Smart Ways to Fight Acne: A Guide to Prevention & Treatments

As we know, every skin is unique and needs specific care. People with darker skin tones (25% of the world population) often share certain structural characteristics and problems that involve their skin and one of these are Acne problems. Having a common understanding of these particular issues helps with prevention and care.

Acne is a common skin problem. Familiarly known as breakouts, pimples, zits. Acne can happen at any age but is typically most prevalent during Adolescence and young adulthood (teenage years through early 20s). However, It can continue further into adulthood. It can appear on the face, chest, shoulders, back, or upper arms and be very mild with only a few pimples (papules or pustules) or severe with cysts and nodules (larger bumps under the skin) and scarring. This condition without doubt can be frustrating and have serious implications for a person’s self esteem, but it is treatable.

For patients with darker skin tones who develop acne, the skin color changes that occur can be significant. Specifically, dark patches of acne, known as Post-Inflammatory Hyperpigmentation (PIH), is often the main complaint.

Ok, You Have Acne, But Why?

The pores of the skin become clogged and oil builds up in the pore or hair follicle. A pore clogged with oil is called a comedo.

There are two types of comedones. Whiteheads which are closed and blackheads, open comedones that are open to the surface of the skin. They appear “black” or dark because the oil (sebum) and densely packed skin cells exposed to the air oxidize and reveal the melanin pigment. Also, a comedo can become inflamed when the bacteria (C. acnes) on the surface of skin gets into the pore. This causes red bumps (papules and pustules) in the skin which can be tender and painful.

What Makes Acne Worse?

Some daily practices can make skin acne worse, some of which are:

• Squeezing, scrubbing or picking at the skin
• Irritants from the environment (i.e. pollution)
• Greasy products such as skin or hair products with oil
• Make-up and makeup brushes that aren’t clean
• Hormones, acne often worsens during puberty and may be related to women’s menstrual cycles
• Some studies also suggest diet, particularly dairy consumption and stress may also play a role
• Things that put pressure on your skin: sportswear, helmets, cell phones
• Grease in workplace (i.e. kitchen with fryers)

Acne Affects All Skin Tones, but In Ebony Skin The Effects Are Usually More Visible

Acne can potentially affect all skin tones, however on darker skin (skin phototypes IV thru VI) the resulting impact can be hyperpigmentation. This can proceed much longer than the initial acne insult and cause quite significant psychological distress.

Additionally, because darker skin is thicker, pimples may be more prominent and larger. This naturally thicker epidermal layer in darker skin can cause more folliculitis, a condition where hair follicles become inflamed and white headed pimples form around the hair follicle.

What Is PIH And Why Does It Tend To Affect Deeper Skin Tones More?

Post Inflammatory Pigmentation (PIH) is the discoloration of the skin that develops after any kind of wounding or trauma, also particularly conditions like acne, eczema, bruises, and lacerations. Darker skin tones have more active melanocytes (cells that produce melanin) that once stimulated produce more melanin when skin suffers inflammation.

Not All Acne Marks Are Permanent but Some can leave scars

You can have marks left by acne that are not permanent, so don’t freak out!

The purple and brown spots left from acne may seem permanent because they can take months to years to fade. But some types of acne such as Cystic Acne can lead to permanent scars so it is important to get it treated early or try to prevent them entirely with a skincare regimen.

Types of Acne Scars

Acne scars fall into two main categories:

• Those caused by a loss of tissue: Atrophic Scars.
• Those caused by an excess of tissue: Hypertrophic Scars.

Within these categories, there are four main types of acne scars: ice pick, boxcar, rolling, and keloid scars. Acne scars can be difficult to treat, and always require professional help if you want to see significant improvement. Unfortunately, over-the-counter products simply aren’t effective in improving anything besides preventing and decreasing inflammation and discoloration.

There are procedures, though, that can improve the look and texture of your skin. Your options depend on the type of scarring you have. Most people have more than one type of scarring on their skin, so you might need a few different treatments to see the best results.

