Research Summary:
Although acne occurs in all races and ethnicities, there are differences in presentation between each group. A recent survey found that papules were the most frequent presentation of acne in African Americans (70.7%) and Hispanics (74.5%), with Asians and other races having similar presentations. The same survey also found that postinflammatory hyperpigmentation was a frequent complaint; in fact, it is often the chief complaint for acne in patients of darker races with acne.
Wilkins and Voorhees found that the nodulocystic variant of acne occurs less frequently in African Americans than in whites. That study also found that nodulocystic acne occurred at a similar rate in Hispanics and whites.
Some studies have shown that whites have more inflammation with acne than blacks. This was thought to occur because follicles of blacks were much less likely to rupture and less likely to cause an inflammatory reaction. Follicles of blacks were more likely to keratinize and form comedones. Additionally, the follicular epithelium of the pilosebaceous unit is thicker in blacks. This is likely why blacks do not present with the clinically apparent inflammatory and cystic acne that is seen in whites.
It is important to note that although African American patients do not seem clinically to have as much inflammatory acne as whites, if one of their acne lesions undergoes biopsy, a histologically significant inflammatory process is seen. An abundance of polymorphonuclear leukocytes were found in areas of acne that seemed to be clinically mild. This marked histologic inflammation is usually not seen in other races. A study of 30 black female patients with a variety of clinical acne lesions showed marked inflammation histologically in all lesions, including comedones. This hidden inflammation may account for the high prevalence of postinflammatory pigmented maculae seen commonly with acne in darker-skinned races.
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