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Expert Q and A: People of Color Face Unique Skin Problems

An interview with Andrew F. Alexis, MD, MPH

What are razor bumps?

It’s a common follicular problem that affects a disproportionately large number of dark-skinned patients. Studies show that the condition, called pseudofolliculitis barbae, affects 45% to 83% of black men.

Hair wise, the most striking difference between fair-skinned and dark-skinned people is that the hair shaft is curved in people of African descent. After shaving, especially close shaving, the sharp tip of shaved hair grows back into the skin, causing inflammation and bumps.

Though not mentioned as much, women are affected too, often on the chin, below the chin, and back area.

A safety razor can help, as can shaving only in the direction of hair growth after applying shaving cream.

Laser treatment can help. But because they target melanin, lasers carry a higher risk of discoloration, blistering, burning, and other side effects in darker-skinned people. A recent study showed that the long-pulsed 1064 Nd:YAG laser is associated with the least complications in people of color.

Creams and gels, including topical retinoids, topical antibiotics, topical steroids, and the topical prescription medication eflornithine, may also help.

What about hair loss?

One particularly disfiguring form of hair loss that I see almost every day used to be called hot comb alopecia (hair loss), and is now called central centrifugal cicatricial alopecia (CCCA). It begins on the crown and leads to a big balding spot on the top of the head.

The cause is not really known, but one study suggests that hair practices that put tension on the hair, specifically sewn-in hair weaves and cornrow or braided hair with artificial extensions is associated with this type of hair loss.

Unfortunately, many people do not seek care until there's a lot of hair loss and once a hair follicle is scarred, it cannot produce hair any longer. But if caught early, hair loss can be treated with a variety of anti-inflammatory therapies, including injections of steroids into the affected areas of the scalp, topical steroids, and oral antibiotics. Minoxidil can help to stimulate hair growth in healthy hair follicles.

And of course, patients must style their hair differently.

There have been no clinical trials on this disorder, but I am involved in the first in which we will compare four anti-inflammatory medications for CCCA.

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