Randy Jacobs, M.D. Patient Education

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People of Color



Do skin conditions differ in people of color?

While most skin diseases have the same clinical appearance in Black, Brown, White, and Asian populations, there are some exceptions. For example, lesions caused by dermatoses such as psoriasis and pityriasis rosea appear gray or purplish in pepple of color but, in lighter skin, the lesions are usually silver, pink, red, or salmon-colored. Some skin conditions, such as keloids, "flash moles," and ingrown hairs due to shaving, are more common among Black Americans. Skin cancer is rare among people of color because pigment protects against damage caused by sunlight. Vitiligo and other diseases that cause loss of pigmentation and results in areas of whitish skin are obviously of greater cosmetic concern to people with darker skin.

What are keloids?

Keloids are benign growths, shiny, smooth, hard, raised areas on the skin believed to result from injury to connective tissue. They may form following an incision for surgery, after burns, or from any cutaneous trauma. People who form keloids apparently have some block that prevents collagenase, the enzyme that breaks down collagen in the body, from working properly. Although keloids can occur almost anywhere, they usually are found on the shoulders, earlobes, and mid chest area. Keloids rarely occur on the scalp, palms, or soles. Initially, they may resemble hypertrophic scars, but, unlike these scars, keloids grow beyond the boundaries of the injured area and usually do not vanish over time. Normally asymptomatic, keloids may occasionally itch, feel tender, or produce a burning sensation. Most patients who seek medical attention for keloids do so for cosmetic reasons. A number of different methods can be used to remove keloids and prevent them from reforming. The most common approach is to excise the keloid after having injected a steroid into it every 2 to 3 weeks for several visits. To prevent the keloid from forming again, the postoperative site is given at least two steroid injections at 2-week intervals. The patient may also wear an elastic garment to apply pressure to the site. Special earrings that apply pressure to the earlobe are also available.

Why is shaving sometimes a problem for Black men?

Often, Black men who shave are troubled, by ingrown hairs or "shaving bumps," a condition known formally as pseudo folliculitis barbae (PFB). The problem is due to the fact that hair follicles in Black skin are curved. The curvature of the follicle causes the distal tip of the hair to grow back into the skin. When the tip reaches the dermis, it causes an inflammatory reaction, and the skin begins to itch. This usually occurs when a man stops shaving for 3 to 5 days, the length of time required for ingrown hairs to reach the dermis. Conversely, in White and Oriental populations, the follicle is straight, allowing the hair to grow up and out of the skin. PFB is most common on the front of the neck and on the chin. The ingrown hairs may become infected. Hairs may become infected. Application of topical Tretinoin or 10% benzoyl peroxide daily or every other day may be helpful for mild to moderate cases of PFB. The only consistent preventive measure, however, is to grow a beard. Following 6 to 8 weeks of hair growth, the new part of the hair is strong enough to pull the embedded hair end out of the skin. Aveeno makes a razor called "Bumpfighter," especially for those with PFB.

Is there an effective way to treat dark spots on the skin?

Dark skin tends to become even darker after it has been inflamed or injured. For example, when an acne lesion heals, a dark spot often remains. The hyperpigmentation, or excess pigment, frequently is of greater cosmetic concern that the acne itself. Fortunately, dark spots can be successfully bleached. Several products containing 2% hydroquinone, a bleaching agent, are available without a prescription; they include Ambi, Black and White Cream, and Esoterica. Higher strength formulations of hydroquinone, from 3% to 4%, can be obtained with a prescription. One study revealed that a combination of hydroquinone, a topical steroid, and topical Tretinoin is more effective than using the bleaching agent alone. A pharmacist can compound such as mixture as well as make up a preparation of hydroquinone in strengths up to 10%. Bleaching agents must be applied twice a day for 6 to 8 weeks before significant results can be expected. If excess pigment does return, a bleaching agent can be applied occasionally to maintain results. Of course, if acne lesions are still active, the inflammation and resulting hyperpigmentation may continue.

When should a dermatologist be consulted?

Help is available for most skin diseases. It is seldom necessary for a person to tolerate a skin condition or problem. If a cure is not available, the condition can usually be controlled or improved. If all else fails, special cosmetics are available to camouflage defects, blemishes, and pigmentation problems. Dr. Jacobs can recommend an appropriate therapy and can explain the diagnosis and expected results.