"Dermatologic Conditions in Skin of Color: Part II. Disorders Occurring Predominantly in Skin of Color" (My Synopsis)

Dermatologic Conditions in Skin of Color: Part II. Disorders Occurring Predominantly in Skin of Color
ROOPAL V. KUNDU, MD, and STAVONNIE PATTERSON, MD, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Am Fam Physician. 2013 Jun 15;87(12):859-865.

    This article focuses on 5 issues; dermatosis papulosa nigra, pseudofolliculitis barbae, acne keloidalis nuchae, keloids, and general hair disorders. 
     Dermatosis papulosa nigra looks like multiple, small (1-5mm) dark-brown papules on the head and neck (think Morgan Freeman). It is benign. Treatment is not needed unless the patient wants them removed for cosmetic reasons. 
     Pseudofolliculitis barbae are the razor bumps that occurs when the hair curls back on itself and penetrates the skin. The best way to treat this is to either stop shaving, destroy the follicles, or permanently remove the hair. Proper shaving techniques includes shaving in the direction of the hair growth, using clippers or single blade razors, not making the skin taut during shaving, and avoiding plucking. Leaving it "scruffy" will also work. Properly preparing the skin (brushing the hair, applying warm compresses, gently massaging the area) can also reduce the inflammation. Applying topical steroids, benzoyl peroxide, retinoids, and topical antibiotics may also help.
     Acne keloidalis nuchae is a chronic inflammation of the follicles on the back of the head. It looks similar to a keloid and is associated with hair loss. The etiology is not known. Treatment consists of topical and intralesional steroids, antibiotics, retinoids, as well as imiquimod, laser therapy, and surgery. 
     Keloids are benign growths of hypertrophic scar tissue over areas of previous trauma, such as  acnes, piercings, tattoos, surgery, or infections (think of that big branded Omega sign on the shoulders of many professional athletes). Prevention is the best intervention (like not getting tattooed, pierced, or "branded")  Avoiding excessive movement of a lesion or incision and keeping it clean may also help. Medications include intralesional steroids, fluorouracil, bleomycin, excision, radiation and cryotherapy. Steroid injections are the first line treatment and can be used every 1-2 months. 
     Hair of dark skinned ethnicities is more curly and brittle. These people wash their hair less to avoid breakage. It should be washed at least every 1-2 weeks to get rid of the buildup of hair products. Conditioning can soften the hair and reduce fragility. Hair grease and emollients can help, but it can increase the incidence of acne, irritation, and seborrheic dermatitis. Chemically straightening this hair more than once every two months can cause it to break. Using heat to straighten it can cause damage. Heat should not be used more than once every 1-2 weeks. Traction alopecia occurs when tight braids and weaves pull out the hair that it is anchored to. It is more prominent in the frontal and temporal area. Centrifugal cicatricial alopecia is hair loss at the crown of the head. Etiology is unknown. It is a scarring alopecia thought to be from excessive relaxers, traction and heat.