The articles by Taylor and Dunwell et al. both give evidence of a high prevalence of acne in the Caribbean. They give less information about the severity of acne and acne scars. Both represent a formidable cosmetic problem in light skin, e. g. Fitzpatrick III or less. The classic treatment options for acne scars are outlined in most dermatology or plastic surgery texts – chemical peeling, laser resurfacing and dermabrasion.
In dark skin types especially Fitzpatrick V and VI effective laser resurfacing with a “hot” (CO2) laser is not really an option due to the considerable risk of permanent pigment changes and the increased risk of unfavorable scarring. Medium depth chemical peels are however moderately useful for acne scars and can be used in darker skin types. Dermabrasion may be the most applicable option. An innovative method, called sandabrasion, uses medical grade sanding paper to manually plane the the skin surface, instead of a mechanical diamond brush dermabrader. Some more innovative methods are listed on the Trinidad Institute of Plastic Surgery website, which has accumulated considerable experience with the problem of acne scars on dark skin.
Even more than in light skin types prevention of acne scars is of paramount importance in dark skin in the Caribbean. Prevention of acne scars, which are more often than not only incompletely treatable, is thus of paramount importance. Prevention of acne scars means aggressive medical treatment by a qualified practitioner like a board certified dermatologist or plastic surgeon. Both are far and in between in the Caribbean. Thus unfortunately acne is often treated by unqualified personnel not cognizant of the disease and its potential lifelong consequences.
The principles of medical treatment to prevent acne scars are lifestyle modifications, hormonal balancing and topical and systemic anti acne medications. Significant commitment to treatment is necessary as well as of financial resources over several years. These commitment are however a small price to pay to avoid lifelong disfigurement in the face and considerably more expensive treatments later for acne scars.