Sunday, 24 March 2019 16:40

Fitzpatrick Skin Types 4-6: Managing Acne and Scarring

Written by   Gina Charles, D.O.

Dark skin is a physical trait that is present amongst diverse ethnic groups, such as African, East Asian, Latino, Middle Eastern, Mediterranean, and Native American. While skin rich in melanin can, for the most part, safely absorb ultraviolet rays, developing acne is unfortunately very common. Consequences of acne in people with dark skin include keloid (raised scar after skin has healed) formation and hyperpigmentation (dark brown or red spots). These manifestations are the skin’s response to untreated acne and poor lifestyle choices.

Acne starts to rear its ugly head during adolescence and can be prominent during adult years. People with darker complexions tend to have inflammatory acne (the most common type of acne), which includes papules and pustules. Because people with darker skin complexions have a high risk of keloid scarring, usually noted on their chests and backs, it is important to be proactive in preventing and managing acne.

Post-inflammatory hyperpigmentation resulting from acne can last for months, even years. Picking at the skin, although tempting, will only worsen it and prolong the time it takes to reverse its effects. Again, it is important that an acne treatment is started early, to mitigate the chance of hyperpigmentation.

One approach to acne prevention is to avoid products that clog pores. For example, excessive use of products that contain oils, cocoa butter, and shea butter can cause pore congestion in skin that is already susceptible to acne. Instead, opt for non-comedogenic products. If breakouts are prominent at the hairline, clients should avoid using hair products that contain pore-clogging ingredients. Glycerin-based hair products are a great alternative.

Another approach to managing acne is adhering to a simple, effective skin care regimen and to use acne products comprised of ingredients that work well with dark skin.

Benzoyl peroxide treats inflammatory acne and is found over-the-counter, as well as in prescription medication. In topical formulations, it causes mild drying and peeling, but is relatively safe for darker complexions. Products containing 2.5 percent benzoyl peroxide will remove bacteria that causes acne. Clients should start by using it every other day until their skin builds a tolerance for it. Then, they can increase the frequency to daily use.

Retinoids and retinols are vitamin A derivatives that help reduce inflammation, minimize the size of pores, prevent new breakouts, and improve the appearance of dark spots. They can be found in prescription medication, as well as over-the-counter. Retinoids and retinols are best used at night.

Salicylic acid is a beta hydroxy acid found in several over-the-counter and prescription products. It is used to reduce swelling and redness and help clear and prevent breakouts and blemishes in people who have acne.

Post-inflammatory hyperpigmentation, secondary to acne, can be treated with topical retinoid and retinol (helps accelerate the renewal of skin cells, thereby diminishing dark spots).

Other key ingredients found in products that target hyperpigmentation include azelaic acid, mandelic acid, kojic acid, tranexamic acid, niacinamide (vitamin B3), and hydroquinone (if tolerated). L-ascorbic acid (vitamin C) has been shown to brighten complexion. Professional treatments, such as chemical peels, laser therapy, and microneedling, have shown to be of benefit, diminishing dark spots.

Acne scarring can be treated via microneedling, steroid injections, laser therapy, or surgical repair. With these professional treatment modalities, the goal is to reduce the start of breakouts, manage and prevent current breakouts, and to improve skin tone and texture. Oral antibiotics can also be prescribed to treat acne.


  • treat acne early in order to prevent dark spots
  • use products that work well with darker skin tones
  • check product ingredients
  • avoid using oily or greasy hair products if prone to breakouts
  • use non-comedogenic skin care products
  • avoid using heavy, oily makeup
  • adhere to a simple skin care regimen
  • drink lots of water
  • remove makeup before going to bed
  • wear sunscreen (SPF 30 or higher) daily


  • pick at acne
  • pop or squeeze pimples
  • wear sweaty baseball hats or headbands for too long
  • eat foods that contribute to acne (sugary foods, chocolate, soda, sweetened drinks, pizza)
  • delay treating acne, do it as soon as possible
  • use harsh scrubs
  • scrub with a washcloth

Gina Charles 2015Dr. Gina Charles, (Dr. G) is a board-certified family physician, skin care expert, and owner of boutique medical spa Serenity Aesthetics & Wellness in Philadelphia, Pennsylvania. Charles, sometimes referred to as the “Self Care Beauty Doc,” has fused her personal skin care experience, medical knowledge, and passion for self-care, which she uses as a medium to address skin care concerns and provide clients with a holistic approach to beauty. Through aesthetic practices and meditation, Charles is passionate about making her clients feel and look their best because she believes that holistic healing is essential to confidence elevation. She is committed to providing corrective skin care solutions, with a focus on acne and hyperpigmentation improvement.

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