1. Ice Pick Acne Scars

Ice pick scars are very narrow scars that extend into the dermis, deeper level of the skin. The skin looks as if it has been pierced by an ice pick or sharp instrument and these scars appear as small, thin, deep holes within the skin. Some may mistakenly look like a large, open pore. Ice pick scars develop after an acne infection from a cyst or papule that occurs deep from the skin surface. Skin structures are destroyed, leaving a long, column-like scar.

2. Boxcar Acne Scars

Boxcar scars are round or oval depressions with steep vertical sides. Wider than ice pick scars, boxcar scars give the skin an uneven, irregular pockmarked surface appearance. When an inflammatory breakout destroys collagen, the tissue is lost. The skin over this area is left without support, creating a depressed area. Boxcar scars can be superficial to severe, depending on the amount of tissue lost.

3. Rolling Acne Scars

This type of scarring is caused by rolling or wave-like depressions across otherwise normal-looking skin. Rolling scars differ from boxcar scars in that they aren’t sharply defined. Rolling scars arise when fibrous bands of scar tissue develop between the skin and the subcutaneous tissue below. These bands pull the epidermis, top layer of the skin, creating the rolling appearance of the skin.

4. Hypertrophic and Keloid Scars

Hypertrophic scars are raised, firm scars that grow above the surface of the skin.

These acne type scars are most often found on the torso, especially in men, but they can happen anywhere on the body. Hypertrophic scars are more common after a deep wound or trauma. Keloids are a more severe type of raised scar. They differ from hypertrophic scars in that keloids grow larger than the original wound. They can send out raised, lateral shoots that expand much farther than the wound itself, and can continue to grow long after the original wound has healed.

Unlike ice pick and boxcar scars, hypertrophic scars are not caused by a loss of tissue. Rather, they develop because of an overproduction of collagen. In the case of keloids, it’s like the skin doesn’t know that the wound has healed, and continues to produce collagen.

What about Retinol, Benzoyl Peroxide, and Salicylic Acid Products?

All ingredients that irritate skin should be used with caution. Forms of irritation on use of these products can present as diffuse redness, scaling, stinging, tightening or burning sensation of the skin. Salicylic Acid in low concentration is helpful to treat acne but higher doses can burn skin causing PIH. Over the counter concentrations for this reason typically come in 0.5 to 5 percent.

The same applies to all acids like Glycolic and Mandelic, as well as Retinol Acid and Benzoyl Peroxide (which is frequently used for acne). None of them should be used during the day when you’re exposed to the sun. Benzoyl Peroxide can be used during the day but often times its advised that your avoid direct sunlight and use SPF.

These are all great ingredients when used correctly and as advised by your doctor. They all have decades of research behind them and are clinically proven to be effective in the management of not only acne but on other skin issues.

Use These Home Remedies to Help Reduce Acne

Here are some natural acne treatments for brown skin.

1. Tea tree oil

Tea tree oil, distilled from the leaves of the melaleuca plant found in Australia, has antimicrobial and anti-inflammatory properties that helps kill the bacteria that contribute to inflammation and acne. A 2015 review published in the International Journal of Antimicrobial Agents, found that tea tree oil could reduce acne spots in people with mild to moderate acne. Tea tree oil caused a similar number of side effects as other treatments.

Try using just a small amount on the end of a cotton swab. Another option is to invest in a skin cleanser that contains tea tree oil.

Tea tree oil products for acne are widely available in drug stores and online.

2. Citric acid

Citric acid, which is most prevalent in citrus fruits, such as oranges and lemons, may help reduce acne lesions in some. Another study in 2016 by the Society of Cosmetic Scientists and the Société Française de Cosmétologie, suggests that this acid may help kill certain types of acne bacteria. While there is little research on whether citric acid can clear up acne, people can try applying lemon juice directly to pimples. Lemon juice can make the skin more sensitive to sunlight, so apply it at night and remember to wear sunscreen.

