Today we want to try to answer the question whether different racial groups are affected differently by acne.

 

Before we get started though, I feel that it is necessary to address the terminology.
I will use the term race or racial group here and not ethnicity mostly in accordance with the US Census Bureau (1) and the US National Institutes of Health (2). The reason is that, although these terms - race and ethnicity - have a large overlap, it seems to be the prevailing opinion in the English scientific literature that ethnicity rather groups people by shared culture and history whereas race groups people by distinct physical properties which is the aspect that we first want to focus on when it comes to different effects of acne. However, there is no commonly agreed upon definition of race and ethnicity as well as the clear distinction between the two (3). And most commonly used definitions have some shortcomings. The reason for that is that especially the term race is heavily charged historically and requires delicate dealing to avoid further formation of prejudices and social conflicts and secondly because it is simply very difficult and complex -biologically and genetically- to group humans into any such categories.
The reason for that is, as the Stanford Institute of Gendered Innovation writes, “Genetic differences within any designated racial group are often greater than differences between racial groups. Most genetic markers do not differ sufficiently by race to be useful in medical research” (4).

 

That means that, if you took, for example, one black and one white person and analyzed their genes, they might be more similar genetically to one another than they are to a random other person of their own racial groups.

 

However, there are of course shared physical attributes within a racial group that might affect the risk for certain diseases. An easy example would be that whites are more at risk for sunburn than blacks because of their lighter skin due to the smaller amount of melanin pigments. So, the dark skin of black people is a protective factor against sunburn whereas the light skin of white people is a risk factor.
In the same way some shared physical attributes might facilitate acne or protect against it.

 

Alright, enough of genetics and terminology, let’s get into today’s topic.
So, how do we best analyze whether different racial groups are affected differently by acne?

 

We could for example look at the rate of acne in different countries. We could use the very comprehensive dataset from the Global Burden of Disease Study and there we find that countries with predominantly white populations such as the United States, Australia or Germany tend to have much higher rates of acne than most countries with predominantly black or Asian populations such as Angola, Kenya, China or India. (5) So that means that Whites get acne more easily than Blacks and Asians, right? No, it’s not that easy.

 

These countries might differ in many aspects that possibly affect acne such as health care system, diet, air pollution, stress levels, climate etc. Also, acne might be harder to detect in Blacks than it is in Whites or Asians. (6) Therefore we don’t know whether the differences in acne are due to biological differences between racial groups or due to these other factors which in science are called confounding factors.

 

Ideally we want to study people of different racial groups that live at the same place and have the same lifestyle. And that’s what researchers from the Massachusetts General Hospital did, for the most part at least. They analyzed people of different races that lived in the same cities. One limitation though, they only looked at women.
They found that Blacks and Hispanics had significantly more acne then far east Asians, Whites and continental Indians. This observation was consistent especially for Blacks over all analyzed age ranges.
The researchers write that this "[…] may suggest biological differences in acne predisposition among different races. African American women in our study were found to have larger and more visible pores than the other groups, supporting previous studies that showed that black subjects had greater gland pore size and sebaceous glands.” (7)

 

The thinking then goes that larger sebaceous glands might lead to increased sebum production which facilitates clogging of the skin pores which then leads to acne.
But isn’t it strange that blacks are supposed to be most prone to acne but those countries primarily inhabited by blacks show much lower acne rates than those primarily inhabited by whites? (5) (7)

 

So, there must definitely be other factors at play here. In the next article we will explore what really lies behind these differences.

 

If you have any questions regarding acne or wishes for future videos and articles, please post them in the comments below. I will answer every question to the best of my abilities.
Also, if you want to learn more about how to treat acne most effectively or would like to support my work, you can check out my book or get a personal counselling session. In the book I explain how to best fight acne focusing on diet - including recipes and shopping lists - but also explaining supplements, skincare and medications. All information is strictly science based but easy to understand.

 

Thank you so much for reading. Stay positive and remember you're not alone with this. See you next time.

 

 

 

 

 

 

References

 

1. U.S. Department of Commerce, Economics and Statistics Administration, U.S. Census Bureau. Race & Ethnicity. [Online] January 2017. [Cited: April 8, 2020.] https://www.census.gov/mso/www/training/pdf/race-ethnicity-onepager.pdf.

 

2. Health, National Institutes of. Racial and Ethnic Categories and Definitions for NIH Diversity Programs and for Other Reporting Purposes. [Online] National Institutes of Health, April 8, 2015. [Cited: April 8, 2020.] https://grants.nih.gov/grants/guide/notice-files/NOT-OD-15-089.html.

 

3. Jeannine Mjoseth, B.A. NIH leaders call for a consensus on use of race and ethnicity data in biomedical research. [Online] National Human Genome Research Institute, September 25, 2018. [Cited: April 8, 2020.] https://www.genome.gov/news/news-release/NIH-leaders-call-for-a-consensus-on-the-use-of-race-and-ethnicity-data-in-biomedical-research.

 

4. Schiebinger, L., Klinge, I., Sánchez de Madariaga, I., Paik, H. Y., Schraudner, M., and Stefanick, M. Race & Ethnicity. [Online] Gendered Innovations in Science, Health & Medicine, Engineering and Environment, 2011-2018. [Cited: April 9, 2020.] https://genderedinnovations.stanford.edu/terms/race.html.

 

5. GBD Compare . [Online] Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, WA, 2015. [Cited: April 9, 2020.] https://vizhub.healthdata.org/gbd-compare/.

 

6. Gary M. White, MD. Recent findings in the epidemiologic evidence, classification, and subtypes of acne vulgaris. Journal of the American Academy of Dermatology. 2, 1998, Vol. 39, 3, pp. 34-37.

 

7. A.C. Perkins, C.E. Cheng, G.G. Hillebrand, K. Miyamoto, A.B. Kimball. Comparison of the epidemiology of acne vulgaris among Caucasian, Asian, Continental Indian and African American women. Journal of the European Academy of Dermatology and Venereology. 2011, Vol. 25, 9, pp. 1054–1060.