Acne, Rosacea, and Keloids in Skin of Color

On the third day of Spring Dermatology Week 2023, Hilary Baldwin, MD, and Shawn Kwatra, MD, presented on keloid scarring, acne, and rosacea and their impact on patients with skin of color during the session, “Inflammatory Skin Diseases in Skin of Color Patients.”

Dr Baldwin shared that keloidal scarring is common, and these lesions typically morph from pimples directly into keloids. She noted that, within her patient population, these have been treated with isotretinoin to halt the development of new lesions; therefore, she argued that physicians have this option to treat their patients as well.

Dr Kwatra weighed in, stating, “A few years ago, we looked in terms of the prescribing patterns of isotretinoin. We found that Black patients in particular were prescribed isotretinoin less frequently than Caucasian patients.”

Dr Baldwin remarked, “I think you also showed that there are fewer pharmacies in those neighborhoods that are enrolled in the iPLEDGE program. So, they don't go to see the dermatologist, then they don't get prescribed it, and then they can't find a pharmacy that would fill it.”

Next, Dr Baldwin transitioned into pomade acne, which is a common acne found primarily on the forehead and hairline from hair care products. She shared that the most common causes of this skin disease include petrolatum, cocoa butter, shea butter, and mineral oil, and suggested these be replaced with alternative noncomedogenic ingredients, such as silicone and cholesterol.

Dr Kwatra added that postinflammatory hyperpigmentation is just as important as the actual erythematous lesions of acne, and awareness of this can lead to the initiation of early treatment.

They continued onto rosacea by sharing that the incidence rate is somewhere in the vicinity of 10%, which means it affects about 16 million people in the United States. They noted that rosacea is believed to be the most common in fair-skinned women over age 40 years, but this is often not the case. In fact, they found that rosacea is not uncommon in darker skin. True erythema may be more difficult to recognize clinically, especially in skin types 5 and 6, but a high index of suspicion is needed because symptoms may be easier to elicit than signs in patients with darker skin.

“If you ask, you might find out that the patients have some burning, stinging, itching, and sensitivity,” Dr Baldwin concluded.

For more meeting coverage, visit the Spring Dermatology Week 2023 newsroom.

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Reference
Baldwin H, Kwatra S. Inflammatory skin diseases in skin of color patients. Presented at: Dermatology Week 2023; May 3-6, 2023; Virtual.