What Nobody Tells You About Using Acne Products on Black Skin

https://www.cosmopolitan.com/style-beauty/beauty/a25180530/acne-scar-treatments-black-skin/

As a beauty editor, and a woman of color, one of the most frequent questions I get asked is how to get clearer skin. Because despite being in our late 20s and early 30s, most of my friends’ concerns center around adult acne and its annoying side effects, like dark spots, scarring, and hyperpigmentation—all of which happen to be especially prevalent in melanin-rich skin. And, not-so-fun fact, that also makes them harder to treat.

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Because although acne affects all ethnicities, not all ethnicities can necessarily use the same acne-treatment plan. So rather than have you wade through some really risky games of trial and error, I went ahead and spoke to four dermatologists of color to find out, once and for all, exactly how to zap breakouts and dark marks the right way.

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First: Acne Affects Dark Skin a Little Differently

Here’s what happens when you get a zit: Your skin gets inflamed, your body works to heal the “trauma,” and, as it heals, it sends a bunch of melanin to the area. But in deeper skin types, your body often sends too much melanin, resulting in hyperpigmentation.

“Post-inflammatory hyperpigmentation, PIH, is an overproduction of melanin that causes dark discolorations on the skin,” says Carlos A. Charles, M.D., dermatologist and founder of Derma di Colore Dermatology in NYC. “In darker skin tones, the cells that produce pigment—known as the melanocytes—are more robust and active compared to those found in less pigmented skin.”

In fact, a 2018 study published the SCMS Journal found that patients with skin of color were more likely develop PIH than their white counterparts. And it’s not just the result of acne—you can get PIH from rashes, excessive sun exposure, or even intense irritation. Fun!

BUT, Your Acne Products Can Make Things Worse

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Logically, the best way to prevent PIH is to kill your zits as soon as (or, ideally, before) they crop up, right? Welp, attacking your breakouts too aggressively with, say, a bunch of spot treatments, masks, washes, and creams, can actually just cause more skin irritation, resulting in new or worsened PIH.

“Since darker skin can respond to any wound with PIH, we often can’t use the same aggressive treatments we would use on lighter skin types,” says Michelle Henry, M.D., clinical instructor of dermatology at Weill Cornell Medical College. “You often hear that ‘black doesn’t crack,’ since darker skin tends to have have more robust fibroblast—AKA the cells that create collagen,” she adds, “and though that’s great for aging, the overabundance of collagen is thought to be the reason why darker skin types are more prone to thick, keloid scarring.”

According to Dr. Charles, most topical acne treatments, like retinoids, benzoyl peroxide, and salicylic acid, have the most potential to cause irritation when used incorrectly on deeper skin tones. “Overall, I find that benzoyl peroxide and retinoids often lead to irritation when being used for acne, which can then result in PIH,” he says.

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So Here’s What You Need to Do…

…If You Currently Have Acne

Listen, one pimple on your face won’t automatically result in a thick patch of PIH and keloids (as you’ve probably already witnessed by, uh, being alive), so don’t let all of this freak you out. But knowing that your skin has a tendency to scar is the first step toward prevention. The second step? Getting yourself to a dermatologist.

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Seriously—the best way to keep your skin clear and PIH-free is to have a board-certified dermatologist walk you through your acne treatment options, rather than trying to wing it at home. “Oftentimes, people wait for their acne to progress over a long period of time before seeking professional help, which can result in extensive discoloration that could have been avoided,” says Dr. Charles.

And if you have cystic zits (the “under-the-ground” zits that never come to a head and just feel painful and swollen), the only effective way to treat them is to see a doctor, since they’re largely caused by hormones. Your derm may start you on a low-dose topical retinoid to chemically exfoliate pores and keep them from clogging, or an oral medication to minimize excessive oil production, like Accutane or Spironolactone.

…If Your Acne Is Mostly Gone, But Your PIH Isn’t

If you’ve just got a few random whiteheads, or, if your acne is gone, and you’re now just stuck with the PIH, you can try some over-the-counter treatments to fade it, as long as you promise to be gentle. Because in reality, most skin types can tolerate retinoids, benzoyl peroxide, and salicylic acid, as long as you ease into them and don’t go overboard.

For retinoids (which speed up your cell turnover to exfoliate skin, treat acne, fade PIH, and even shrink keloids), you need to start slow until your skin acclimates. “I tell my patients to apply their retinoids on top of their normal moisturizer to dilute it, and then apply it one night a week for one week, two nights a week for two weeks, three nights a week for three weeks, and then every other night indefinitely,” says dermatologist Mona Gohara, M.D. associate clinical professor at Yale University.

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If retinol seems too intimidating, you can try a product with benzoyl peroxide or salicylic acid, but make sure to use just one at a time (no doubling up!), and apply a thin dab over well-moisturized skin every other night to avoid any irritation. You’ll get some slight exfoliating effects from either one, which will help a tiny bit with PIH, though it will still take a good six months to really see major results.

…If You Just Want Your PIH Gone ASAP

At-home treatments are fine and dandy, but if your acne isn’t going anywhere soon, and you need your PIH gone by, like, yesterday, it’s time to head to the derm for some in-office treatments.

Lasers, chemical peels, and microdermabrasion can all be effective in fading PIH, but dermatologist Fran Cook-Bolden, M.D., founder of Skin Specialty Dermatology in NYC, says her “all-time favorite treatment for acne, especially for skin of color, is the NeoClear Acne Laser treatment, which gently attacks the inflammation and pigment, while also stimulating collagen for scar prevention, treatment and correction.” It’ll take a few sessions (and they can be pricey) before your PIH is fully gone, but it’s as close to a quick fix as you can get in modern medicine.

The Bottom Line

In the end, acne and PIH affect all ethnicities—so you’re obviously not alone. But if you’re not feelin’ your dark spots or scars, and you do want to add some treatments to your routine, you’ve got your handy guide (ahem, this one) with product recommendations and tips, all in one place.

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Just pinky-promise me you won’t go overboard with the products, okay? Good.

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