Acne on darker skin: care that avoids dark marks

Acne on brown and black skin needs the same basic treatment as acne on any skin, with two extra concerns. The first is dark spots. The American Academy of Dermatology (AAD) says that for people with skin of color, acne is often accompanied by dark spots or patches called hyperpigmentation, which can last much longer than the acne. The second is irritation, because on darker skin an irritated patch can turn into a dark mark of its own. This guide sets out how to treat acne while keeping both risks low. It covers the acne. For fading the marks that are already there, see dark marks after pimples and dark spots on darker skin.

The AAD says the term "skin of color" includes people of African, Asian, Latino, Mediterranean, Middle Eastern and Native American descent. The advice here applies to every skin type. To work out whether your skin is oily, dry or combination, see how to find your skin type.

How acne looks on darker skin

Acne can look different on brown and black skin, which can make it harder to judge. The NHS says papules, the raised bumps of acne, look pink or red on white skin and may look brown or purple on brown and black skin. It also says the redness of a skin infection can be harder to see on brown and black skin.

The spots left after a pimple heals are often darker than the pimple was. The AAD says many people see a dermatologist for the dark spots, and that it is important to treat the acne too, because getting rid of the acne removes what is causing the dark spots.

Treat early

The AAD says studies show that treating acne when it is just beginning can prevent it from getting worse. If acne becomes moderate to severe before treatment begins, it says people with skin of color have a higher risk of developing spots and patches of darker skin and keloids, a type of raised scar.

The NHS says keloid scars can form after acne, that people of south Asian, Chinese, African Caribbean or Black African origin are more likely to get them, and that early treatment for acne is recommended to reduce the risk of scarring.

What works for mild acne

The AAD lists ingredients that work well in skin of color for mild acne:

Ingredient	What the AAD says
A retinoid plus benzoyl peroxide	Two separate products that work well together in skin of color. The retinoid unclogs pores, reduces inflammation and can prevent new breakouts
Benzoyl peroxide	Removes the bacteria that cause acne. Start at 2.5%
Salicylic acid	Helps unclog pores and prevent new breakouts
Retinol	Can unclog pores and fade dark spots
Adapalene gel 0.1%	A retinoid the FDA has approved for sale without a prescription

Benzoyl peroxide. The AAD says to start with a product that contains 2.5% benzoyl peroxide, because products with more can cause dryness and flaking, which can worsen acne. If the 2.5% product irritates your skin, it suggests using it every other day. The AAD calls the worry that benzoyl peroxide causes light spots on skin a myth, and says it will bleach clothing, sheets, pillowcases and towels. Skinli's plans use benzoyl peroxide 2.5% and adapalene 0.1%, started every other night for two weeks.

Start one product at a time. Adding one product, then waiting two to three weeks before adding another, shows you which product causes a reaction if one happens. Salicylic acid vs benzoyl peroxide compares two common first choices.

Retinoids and pregnancy. The AAD says not to use retinol products if you are pregnant or breastfeeding. Retinoids during pregnancy and breastfeeding covers what the sources say.

Avoid irritation

On darker skin, irritation is more than discomfort. The AAD's page on dark spots in darker skin tones says that when a skin or hair care product irritates your skin, the product can cause dark spots. It suggests gentler products, which are often labeled "for sensitive skin" or "fragrance-free", and says that once the skin is no longer irritated, new dark spots tend to stop appearing.

The AAD's acne tips for skin of color list habits that worsen acne:

• Scrubbing and strong soaps. The AAD says these worsen acne, and that gentle skin care is what works. Use a mild cleanser labeled "won't clog pores" or "non-comedogenic", apply it with your fingertips, and pat the skin dry with a clean towel.
• Picking, popping or squeezing. The AAD says this raises your risk of a scar.
• Strong exfoliation. The AAD's exfoliation page says to avoid strong chemical or mechanical exfoliation if you have a darker skin tone or get dark spots after burns, bug bites or acne, because more aggressive exfoliation can lead to dark spots.
• At-home peels, microdermabrasion and laser devices. The AAD says even the at-home versions can cause permanent dark marks and light spots on darkly pigmented skin. See a dermatologist who treats skin of color often before any of these.

Check what else touches your face

Hair oil. The AAD says that if acne appears only on your forehead and temples, hair oil may be the cause, and that this is common enough to have its own name: pomade acne. Its suggestions are to switch to hair products that contain water or glycerin instead of oil, to put hair oil only in the middle of the scalp and on the ends of the hair, or to stop the product. The AAD's hair products page says the acne can take 4 to 6 weeks to clear after you stop the product.

Butters and oils on the skin. The AAD says products that contain oil, such as cocoa butter or shea butter, can clog pores when applied to the face, back or chest. It says there is no scientific evidence that cocoa butter can even out skin tone, but it can cause acne. Choose skin care labeled "non-comedogenic" or "won't clog pores."

Makeup. The AAD says heavy, oily makeup used to hide dark marks can cause new blemishes. It says makeup is fine if you choose mineral makeup or one labeled "non-comedogenic."

Hats. The AAD says wearing a cap or anything else on your head without washing it lets sweat, dirt and oil build up, which can make acne flare.

Moisturizer and dryness

Acne treatments dry the skin, and dry skin on darker tones shows. The AAD says flaking, discoloration and rough texture are more noticeable on darker skin, and dry skin can look whitish or grayish. A dermatologist quoted by the AAD says a moisturizer with ceramides can reduce that look. For acne-prone skin, pick a moisturizer labeled non-comedogenic. A dermatologist in the AAD's moisturizer guide warns that in people with black or brown skin, acne caused by too much moisturizer can lead to discoloration.

Sun protection

The AAD's dark spots page says sunscreen is essential for dark spots, because it can prevent new ones and help clear existing ones. It recommends a tinted sunscreen with iron oxide, which protects against visible light, a cause of dark spots, and a non-comedogenic formula if you have oily skin.

A simple routine to start with

This routine puts the AAD advice above into daily steps.

When	Step
Morning	Mild, non-comedogenic cleanser with fingertips and lukewarm water. Pat dry
Morning	Non-comedogenic moisturizer, with ceramides if your skin looks ashy or flaky
Morning	Tinted, broad-spectrum sunscreen with iron oxide, SPF 30 or higher, non-comedogenic
Night	The same mild cleanser. Remove all makeup first
Night	One acne treatment in a thin layer over the whole area that breaks out, every other night for the first two weeks
Night	Moisturizer after the treatment has dried

Keep hair oil off the forehead, wash hats and pillowcases often, and use a white towel if you use benzoyl peroxide.

How long to expect

Acne treatment takes time on every skin tone. Skinli's plans use 8 to 12 weeks for skin to change, and the AAD says to use an acne product for 6 to 8 weeks before judging it. Dark spots take longer. The AAD says a spot a few shades darker than your natural skin color usually fades within 6 to 12 months once its cause is found and stopped, and that deeper discoloration can take years. Clearing the acne comes first, because it stops new spots from forming.

When to see a dermatologist

The AAD says that with a dermatologist's help, almost every case of acne and most dark spots can be treated, and that some people need prescription medicine or a combination of treatments. See a dermatologist if:

• your acne is moderate or severe, deep or painful
• you see raised scars, or you have had keloids before
• dark spots keep appearing despite gentle care
• over-the-counter treatment has not helped after 8 to 12 weeks

The AAD suggests choosing a dermatologist who often treats people with skin of color.