For some, acne has a way of persisting past their pimple-peppered youth into adulthood. And for those of an ethnic background, the skin condition is more difficult to heal and, therefore, more difficult to treat—so much so that many physicians shy away from even learning how. So how do we treat the “untreatable,” then? We asked David Rahimi, MD, FAAD, FAACS to find out the real cost of acne and how it can be treated in cases where darker skin is affected.
Acne affects the skin’s oil glands, due to an occlusion of a follicle. When a follicle begins to clog up, a dreaded pimple soon develops—the majority forming on or near the face, neck, back, chest and shoulders, effectively putting a pin in countless date nights.
Acne can be spurred by a multitude of factors, including genetics and everyday facial contact from dirty hands, bacteria-laden mobile devices, pillowcases and bedding, and cosmetics. Although it does not discriminate among various ethnic groups, Dr. Rahimi says it’s harder to treat where patients have darker skin.
This is because patients with dark skin develop a different kind of acne, such that the inflammatory papules, pustules, nodules, and cysts can have a high degree of pigmentation with thick, unsightly scars (keloid scars) that differ from patients with lighter skin.
“So, yes, it helps to have an expansive definition of— and innovative approaches to— the causes and treatment options involving acne,” said Dr. Rahimi.
According to Dr. Rahimi, acne is the most common skin disorder among African-American adolescents and adults. This group does, however, tend to have a more common version of inflammatory acne, which is easier to treat. Still, the pigmentation problems described above leave many African-Americans prone to keloid scars. The same is true of Latino patients, in which there is a higher occurrence of this pigmentation disorder. Acne is common among Asians, causing the post-inflammatory pigmentation (dark spots) that remain after acne lesions heal.
“Treating this specific category of acne is difficult, ad I do not understate the case when I make this point, because it requires a different regimen and a new method,” stated Dr. Rahimi. “Many physicians shy away from treating ethnic skin because it heals differently than white or European skin. We find that less-experienced physicians discourage patients with darker skin from seeking laser treatments, chemical peels or surgery.”
However, Dr. Rahimi deems many lasers to be fit for use on ethnic skin so long as a skilled physician is at the helm of the equipment. A relatively new edition is the MiXto Fractional CO2 Laser—an exciting new development in acne scar treatment. It delivers powerful results without the harsh side effects and downtime of traditional CO2 resurfacing.
“Laser treatments, chemical peels or surgery require innate talent and skill, even a measure of artistry. Now, imagine using one of 26 different lasers—picture the exactitude and calibration necessary to apply this resource properly—and you should understand why so few doctors choose to treat (or even attempt to learn how to treat) ethnic acne,” said Dr. Rahimi.
The good message is that acne—ethnic or not—is a treatable condition within the abilities of a trained physician, provided they have access to the equipment and staff to markedly change their patient’s life for the better. As a final note, Dr. Rahimi encourages readers to perform their own due diligence—to be active participants in the care they receive, not passive recipients of whatever a doctor says is necessary or right.