Patients of color (SOC) are often more concerned about post-inflammatory hyperpigmentation (PIH) and scarring than the acne itself, says Valerie D. Callender, MD, at the Fall Clinical Dermatology Conference, organization held October 21-24, 2021, in Las Vegas, Nevada, and virtually.first

“Dermatologists need to show empathy and understand the negative impact of PIH on patients’ quality of life,” says Callender, professor of dermatology at Howard University School of Medicine and founder of the Skin Center. Dermatology & Aesthetics Callender in Washington, DC.

Because PIH can be mentally devastating for SOC patients, she says, clinicians must not only treat it promptly, but also appreciate the psychosocial harm of acne. Listening goes a long way: “[Patients] say, ‘I want to get rid of these scars.’ But most of the time, they are hyperpigmented macules rather than callus. “2

Patients may also refer to PIH as a weakness, which is another emotional term, according to Callender. “They can put on a lot of makeup to camouflage and cover up,” she says. “PIH can be difficult to disguise. PIH makes them cosmetically unsatisfactory, and they are most likely emotionally worried about it. “

A study of acne in adult women revealed that while the main complaint of Caucasian patients was often acne, non-Caucasian patients preferred PIH.3 “Early intervention and aggressive treatment of acne are important in patients with SOC to treat as well as prevent acne-related PIH,” says Callender. “Start using topical retinoids and antibiotics—everything you can do—to control acne and prevent further PIH.”

Her presentation also included recent data showing that antibiotic resistance patterns may vary across racial and ethnic groups. Two studies found that Black patients received less oral acne treatment than Caucasian patients.4.5 “These findings suggest that antibiotic resistance may be lower in patients with SOC because they are prescribed antibiotics less often,” she explains.

Treatment preferences also varied between racial groups. In one study, East and South Asian patients were less likely to see their health care provider about acne than Caucasian patients. Additionally, Asian and Black patients prefer OTC acne cleansers over prescription treatments.4

Likewise, media choices are of greater importance for SOC patients. With aggressive acne treatments, tolerability is a concern. “Dose is always important — starting low, then going high, maybe every other day,” says Callender. Topical retinoids in lotion formulations are very well tolerated by SOC patients, she adds, and maintenance regimens can help prevent PIH.

“Essentially, I let the patient know we are clearing acne and PIH at the same time,” says Callender. “Acne is the cause, so we have to be aggressive about it, but PIH improves over time. It doesn’t happen overnight.” For stubborn PIH, she prescribes topical hydroquinone at the patient’s second or third visit.

For general skin care, Callender recommends gentle, non-abrasive cleansers; non-comedogenic moisturizer; and sunscreen. Although acne is becoming less common, she adds, some patients ask to discuss hair care. The hair-irritating oils used to manage frizz, she explains, can drip onto the forehead, causing breakouts along the hairline.

“You have to discuss everything, not just prescription drugs,” she said. “You really have to know what your patients are using on their skin and hair.”


  1. Callender VD. Treatment of acne on the skin of patients of color. Fall Clinical Dermatology Conference; October 21-24; Las Vegas.
  2. Davis EC, Callender VD. Ethnic skin acne assessment: pathogenesis, clinical manifestations and management strategies. J Clin Aesthet Dermatol. 2010; 3 (4): 24-38.
  3. Callender VD, Alexis AF, Daniels SR, et al. Racial differences in the clinical, cognitive and behavioral characteristics, and psychosocial impact of acne in adult women. J Clin Aesthet Dermatol. 2014; 7 (7): 19-31.
  4. Mehta M, Kundu RV. Racial differences in acne treatment preferences: a cross-sectional study. J Drug Dermatol. 2020;19(12):802. doi:10.36849/JDD.2020.5488
  5. Barbieri JS, Shin DB, Wang S, et al. Association of race/ethnicity and sex with differences in health care use and acne treatment. JAMA Dermatol. Year 2020; 156 (3): 312-319. doi: 10.1001 / jamadermatol.2019.4818


Callender has served as a clinical researcher, advisory board member, consultant and/or speaker for Acne Store, Aerolase, AbbVie/Allergan, Beiersdorf, Eli Lilly, Galderma, Incyte, L’Oreal, Ortho Dermatologics, Pfizer, Revance, Skinbetter Science, UCB, SkinCeuticals, UCB and VYNE Therapeutics.


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