Acne & Skin of Color

An Interview With Dermatologist Sejal Shah

Sejal Shah, MD. Photo: Courtesy of Sejal Shah, MD

Sejal K. Shah, M.D. is a board certified dermatologist in Manhattan, NY with a special focus on addressing the unique skin concerns of African American, Asian, Latin and Indian individuals. She is also the Director of Skin of Color at Clear Clinic. In this interview with About.com Multicultural Beauty, Dr. Shah discusses how to take care of acne-prone skin of color.

Multicultural Beauty: I’ve read conflicting information about salicylic acid and whether it is safe to use on black skin and other skin of color. Is this ingredient safe for skin of color and do you recommend salicylic acid for those with acne-prone skin?

Sejal Shah: Salicylic acid is safe to use on skin of color. I do recommend salicylic acid products or in-office salicylic acid peels for some of my patients with acne-prone skin, including skin of color patients.

One concern in skin of color patients when using any potentially irritating skin product, such as salicylic acid, is the development of skin darkening (post-inflammatory hyperpigmentation) due to the irritation. In order to minimize this risk, I either have the patient test the product on the inner arm before applying it to the face, use the product one to three times a week and increase the use as tolerated, or try short-contact application (wash the product off after leaving it on for a short time and gradually increase the time it is left on as tolerated).

MC: What other ingredients would be safe and beneficial to use?

SS: Benzoyl peroxide, topical antibiotics (e.g. clindamycin) and topical retinoids are all safe and effective acne treatments, which are commonly used as part of an acne treatment regimen.

MC: What should you do at the first sign of a breakout?

SS: For my patients, I recommend that they come into the office for a steroid injection when they first start to see an acne bump forming. If you are not in care of a dermatologist, then I would suggest an over-the-counter spot treatment containing benzoyl peroxide, salicylic acid, or sulfur.

An at-home blue light device may also be helpful.

MC: What should be used on acne scars and dark spots (on skin of color)?

SS: Unfortunately post-acne sequelae, dark spots and acne scars, commonly occur in skin of color. Thankfully, there are treatments available.

Dark spots generally require a multimodal approach. The first step is to start a topical lightening agent. Currently, hydroquinone is considered the gold standard for lightening, but other ingredients such as retinoids, azeleic acid, kojic acid, glycolic acid, and vitamin C, have lightening properties.

The second step is a series of superficial chemical peels that can specifically target pigment. It is also important to use a daily sunscreen with an SPF of at least 30. For depressed or pitted acne scars, laser treatments are more appropriate. In skin of color, the safest and most effective option is a non-ablative resurfacing laser, such as the Fraxel Re:store. Usually a series of at least four treatments is required.

MC: Which products are the best to use?

SS: If you are on a prescription acne treatment plan then it is best to stick with simple, gentle skin care—gentle cleansers and light, non-comedogenic moisturizers and makeup.

If you are not on any prescription products, then you may want to add an over-the-counter acne cleanser containing benzoyl peroxide or salicylic acid, or acne cream containing retinol, salicylic acid, benzoyl peroxide, alpha hydroxy acids or sulfur, to your regimen. In general, it is always best to consult with a dermatologist for a skin care plan.

MC: Which products should be avoided?

SS: Any products that can lead to more acne breakouts should be avoided. This includes harsh scrubs or cleansers, thick moisturizers (I often see this in my skin of color patients who like to use shea butter or petroleum jelly as a facial moisturizer), and heavy makeup. Another thing that is important to avoid are oil- or petroleum-based hair care products. Your hair comes into contact with the skin on your face and these products can clog your pores, resulting in acne.

MC: What should acne-prone women do to keep acne outbreaks at bay?

SS: The most important thing that acne-prone women can do is to establish a skin care routine and stick with it. It is so important to gently cleanse the face especially at night; women often either forget or get lazy to wash their faces at the end of the day and end up sleeping with their makeup on, which can trigger their acne.

Two other things that are often overlooked are cleaning makeup applicators and brushes and throwing out cosmetic products when they are expired. Oil-based, heavy, occlusive moisturizers, makeup and hair care products should be avoided. Instead choose light, oil-free, non-comedogenic products. Lastly, try an acne treatment regimen for maintenance. I find that a lot of acne-prone women do well on regular maintenance treatments rather than spot treatments.

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MC: Are any natural homemade recipes effective?

SS: Tea tree oil as a spot treatment or facial cleanser can be helpful for acne-prone skin. Oatmeal masks are helpful to reduce inflammation and redness. A raw oatmeal mask provides more exfoliation than a cooked oatmeal mask. A yogurt and yeast mask may be helpful for more oily acne-prone skin. Turmeric masks, which are traditionally used in India, are also helpful to reduce acne.