Acne treatment in darker skin types such as Asians and Middle Eastern patients are slight different compared to treating Caucasian acne.
Darker skin types tend to scar more easily, and acne can be associated with skin changes, including darkening of the skin- also known as post-inflammatory hyperpigmentation.
The Specialist Acne Clinic in Brisbane deals with all types of acne, including treating ethnic patients.
Specialist Perspective on treating acne and scarring in darker skin patients
Treating acne and acne scarring in Asian and ethnic skin requires a different approach. Treatment of acne is more aggressive, and this can reduce the incidence of scarring and post- acne pigmentation changes. The reverse applies to acne scars, in this case a more conservative approach is needed to prevent scarring and post treatment colour changes. The use of a high factor SPF sunscreen is paramount in both cases of acne treatment and acne scar management. This forms the basis of reducing post inflammatory skin changes. Acne scar management can be challenging. In treating darker skin acne scar patients, we have to carefully match the skin colour of the patient, the acne scar type and the down time to give patients a safe but noticeable improvement in acne scars. There in lies the challenge. I choose erbium laser over CO2 laser in darker skin patients. Additionally my TCA cross concentrations are lower, and my fractional laser treatments are more conservative with less overlap. For fractional laser, I usually use the Erbium Profractional over the CO2 or Fraxel, as pigmentation changes are less frequently encountered with Erbium. We can achieve very similar results with lasers and chemical peels in ethnic patients compared with fairer skin types, however extra treatments are needed on the side of safety. Challenging, but results can be achieved.
Darker skin patients such as Asian or Middle Eastern have a harder time dealing with acne and acne scarring compared to Caucasian patients. There are several reasons why treating acne earlier and with more powerful medications maybe appropriate.
Firstly, scarring can be more profound in Asian patients, especially keloid scarring.
Secondly, colour changes such as darkening of the skin (post inflammatory hyperpigmentation) is more commonly seen with acne. If post inflammatory changes occur, it may take many months before it settles down. Prevention of scars and colour changes is very important.
Sunscreen is especially important in the treatment of acne in darker skin types. UV exposure can stimulate pigmentation, known as post inflammatory hyperpigmentation. Dark acne scars can occur as a result. It is important to use a high factor non-greasy sunscreen on a daily basis, as part of your skin care treatment. Preventing scarring is very important.
The Specialist choice of sunscreen is La Roche Posay, as this provides maximal UV protection and is not acne forming.
The same types of treatments apply to treating darker skin types as treating Caucasian patients. Depending on the severity of your acne, your specialist may elect to use creams, tablets, chemical peels, or prescription washes. We would always recommend that you use a sunscreen on a daily basis to prevent darkening of your acne lesions.
In some cases we may elected to use a higher-grade acne treatment such as Roaccutane to prevent scarring.
In more severe cases we may recommend the Acne Free RF Program to treat scars and acne at the same time.
Treating acne scarring in darker skin patients is very difficult, and treatments can be tricky. The risks of scarring and skin colour changes can occur. The treatments we perform are dependent on not only the type of acne scars, but also the skin colour of the patient. In general we go a lot slower, and less aggressive in scar treatments compared to lighter skin patients.
For example, a fair skin acne scar patient may only need one or two laser treatments, however a darker skin patient may require an additional one to two treatments to achieve the very same results. Darker skin patients are suited for the Erbium laser compared to the CO2 Core laser.
Another example is TCA Cross, in darker skin patients, we use a different technique, a lower concentration, and a different time interval compared to treating fairer skin patients.
Asian and Middle Eastern patients who suffer from acne will often develop darkening of the skin. This is called post-inflammatory hyperpigmentation and is very commonly seen. Early and effective treatment of acne can reduce or prevent pigmentation changes.
There are several methods to lighten the skin if you have pigmentation changes -
- Twice daily use of a high factor SPF, we recommend La Roche Posay sunscreen in acne prone patients.
- A topical Vitamin A cream can both treat acne and reduce pigmentation
- Chemical peels with AHA fruit acids can treat acne, reduce pigmentation and help with mild scarring
- Laser treatment with QSL or Q switch laser can help with pigmentation
- Most importantly, time will fade pigmented scars, but this can take 9-12 months
Yes they are. A correct match of the type of chemical peel and the concentration of peeling agent makes chemical peeling a very safe treatment for even the darkest skin type. Chemical peels can be tiered to treat both acne and acne scarring.
Chemical peels for acne
We use two types of chemical peels to treat active acne, including an AHA or Glycolic acid Peel, and a BHA or Beta Hydroxy Acid peel, also known as a salicylic acid peel. The concentration is tailored according to your acne and skin type.
Chemical peels for acne scarring
We use a special peel called TCA cross chemical peel to treat deep ice pick and box car scars. Once again the concentration is tailored according to the skin type, and severity of the acne scars.
Yes, but… treatments will need to be tailored to the skin and acne scar type. Unlike fair skin patients, treating acne scars in darker skin patients can be much harder, and different lasers and techniques are used.
Dr Davin S. Lim, Laser Dermatologist undertook his laser training in both the US and in Asia and has experience in treating acne scars in all skin types, including very dark skin types and will discuss salient points on laser treatments in darker skin patients -
"As emphasised throughout this website and in my lectures on acne scar revision, I choose a method based upon 3 factors- acne scar type, skin type or skin colour and the downtime of the patient. In treating darker skin patients, the order of importance is, firstly skin colour, secondly scar type, and thirdly down time. Treating darker skin patients is a lot more difficult compared to lighter skin patients due to two reasons.
- Scarring after a laser procedure is more commonly seen in darker skin patients.
- Skin colour changes (either lighter or darker skin) is 10 x more likely to occur in darker skin patients.
Bearing all this in mind, laser treatments in darker skin patient with acne scars can still be safely and effectively performed however I advise the following -
- I choose Erbium Fractional over Fraxel and CO2 Fractional, as erbium laser has less chance of causing post laser skin colour changes
- I don't laser as deep, nor do I treat as aggressively compared to fair skin patients. This means darker skin patients may need an extra two or three laser treatments to achieve a similar improvement in acne scarring compared to lighter skin patients.
- I raise deep scars with a customised TCA Cross Chemical peel- this elevated deeper ice pick and box car scarring. This in turn will make laser treatment safer, as I do not need to go as deep to target these scars
- I advise treatments such as RadioFrequency early in acne treatment, as RF treatments are safe, effective and can prevent scar formation
- I always emphasise a high factor SPF sunscreen 2-3 times a day, before any acne scar treatments. Occasionally I use a bleaching cream to help reduce any post laser complications.
- Laser for acne scars in darker skin patients can be effective, however safety is always the number one priority."
No, a referral is not need to visit a Specialist, however a referral is encouraged. Keeping your GP informed of your treatments maybe a good idea. Additionally a referral can enable you to a claim from Medicare. Some treatments for acne scarring can be claimed on Medicare.
Call reception on 07 3871 34 37 to discuss the referral process, fees and appointment times.