Pomade Acne and Cosmetic Concerns in Skin of Color

Overview / Definition Pomade acne is a type of acne mechanica that arises from the use of greasy hair products, such as pomades, gels, and oils, which can occlude hair follicles. This condition is particularly prevalent in individuals with skin of color, where the use of these products is common for styling and maintaining hair health. Epidemiology The incidence of pomade acne is notably higher in individuals with African American and Hispanic backgrounds, largely due to cultural hair care practices. It often presents in adolescents and young adults, coinciding with increased use of styling products. Commonly affects young adults (ages 15-25). Higher prevalence in individuals using occlusive hair products. Incidence in skin of color populations due to specific hair care practices. Pathophysiology / Mechanism Pomade acne occurs when the occlusive properties of hair products block the pilosebaceous units, leading to clogged pores. The combination of trapped sebum and bacteria creates an inflammatory response, resulting in the formation of acne lesions such as papules, pustules, and sometimes cysts. Occlusion of hair follicles leads to follicular hyperkeratinization. Increased sebum production in response to inflammation. Secondary infection by Propionibacterium acnes. Clinical Presentation Patients with pomade acne typically present with: Lesions primarily on the forehead, temples, and nape of the neck. Presence of papules and pustules in areas where pomade is applied. Potential for hyperpigmentation, particularly in darker skin types. In darker skin types, post-inflammatory hyperpigmentation can occur, leading to additional cosmetic concerns for patients. Diagnosis / Workup Diagnosis is primarily clinical, based on the characteristic distribution of lesions and a history of pomade use. Important aspects of the workup may include: Detailed history of hair product use. Examination for other types of acne or dermatological conditions. Consideration of differential diagn