3. Use sunscreen

This is our mantra, and you could be wondering “Why? If Black don’t Crack” as the saying goes. Well, the reality is that dark spots can appear on the skin for many reasons, and people with darker skin tones often notice these spots after a minor skin injury, such as an acne spot or other skin irritation.

Applying sunscreen to the skin daily, may prevent dark spots from appearing or getting worse. It is also a healthful habit to maintain, as limiting sun damage can help reduce a person’s risk of skin cancer and minimize photo-aging. Yes, wrinkles.

Lifestyle Changes

The American Academy of Dermatology (AAD) suggests the following lifestyle remedies to fight acne in brown skin:

• Treat acne at the earliest possible sign to help prevent dark spots.
• Use hair oil only in the middle of the scalp. Hair oils can cause acne on the hairline and forehead.
• Do not touch the hair and then touch the face, since this can get hair oil on the skin, clogging pores.
• Avoid using skin care products that contain heavy oils on acne prone areas.
• Choose oil-free skin products marked as “non-comedogenic,” since they are less likely to clog pores.
• Avoid popping pimples, as this can worsen inflammation and cause scarring and dark spots.
• Use only non-comedogenic make-up.
• Frequently wash your clothes like scarves, hats, and anything else that comes into contact with the face or hair.

There Are Also Some Clinical Treatments You Can Approach

Some of the best acne treatments are not “natural” and rely on specific substances that are tried and true to treat the condition. These treatments are generally safe and effective, so a person can consider trying them if natural methods fail.

Medical treatments can increase the skin’s sensitivity to sun. For some, such as the topical retinoids, it is best to apply them at night, as the sun inactivates them.

The American Academy of Dermatology suggest that acne products containing the following ingredients are the most effective on melanin-rich skin:

Benzoyl peroxide

This product can help kill the bacteria that contribute to acne. While it does not bleach dark skin, it can bleach clothing and other fabrics so watch out if you don’t want to damage your favorite shirt.

Benzoyl peroxide can irritate or dry out the skin, so it is best to start with a 2.5% solution or a 4% wash and use it every other day, gradually working up to daily use with a more concentrated solution, if necessary and tolerated. The chest and back can usually tolerate higher concentrations of benzoyl peroxide than the face.

Salicylic acid

Salicylic acid can help unclog pores and prevent new acne from forming. The peeling function of salicylic acid may also help with melasma, a common skin problem that causes discoloration.

Retinoids

Retinoids, such as retinol and tretinoin, are chemicals that derive from vitamin A. They can help fight inflammation and unclog pores, preventing acne. Retinoids can also help prevent signs of aging.

Retinoids can also irritate the skin making it more sensitive to sunlight so regular sunscreen use is advised and it may take several months to see their full effect.

There Are Some Treatments That Should Be Avoided

One myth suggests that cocoa butter can help even out ebony skin, but there is no evidence to support this. There is, however, evidence that cocoa butter can clog pores, especially on the face, back and chest. Those with acne prone skin should avoid using products containing this ingredient on acne prone areas, as it can make acne worse.

Skin lightening products may help fade dark spots, but they can also damage the skin and cause irritation. If you still want to use them, consult a specialist for the proper dosage and treatment. However, skin lightening products may contain steroids or mercury, which can be harmful. They may also cause rashes, acne, or even make dark spots worse, so talk to a doctor before trying a skin lightener.

Be Patient!

We know that dealing with acne is very stressful and sometimes frustrating, but please don’t lose your patience. Consult with your doctor for the right treatment for your skin type and acne, and ask about home treatments you can use to complement it. Even with the most careful and conscientious treatment, you may develop acne scars. It’s important that if you have acne, you get breakouts under control as early as possible and have a preventative regimen in place. It’s very difficult to effectively treat acne scars if you’re still actively breaking out.

It can take at least 6-8 weeks for acne to respond to treatment. Give your skin the time to heal and change.

Also, if treatment is stopped early, you may not see results and the acne will return. Remember that sometimes skin will look worse before it gets better as clogged pores are getting cleared out of the skin, so be patient. Often, more than one medication is required.

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