ABSTRACT
Acne is a frequent problem among all races and ethnicities. Darker-skinned individuals are at increased risk of post-inflammatory hyperpigmentation (PIH) and hypertrophic scarring such as keloids. Acne in pigmented skin is distinguished by the higher incidence of post-inflammatory PIH and scarring. The chapter focuses on these two major acne sequelae occurring primarily in individuals of African descent. Acne scarring and PIH can have significant psychosocial impact on patients. Scarring can lead to emotional debilitation, embarrassment, poor self-esteem, social isolation, depression, and many other effects. Hypertrophic and keloidal scarring is not as common in the general population as PIH and atrophic scarring; however, it is more frequent in skin of color and can be more permanent and disfiguring. The morbidity of acne is due to the lesions themselves, which may be painful and tender, as well as from residual scarring and PIH after the nodules and cysts resolve.
