Patients with ethnic skin are at an increased risk for developing postinflammatory hyperpigmentation (PIH) and keloid scarring subsequent to acne lesions. Treatment approaches for acne in darker skinned patients must balance early aggressive intervention with the selection of efficacious and nonirritating agents. Most patients with prominent or long-lasting PIH will require treatment with a topical retinoid and hydroquinone, the gold standard in the treatment of PIH. Keloids may be treated with surgical excision, but the rate of recurrence can be as high as 50%. Successful management of ethnic skin with acne can be achieved with the appropriate combination drug regimen and good patient compliance. For best results, clinicians should manage the entire grooming regimen of the skin and hair of their ethnic patients.