Acne is a common skin condition that affects individuals of all skin types and colours, but it has a unique and more severe implication for people with skin of colour. One of the most significant impacts of acne on individuals with darker skin tones is the development of post-inflammatory hyperpigmentation (PIH), a condition where dark patches appear on the skin after the acne has healed. These hyperpigmented spots can persist for months or even years, leading to significant cosmetic concerns and emotional distress. [It should be noted that in lighter skin tones- post inflammatory erythema (redness) often occurs instead and can be an equivalent problem].
The Nature of Hyperpigmentation
Post- Inflammatory Hyperpigmentation (PIH) occurs when the skin produces excess melanin (the pigment responsible for skin colour), in response to inflammation or injury. In the case of acne, the inflammation caused by pimples, cysts, or nodules can trigger an overproduction of melanin, resulting in dark spots. For people with skin of colour, the higher baseline levels of melanin make them more susceptible to this type of pigmentation. These spots are not only a cosmetic issue but can also affect a person's self-esteem and quality of life. These dark marks can persist for months after the initiating acne lesion has healed and they can follow even relatively mild acne! Picking and irritating the skin makes things even worse so avoid please.
Treatment Options for Hyperpigmentation
Treating PIH in people with skin of colour requires a multifaceted approach that addresses both the underlying acne and the resultant dark spots. It is a mistake to focus on the pigmentation without treating the cause, which is the acne. The good news is that in most cases, they can certainly be treated simultaneously. Various depigmenting agents have been identified as effective in reducing the appearance of hyperpigmentation. These agents work by inhibiting the production of melanin or promoting the turnover of pigmented skin cells. This list is NOT meant to be exhaustive.
Retinoids:
Retinoids, such as tretinoin, are derivatives of vitamin A that promote skin cell turnover and reduce the appearance of hyperpigmentation. They also help prevent new acne lesions from forming, so is an essential part of the toolkit, ticking both boxes!!
Hydroquinone:
Hydroquinone is one of the most well-known and widely used depigmenting agents. It works by inhibiting the enzyme tyrosinase, which is essential for melanin production. Available in various concentrations, hydroquinone can be used topically to lighten dark spots over time. However, it is important to use hydroquinone under the guidance of a dermatologist, as prolonged use, particularly at high doses, can lead to side effects such as exogenous ochronosis, a condition where the skin darkens instead of lightening.
Arbutin:
Arbutin is a natural derivative of hydroquinone found in certain plant extracts, such as bearberry. It is considered a safer alternative to hydroquinone, as it has a lower risk of side effects. Arbutin also works by inhibiting tyrosinase activity and can be found in various over-the-counter skincare products. When used consistently, arbutin can help reduce the appearance of hyperpigmentation.
Kojic Acid:
Kojic acid is another effective depigmenting agent derived from certain fungi. It works by inhibiting the enzyme responsible for melanin production. Kojic acid is often used in combination with other depigmenting agents to enhance its efficacy. It is available in various formulations, including creams, serums, and soaps. While generally well-tolerated, some individuals may experience mild irritation or allergic reactions when using kojic acid.
The good news is that it is possible to combine these topicals into well tolerated creams that provide multiple benefits- please do not simply buy dubious over the counter potions with potentially harmful ingredients.
Other Treatment Modalities
In addition to topical depigmenting agents, other treatments can help manage hyperpigmentation in people with skin of colour. These include:
Chemical Peels: Chemical peels or treatments using agents like glycolic acid or salicylic acid can help exfoliate the skin and promote the removal of pigmented cells. These peels should be performed by a trained professional to avoid complications.
Skin needling with lightening agents such as tranexamic acid or exosomes help to reduce pigmentation. Tranexamic acid blocks the transfer of melanin from melanocytes to the cells in the upper layers of the skin and is anti-inflammatory.
Sun Protection: Protecting the skin from UV radiation is crucial in preventing the worsening of hyperpigmentation. Broad-spectrum sunscreens with an SPF of 30 or higher should be used daily, regardless of skin tone and irrespective of the weather. Supplementing with oral Vitamin D is highly recommended as patients with skin of colour living in the UK also tend to have lower levels of Vitamin D.
Conclusion
Hyperpigmentation as a result of acne poses a significant challenge for people with skin of colour. Consulting with a dermatologist is essential for personalised treatment plans that address both acne and hyperpigmentation in a safe and effective manner.
Ring Aventus Clinic on 01462 512166 to book your consultation today!