Skin Problems in Men
of Color
By: Carlton Moses Jr.
Mentor: Dr. Andrew F. Alexis
St. Luke’s Roosevelt Hospital Center
University Hospital of Columbia University College of
Physicians and Surgeons
Learning Objective
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Describe the common clinical presentation of
Pseudofolliclitis Barbae (PFB) and Acne
Keloidalis Nuchae (AKN) in men of color.
Describe the differential diagnosis for PFB and
AKN.
Explain the Medical and Surgical management
for patients with PFB and AKN.
Pseudofolliculitis Barbae
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PFB is a Chronic Inflammatory disorder of the hair-bearing
skin.
PFB occurs as a consequence of hair removal when tightly coiled
hair shafts, after being shaved or plucked, reenter the epidermis
or penetrate the hair follicle wall causing inflammation.
What Is Actually Going on?
The Skin
The Epidermis
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The Epidermis consist of four basic cell parts
Keratinocyte
 Melanocytes
 Langerbans
 Granstein
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What Do These Cells Do ?
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Keratinocyte - helps to waterproof, defend and
immunise.
Melanocytes - are located at the base of the skin, and
protects the melanin pigments, which are responsible
for the absorption of Ultraviolet light.
Langerhans and Granstein - arise from the bone
marrow, and help the immune responses of the skin,
and usually act as markers of antigens, which are
attacked by the T-Lymphocyte immunity cells.
5 Layers of the Epidermis
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The Epidermis consist of 5 layers:
Stranum corneum
 Stranum spinosum
 Stranum lucidium
 Stranum garnulosum
 Stranum basale
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What’s the Function of each layer?
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Stranum corneum: The top layer consists of 25 layers
of dead cells, filled with tough keratin the substance
that makes nails, and used in protective chainsaw suits.
These are continuously being shed and replaced. It
serves as an effective barrier against light, heat, bacteria
and chemicals. In the manufacture of these cells, a
process called keratinisation, new cells are pushed up
from the basal layers. The period between forming and
shedding takes about two weeks.
What’s the Function of each layer?
Cont’
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Stranum spinosum: This layer contains many
sided cells that fit together.
Stranum lucidium: This layer is found only in
thick skin, such as the palm and soles.
They contain clear dead cells called eleidin,
which is eventually transformed into keratin.
What’s the Function of each layer?
Cont’
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Stranum garnulosum: The second layer consists of 4
rows of flattened cells that contain forms of stained
keratin. This provides a waterproofing protein. They
are in a vigorous state of degradation.
Stranum basale: This single layer pushes up towards
the surface. The nuclei disintegrate and
become the next layer. Other cells may arise and forms
hair follicles or glands.
Etiology and Pathogenesis
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A Key Factor in the etiology of PFB if the
unique structure of the hair follicle in people of
color.
Folliculitis

What is folliculitis?
Folliculitis is an infection of the hair follicles.
Each hair on your body grows out of a tiny
pouch called a follicle. You can have folliculitis
on any part of your body that has hair. But it is
most common on the face, scalp, and areas
rubbed by clothing, such as the thighs and groin
Folliculitis Cont’
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What causes folliculitis?
It is usually caused by bacteria, especially the type called
staph (Staphylococcus). It can also be caused by yeast and
another type of fungus. Folliculitis caused by a fungus
is most often seen in people who have trouble fighting
infections because they have an impaired immune
system.
Often folliculitis develops because you have damaged
your hair follicles. Shaving or wearing clothes that rub
the skin can irritate the follicles. They can also become
blocked or irritated by substances like sweat, machine
oils, or makeup. Once the follicles are injured, they are
more likely to become infected.
Hair Follicle
Nestin-GFP expression in hair
follicle stem cells during hair cycle
More Hair Follicle
Acne Keloidalis Nuchae
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Acne keloidalis nuchae (AKN) occurs when
hairs on the back of the head and neck grow
into the skin, become inflamed, and cause scar
tissue
AKN is more common in people with stiff or
curly hair and those with darker skin.
Acne Keloidalis Nuchae Examples
Future Research

For Future Research Dr. Alexis and I will try to
find out which are the common skin diseases
among not only African Americans, but of
people of all ethnic backgrounds and skin colors.
We will do this by looking in to records of the
patients and formulating a table including the
person's name , gender, diagnosis, doctor who
attended them, and weather their follow-up
patients or new.
How the Data will be Recorded
Race
Gender
Diagnosis
New
Follow up
Doctor
Date of
Visit
References

Alexander AM: Evaluation of a foil-guarded shaver in the management of pseudofolliculitis barbae. Cutis 1981 May; 27(5): 534-7,
540-2[Medline].

Alexander AM, Delph WI: Pseudofolliculitis barbae in the military. A medical, administrative and social problem. J Natl Med
Assoc 1974 Nov; 66(6): 459-64, 479[Medline].

Brauner GJ, Flandermeyer KL: Pseudofolliculitis barbae. Medical consequences of interracial friction in the US Army. Cutis 1979
Jan; 23(1): 61-6[Medline].

Bridgeman-Shah S: The medical and surgical therapy of pseudofolliculitis barbae. Dermatol Ther 2004; 17(2): 158-63[Medline].
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Brown LA Jr: Pathogenesis and treatment of pseudofolliculitis barbae. Cutis 1983 Oct; 32(4): 373-5[Medline].
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Childs ND: Tretinoin, hydrocortisone cream controls PFB. Skin and Allergy News 1999; 30(5): 20.
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Coquilla BH, Lewis CW: Management of pseudofolliculitis barbae. Mil Med 1995 May; 160(5): 263-9[Medline].
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Crutchfield CE 3rd: The causes and treatment of pseudofolliculitis barbae. Cutis 1998 Jun; 61(6): 351-6[Medline].
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Galaznik JG: A Pseudofolliculitis Barbae clinic for the black male who has to shave. J Am Coll Health 1984 Dec; 33(3): 1267[Medline].
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Garcia-Zuazaga J: Pseudofolliculitis barbae: review and update on new treatment modalities. Mil Med 2003 Jul; 168(7): 5614[Medline].
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Halder RM: Pseudofolliculitis barbae and related disorders. Dermatol Clin 1988 Jul; 6(3): 407-12[Medline].
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Kauvar AN: Treatment of pseudofolliculitis with a pulsed infrared laser. Arch Dermatol 2000 Nov; 136(11): 1343-6[Medline].
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Kligman AM, Mills OH Jr: Pseudofolliculitis of the beard and topically applied tretinoin. Arch Dermatol 1973 Apr; 107(4): 5512[Medline].
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Leyden JJ: Topical treatment for the inflamed lesion in acne, rosacea, and pseudofolliculitis barbae. Cutis 2004 Jun; 73(6 Suppl): 45[Medline].

Nidecke A: Saving face: help black men avoid pseudofollicultis barbae. Skin and Allergy News 1998; 29 (10): 46.
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Olsen EA: Methods of hair removal. J Am Acad Dermatol 1999 Feb; 40(2 Pt 1): 143-55; quiz 156-7[Medline].

Scheinfeld NS: Pseudofolliculitis barbae. Skinmed 2004 May-Jun; 3(3): 165-6[Medline].
Acknowledgments
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Dr. Sat Bhattacharya
Dr. Andrew Alexis
Ms. Jasmyne Jones
Mrs. Cathleen Donovan; Med. Ed. Coordinator
Mrs. Linda Cooper
Mr. Keifer
Grover Cleveland High School
MSKCC
Harlem Children Society
St. Luke’s Roosevelt High School