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Acne vulgaris in richly pigmented patients

Dr. Quarles: Exclusive of the scarring, I don’t think there is much inter-ethnic difference in the clinical presentation of acne. Richly pigmented patients with even a few cysts frequently present with postinflammatory hyperpigmented macules as well as hypertrophic papular scarring predominantly on the nose and chin. In patients with concomitant sensitive skin, eczema, and/or seborrheic dermatitis, the dermatologist must be careful when choosing acne therapy taking into consideration that any irritant could increase the risk of potential of postinflammatory hyperpigmentation. Patients not infrequently “blame” therapy for these dark spots. Once the acne is controlled, the real work of correcting post inflammatory hyperpigmentation begins.