SKIN CONDITIONS
OF BLACK PEOPLE
Do skin conditions differ in Black people?
While most skin
diseases have the same clinical appearance in Black, White, and Oriental
populations, there are some exceptions. For example, lesions caused by
dermatoses such as psoriasis and pityriasis rosea appear gray or purplish in
Black skin 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 Black Americans 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?
Black skin tends
to become 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.
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