Acne on every skin tone — and the marks it leaves

Sources

Retrieved and read for this guide; reviewed 2026-09-13. A source listed here says what it establishes and what it does not — a citation is not an endorsement.

1. [1]Guidelines of care for the management of acne vulgaris · Reynolds RV et al. J Am Acad Dermatol 2024. PMID 38300170. JAAD / AAD, 2024 · read at abstract levelEstablishes: Strong recommendations for benzoyl peroxide, topical retinoids, topical antibiotics and doxycycline. Isotretinoin is strongly recommended for severe acne, acne causing psychosocial burden or scarring, or acne not responding to standard therapy.Does not establish: Skin-of-color-specific considerations — the abstract does not address them.
2. [2]10 tips for clearing acne in darker skin tones · American Academy of Dermatology, 2026Establishes: Advises treating acne and dark spots together and early, to lower the chance of keloids and dark spots, and starting benzoyl peroxide at a low strength (2.5%) to limit irritation. Suggests swapping oil-based hair products for water- or glycerin-based ones if acne is on the forehead or temples ('pomade acne'), and using non-comedogenic products and gentle care. Says to avoid scrubbing and picking, and to see a dermatologist before peels, microdermabrasion or lasers, which can leave lasting light or dark spots in darker skin without expertise.Does not establish: How often these complications happen, or trial evidence for the tips. It does not address isotretinoin.
3. [3]Postinflammatory hyperpigmentation: a review of the epidemiology, clinical features, and treatment options in skin of color · J Clin Aesthet Dermatol 3(7):20–31, 2010Establishes: PIH is more frequent and more severe in darker skin. Cites a 2002 acne study reporting PIH in 65.3% of African-American, 52.7% of Hispanic and 47.4% of Asian acne patients. Explains epidermal vs dermal PIH. First-line care is treating the underlying inflammation plus photoprotection and depigmenting agents; treatment irritation can worsen PIH. Agents covered: hydroquinone 2–4% (ochronosis risk with prolonged use), azelaic acid 20%, retinoids (irritation in up to about 50%), niacinamide, kojic acid (contact dermatitis common), vitamin C. Glycolic and salicylic peels need care. Longer laser wavelengths are described as lower-risk.Does not establish: Graded evidence — it is a narrative review, 16 years old. The survey figures are secondary citations; the primary study was not fetched.
4. [4]Common Dermatologic Conditions in Skin of Color · Frazier WT, Proddutur S, Swope K. Am Fam Physician 2023;107(1):26-34. American Academy of Family Physicians, 2023Establishes: Clinical review with SORT ratings. Reported prevalence: DPN about 33% in skin of color, PFB 45–83% in affected groups, and keloids higher in types III–VI than I–II. Recommendations with SORT grades: stopping shaving for at least 8 weeks for PFB (SORT C); avoiding close shaves and tight collars or helmets for AKN; laser for AKN (SORT B). Notes erythema looks different on darker skin.Does not establish: The primary prevalence studies, which were not retrieved. One PIH percentage in the fetched page looked garbled and is not used.
5. [5]Effects of Topical Retinoids on Acne and PIH in Patients with Skin of Color · Callender VD et al. Am J Clin Dermatol 2022. PMID 34751927. Springer / PMC, 2022Establishes: Irritation can worsen hyperpigmentation in skin of color. Moisturisers and gentler formulations may reduce irritation. Hyperpigmentation may distress people more than the acne itself; one cited survey found PIH most bothersome to Black women (18.8%) versus White women (2.8%). Oral isotretinoin may be considered for severe acne at risk of scarring.Does not establish: Independence from industry — medical writing was funded by Ortho Dermatologics. It does not compare products head to head.
6. [6]Skin of Color: Weighing Risks of Treating Dark-Skinned Patients With Isotretinoin · MDedge Dermatology (Frontline Medical Communications), 2021Establishes: Clinician commentary arguing that PIH and hyperpigmented scars can distress patients more than acne, and that withholding isotretinoin can be more harmful. Cites a 2010 BMJ cohort suggesting pre-existing suicide-attempt risk reflects disease burden.Does not establish: Guidance of any kind — it is expert opinion, and the author name was not captured. It cannot be used to imply any drug is appropriate for anyone.
7. [7]A survey of skin disease and skin-related issues in Arab Americans · El-Essawi D et al. J Am Acad Dermatol 2007. PMID 17321004. JAAD, 2007 · read at abstract levelEstablishes: Community survey, n=401, Michigan. The most commonly self-reported conditions were acne, eczema, warts, fungal infections and melasma. Access to care correlated with socioeconomic status. Concerns resembled those of other darker-skinned groups.Does not establish: Middle Eastern or North African people broadly — self-report from a single US region.
8. [8]Ethnic considerations in the treatment of Hispanic and Latin-American patients with hyperpigmentation · Hexsel D, Arellano I, Rendon M. Br J Dermatol 2006. PMID 17176299. BJD / Wiley, 2006 · read at abstract levelEstablishes: Hispanic and Latin-American populations have heterogeneous ancestry spanning many phototypes. Little research exists on treatment response in these groups, and PIH risk is noted with darker phototypes.Does not establish: Treating 'Latino skin' as one type. Specific regimens are out of scope.
9. [9]Diagnostic Disparities in Erythema Visibility: A Call to Redefine Inflammatory Assessment in Diverse Skin Tones · Forsyth A et al. Cureus 2025;17(10):e94930. Cureus / PMC, 2025Establishes: Melanin masks redness, so inflammation may look violaceous, grey or brown. Redness-based scoring and trial criteria can underestimate or exclude darker-skinned patients. Recommends using palpation (warmth, swelling), texture and patient-reported symptoms such as itch and pain.Does not establish: Validated questionnaire wording. Cureus is a lower-barrier journal; treat as supporting commentary.
10. [10]Dermatology: how to manage rosacea in skin of colour · Maliyar K, Abdulla SJ. Drugs Context 2022. Drugs in Context / PMC, 2022Establishes: In darker skin, centrofacial redness can be masked. Patients more often report warmth, burning and stinging. Papules and pustules are easier to see than redness. Advises history-taking about stinging, flushing, triggers and 'acne' that does not respond to treatment. Lists conditions it can be confused with (acne, seborrheic dermatitis, contact dermatitis, lupus, sarcoidosis).Does not establish: Its large global case estimate, which is modelled rather than measured and is not relied on.
11. [11]Global epidemiology and clinical spectrum of rosacea, highlighting skin of color · Alexis AF et al. J Am Acad Dermatol 2019. PMID 30240779. JAAD, 2019 · read at abstract levelEstablishes: Review plus clinical experience. Rosacea may be underdiagnosed in skin of color because redness and visible vessels are harder to see, which risks delayed or inadequate treatment.Does not establish: Validated prevalence in skin of color.
12. [12]Keloids and hypertrophic scars · DermNet (Yoong, Numan; reviewed Coulson), 2022Establishes: Keloids are more frequent in Fitzpatrick III–VI. Listed triggers include trauma, burns, surgery, acne, insect bites and immunisation. Lists treatments and warns that excision can produce a larger keloid.Does not establish: Anything about piercings or tattoos, or risk figures by ancestry beyond one self-report figure.
13. [13]Keloid scars · NHS (UK), 2023Establishes: Higher likelihood is listed for South Asian, Chinese, African Caribbean or Black African descent, age 10–30, pregnancy and prior keloids. If at higher risk, avoid tattoos and piercings. Early acne treatment reduces scarring. Keloids cannot be prevented outright.Does not establish: Numeric risk.