Breaking Out

The Best In-Office Acne Treatments For Melanated Skin

No one should be afraid to see a dermatologist.

By Simedar Jackson
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Acne is the most common skin condition in America — and yet, many POC are hesitant to get professional help for their acne woes. (True story: A 2018 study found that white patients were twice as likely as African-American and Hispanic patients to visit a dermatologist, even when their income levels were similar.) “My perception was that I was limited in what treatments people like me could get due to [my] darker skin tone,” says Dr. Lisa Akintilo, M.D., M.P.H., who was a teenager in the late 2000s. She doesn’t remember what specifically gave her this impression but knows it once felt like a matter of fact. “Even to this day, I think it’s kind of the pervasive belief amongst the community of people with darker skin.”

The truth is, the biggest issue with acne care and darker skin tones is the dermatology world’s blind spots and prejudices. “For years, the industry did not think people of color cared or even had the finances to get [in-office treatments],” says Morgan Rackley, licensed aesthetician, licensed laser practitioner, and med-spa owner. “We were instantly deemed as an unwanted client, so it wasn't worth it to invest in education or equipment.” The result: burns, chemical peels-gone-wrong, sagas of doctors’ misdiagnosesacne horror stories that would make anyone hesitant to trust a so-called “expert” with their skin.

But things are changing, slowly but surely. “In recent years, [nationwide programs] have really improved and focused on caring for patients with more melanated skin,” says Akintilo, who recently concluded her residency in dermatology at New York University. “As the demographic continues to evolve, education administrators recognize the importance of [identifying] diseases in all skin types. They want physicians to be fully prepared.”

Case in point: dermatology journals are increasing the publication of papers focused on skin of color. Similarly, the Skin of Color Update, one of the largest medical conferences focused on darker skin, is expanding its programming to reflect an industry-wide push to close the education gap. Things like the Black Derm Directory, Skin of Color Society, and Brown Skin Estie are good starting points for people of color looking for providers they can trust. Resources like See My Skin, created by Vaseline and Hued, allow people to search for different skin conditions on all skin tones — something that was greatly lacking, even in dermatology courses, up until now.

As the dermatology industry steps it up, we’ve put together an expert-approved guide on all the acne treatments for melanated skin tones so you can keep your skin looking 10/10.

Chemical Peels

Chemical peels are some of the most popular cosmetic treatments for tackling several skin issues including acne, aging, and hyperpigmentation, and TBH, they often get a bad rep (see: Samantha Jones’ burnt-red face in that one SATC episode). Common misconceptions about these treatments include the belief that certain peel ingredients, like glycolic acid, are unsuitable for darker skin. “That couldn’t be anything further from the truth,” says Akintilo.

Rackley explains that preparation is the most important part of applying chemical peels on a client with darker skin. “We want to introduce certain acids or stronger ingredients to the skin at a lower percentage,” she says. “We allow the client to get used to it so that when we apply a stronger percentage, the skin is not shocked.”

Quick In-Office Chemical Peel Tips For POC:

  • Vet your provider. Research your aesthetician or dermatologist and ensure their license is in good standing. Look at previous client photos and ask about their experience treating darker skin.
  • Be consistent with your at-home routine. Preparing your skin for stronger treatments primarily happens at home. Follow your aesthetician or dermatologist’s recommendations as close as possible.
  • Be patient! Darker skin typically requires more treatments at increasing strengths. Don’t push for too much too fast, and be wary of providers willing to perform advanced treatments early on.
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Lasers

Lasers are a great option if you’re looking to tackle acne scarring. When it comes to lasers, the issue for darker skin isn’t the available technology or formulas but the practitioner's skill level. “On the device side, it’s so poorly regulated,” says Dr. Geeta Yadav, M.D., founder of Facet Dermatology. “These tools can induce serious damage when mishandled, yet the requirements for administration vary significantly across the U.S. with loopholes allowing less-experienced providers to take the wheel. The experts I spoke to encourage patients to ask questions, check credentials, and be sure their esthetician or dermatologist’s license is in good standing when considering these treatments.

Additionally, the need to administer a higher number of progressively stronger treatments on darker skin requires patience from both the service provider and the patient. Starting low and slow with the proper laser makes laser treatment safe for melanated skin. Rackley exclusively uses an Nd:YAG laser in her spa, which has a decades-long track record for safely treating darker skin types. The Moxi Laser is also meant to work across all skin tones.

Quick In-Office Laser Facial Tips For POC:

  • Ask your technician about the type of laser used and its safety profile for darker skin.
  • Know the laser laws in your state to better avoid sketchy laser techs.
  • Prioritize results over price. Significantly discounted pricing may be a sign of a less-experienced technician. Stay on the safe side and don’t skimp on your face!

Topical And Oral Prescriptions

Topical and oral acne medications are highly effective and primarily colorblind. However, access to equitable medical care is a barrier for darker-skinned patients looking for these options. “There’s data that oral and systemic options are offered less often [to patients of color] than they are to white people,” says Yadav. “There are different theories as to why, if it’s misdiagnoses or [that physicians] don't appreciate the severity.”

Prescription acne medications are plentiful and can be combined based on skin type and acne severity. Antibiotics like clindamycin are taken orally or applied topically to reduce acne-causing bacteria. Popular prescribed ingredients like retinoids and benzoyl peroxide balance oil production and encourage skin cell turnover, while hormonal regulators like spironolactone and the newer clascoterone target the hormonal pathway that leads to acne.

Seeing a professional early and participating in your treatment plan can help you avoid extended periods of suffering without answers. If you think your acne has to be super stubborn or severe to get one of the above prescriptions, think again. “A doctor can help you with even mild acne,” says Yadav. So before spending your entire paycheck on a Sephora haul, consider the option of seeing a skin care expert first — it might just save your acne (and your wallet). Remember: Higher percentages of ingredients come with more efficacy but also an increased risk of a negative reaction. You should only use these prescriptions under the supervision of a doctor to avoid serious complications.

Quick Topical And Oral Acne Medication Tips For POC:

  • Consider medication as a first resort. Don’t wait until your acne is unbearable to weigh all your options.
  • Do your research. Get a general grasp of what’s currently available so you can participate in your care plan.
  • Advocate for yourself. Asking your doctor about trying a certain medication can increase your chances of receiving comprehensive treatment.

OTC Acne Products

Over-the-counter acne treatments from drugstores and beauty stores, like low-percentage salicylic acid and other exfoliants, can be useful but often require a lot of skin care knowledge for best results. “My preference is to use [prescribed] medical treatments to manage the active acne and then cosmetic treatments for the sequelae, like the scarring,” says Yadav.

Quick OTC Acne Product Tips For POC:

  • Don’t overdo it on the salicylic acid: There’s a reason OTC salicylic acid products are only available up to 2%. Although dermatologists can prescribe higher percentages, they’re more likely to recommend retinoids and other medications for more effective acne treatment.
  • Know your retinoids: Retinoids are a family of ingredients that fight acne by increasing cell turnover and balancing oil production. The strongest and most effective retinoids, like tretinoin, are available by prescription only. Over-the-counter retinoids usually contain less active types at 1% or lower.
  • Azelaic acid can reduce acne-causing bacteria, soothe inflammation, and prevent buildup that blocks pores. Over-the-counter products are available up to 10% and prescription-only strengths come in 15% to 20%.

Studies:

Tripathi R, Knusel KD, Ezaldein HH, Scott JF, Bordeaux JS. Association of Demographic and Socioeconomic Characteristics With Differences in Use of Outpatient Dermatology Services in the United States. JAMA Dermatol. 2018 Nov 1;154(11):1286-1291.