansers, and non-comedogenic moisturizers) to minimize irritation or dryness. Conclusion: Acne treatment in patients with SOC involves unique therapeutic considerations, including management of PIH through efficacious longitudinal acne treatment, prevention of irritation, and potential active treatment of PIH. Skincare products are recommended as an adjunct to prescription therapy to maximize tolerability and may also play a role in maintenance therapy. J Drugs Dermatol. 2022;21:11(Suppl 2):s3-14.
INTRODUCTION
Acne vulgaris (acne) is ranked by the Global Burden of Disease Project as the eighth most prevalent disease worldwide.1,2 Globally, the prevalence of acne is estimated at 9.4%, affecting 650 million adolescents and adults.1-5 The peak incidence of acne for adolescent girls is at 14 to 17 years of age, and for boys, 16 to 19 years old; however, acne is becoming more prevalent in adult women.3-5 A US-based survey on ambulatory medical care demonstrated that acne was highly prevalent in people with SOC in the US, including African Americans, Asians, and Hispanics.6 Acne was found to be more prevalent in African American, and Hispanic women than in Continental Indian, White, and Asian women in a review of one-sided facial photographs of girls and women aged 10 to 70 from 4 cities.7 Post-inflammatory hyperpigmentation (PIH) was observed in 65% of Black and 48% of Hispanic women.7-9
A prospective study assessed the demographic and clinical characteristics of 1,384 patients between 25 to 60 years from 21 countries in Latin America and the Iberian Peninsula.8 The study identified parameters for the severity of acne and its links to demographic, biological, social, environmental factors, and potential triggers in Latin America and the Iberian Peninsula
