Acne on pigmented skin

Abstract Acne on pigmented skin occurs in Africans and their descendants, as well as in patients with a skin phototype above IV. Acne is common in Africans and is often the primary reason for consulting a dermatologist. Acne on pigmented skin is principally inflammatory acne. The sequelae in terms of pigmentation are often the main reason for consulting a dermatologist, and take precedence over the acne itself. Research is needed into cosmetic acne and steroid‐induced dermatitis, which are common in users of skin bleaching products. The treatment for acne in pigmented skin involves the same medicines as used in acne in white skin. Of the available topical treatments, benzoyl peroxide is particularly effective for the inflammatory component. Retinoids act on both the retentional and inflammatory components of acne and have skin bleaching properties. Tetracyclines are essential on initiation of treatment, regardless of severity. They prevent an inflammatory episode at the onset of acne and rapidly improve the inflammatory component. Minocycline should not be prescribed in African patients. Fatal cases of hypersensitivity have been described, with a particular frequency in this population. Doxycycline is effective, but has photosensitizing properties. Lymecycline is well tolerated. Isotretinoin is indicated for nodular acne. The same precautions for use should be followed as in all cases of acne. The skin bleaching effects are considerable. Photoprotection should generally be imposed, but, in patients with black skin, photoprotective agents are often not applied. The administration of a cosmetic containing a skin bleaching agent combined with a photoprotective agent for application in the morning, instead of hydrating cream, is acceptable to patients, improves compliance, and is effective.