The Impact of Pomade Acne

This blog series highlights conditions that have a strong impact on people of color and appears as part of Project IMPACT: Improving Medicine’s Power to Address Care and Treatment.

How does pomade acne impact people of color?

Pomade acne, a variant of acne vulgaris, is more common among Black individuals and those with textured hair because of cultural hair styling practices that use thick oil-based hair products and emollients to prevent dryness and condition the hair. When products migrate from the scalp to the facial skin, pomade acne can result. Tightly fitted head coverings (eg, wave caps) that are often used after the application of the hair products can further lead to the development of pomade acne.

Why is it overrepresented, hard to spot, or misdiagnosed?

Acne vulgaris is one of the most common dermatological conditions in both children and adults. The use of pomade hair products often exacerbates underlying acne. When patients present with acne, clinicians may overlook hair care practices as the underlying cause.

Overview in skin of color vs lighter skin types:

Erythema may be less apparent on dark skin colors and may appear more gray or violaceous than red.

Inflammatory papules may also vary in color, ranging from brown to dark red or violaceous. Patients with darker skin colors are more likely to experience postinflammatory hyperpigmentation following breakouts, and these hyperpigmented macules often persist longer in darker compared with lighter skin colors.

Synopsis:

Pomade acne is a subtype or variant of acne vulgaris, which is caused by increased sebum production, follicular hyperkeratosis, and colonization of the pilosebaceous units by Cutibacterium acnes (formerly Proprionibacterium acnes). The use of pomades and oil-based hair products can cause obstruction of the pilosebaceous unit and subsequent inflammation resulting in pomade acne. Patients who present with this condition should be counseled on the use of alternative products like silicon-based hair serums, which are less likely to cause acne.

What to Look for:

This variant of acne vulgaris is characterized by closed comedones and papules that are closely packed and often present along the hairline, on the forehead, and on the temples. Eruptions may also be seen on the entire face if the hair products trickle down from the scalp. Postinflammatory hyperpigmentation may also be present as lesions resolve.

Differential diagnosis:

The differential for pomade acne includes many of the same diagnoses in the differential for acne vulgaris. A nonexhaustive list includes:

While discontinuation of pomade use should cause gradual resolution of pomade acne, standard acne therapy can facilitate the process. For mild comedonal acne, topical retinoids are most effective. If papules and/or pustules are present, add a topical antibiotic / benzoyl peroxide combination.

 

Sources

Alexis AF. Acne vulgaris in skin of color: understanding nuances and optimizing treatment outcomes. J Drugs Dermatol. 2014 Jun;13(6):s61-5. PMID: 24918573.

Alexis AF, Harper JC, Stein Gold LF, Tan JKL. Treating acne in patients with skin of color. Semin Cutan Med Surg. 2018 Jun;37(3S):S71-S73. PMID: 30192346.

This Project IMPACT blog series was created to highlight dermatologic conditions that disproportionately affect people of color. By improving diagnosis in skin of color we can reduce racial disparities in healthcare.

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