Skin Care Tips for Men With Brown Skin

Hair - Pseudofolliculitis Barbae (PFB)
With the growing popularity and acceptance of longer, natural hairstyles in the workplace, such as dreadlocks and twists as well as facial hair and beards, some men now have more options for hair care than in times past.  However, this trend has been slow to reach more conservative companies and organizations, so most of our brothers with brown skin still sport close-cut hairstyles or shaved heads and chins to work each day.  Although the upkeep for these “clean” cuts is easier in many ways, it is not without its drawbacks.

One of the most common drawbacks of frequently cutting the hair on one’s head and face closely, is pseudofolliculitis barbae (PFB), or ingrown hairs, which subsequently form dark marks and bumps—more commonly referred to among men with brown skin as “razor bumps”. These bumps may be small or large and commonly occur on the cheeks, chin, jawline, neck, submental (the area under the chin) areas and the scalp. This condition is quite common among men with brown skin, particularly those who are African American and Latino American, with tightly curled hair. The cause of pseudofolliculitis barbae is the hair emerging from the curved follicle, which grows almost parallel to the skin surface (instead of away from the skin), and then curves inward again. The inward-curving hair punctures the skin, causing an inflammatory reaction, irritation, pain and unsightly bumps.

Pseudofolliculitis Barbae (PFB) Resulting from Shaving
PFB can also result from shaving one’s beard and scalp, for all of the reasons mentioned above.  The whole purpose for shaving is to cut close enough to obtain the desired (and in most professional settings, the required) look. But, if you cut too closely, which often happens with a double or triple edge blade, the cut hair with its pointy tip can retract below the surface of the skin, and pierce the hair follicle leading to further irritation and PFB. To avoid persistent bumps, some men of color simply choose to grow beards and never shave. Fortunately for those men who do not have this option, there are some shaving precautions that may minimize the development of bumps and irritation associated with PFB:

  • Shave daily with a sharp, single-blade razor.  Dispose of razors every 2-3 days, as dull razors are more likely to cause irritation.
  • Use shaving cream very liberally.  The cream softens the hair, making it easier to cut and less likely to curve and pierce the skin to grow inward.
  • Consider using a clipper instead of a razor.  Although clippers do not give a close shave, they keep the hair long as a grain of rice, which is too long to curve and grow inward.

Treatments
As mentioned, there is no cure for pseudofolliculitis barbae.  However, there are several safe and effective treatments that your dermatologist can prescribe to treat the bumps and inflammation associated with PFB. These include:

Prescription Creams

Topical antibiotics

  • Erythromycin or clindamycin
  • Clindamycin/benzoyl peroxide combination (Duac, Benzaclin) - A study of male subjects treated with a clindamycin/benzoyl peroxide combination cream revealed, for black patients, a mean percentage reductions in bumps ranging from 38.2% at week 2 to 63.9% at week 10.

Retinoids

  • Adapalene (Differin) - Adapalene gel 0.1% applied at bedtime decreased bumps and dark marks resulting from the bumps
  • Tretinoin (Retin-A) - In blacks, tretinoin 0.025% cream combined with hydrocortisone 2.5% cream twice daily for 8 weeks reduced bumps and dark marks
  • Tazarotene (Tazorac) - Fifty African American or Hispanic patients who applied tazarotene 0.05% or 0.1% gel once daily for 90 days had a significant decrease in overall PFB severity after 60 days.

Hydroquinones

  • Combination Fluocinolone acetonide 0.01%/ Hydroquinone 4%/Tretinoin 0.05 creams (TriLuma) – Ten African-American subjects who applied TriLuma nightly for 90 days had overall PFB improvement of 34.5% over baseline as well as improvement in the dark marks.

Hair Removal Methods

Eflornithine HCl Cream, 13.9% (Vaniqa) - A cream that when applied to the skin slows hair growth by blocking a hormone that causes hair to grow. Studies demonstrate that about 58 percent of women who use it are less bothered by the facial hair on the lip and under the chin. Vaniqu has not been studied in men but your dermatologist may recommend it alone or in combination with laser hair removal. Generally well tolerated, Vaniqa can cause irritation and bumps in some people.

Electrolysis

This method involves the use of an electric current to destroy hair follicles. A needle is inserted into the hair follicle and a current destroys the hair and follicle. It takes time—often repeat visits over months or years—and is more expensive than many methods. In men with curved follicles, it may be technically difficult to insert the needle into this type of follicle. Electrolysis has the advantage of giving long-term results, but it may cause redness and scarring of the skin particularly in men of color.

Laser Hair Removal

Laser hair removal targets the hair follicle with a beam of light which heats and destroys the hair in the follicle. Since a large area can be treated, it requires far fewer visits than electrolysis. Results are long-term, although it is possible for some hair to re-grow. However, this method can remove pigment from skin of color or cause dark areas on the skin. It is also critically important that the hair removal laser be performed by a dermatologist knowledgeable about brown skin. The long pulse Diode and Alexandrite Lasers are preferable for skin of color because they have a less harmful effect on the skin.

Acne Keloidalis Nuchae (AKN)
Persistent (and potentially embarrassing) bumps that are most often located on the back of the neck are called AKN.  There are several reasons why they occur but the most likely is that, like PFB, the growing hair curves inward and punctures the skin. Also, it is the back of the neck where men shave more often and most closely.  When hair is “faded” the desired look is for the hair on the back of the neck to be cut the closest, to be faded into the rest of the skin.  The trauma of the close shave may contribute to AKN. In addition, when brothers give themselves a shape-up, they often accidentally cut the area on the back of the neck. These nicks and cuts in the skin most likely contribute to AKN.

Like PFB, t here is no cure for AKN. To avoid the condition, some men choose not to cut their hair so close to the scalp and instead where dreadlocks, twists, or higher “fros”.  Other men choose to keep their heads completely shaved (which may lead to PFB).    Unfortunately, not every man has the luxury of choosing these more natural hairstyles.  For those who still must wear close haircuts, the following precautions should always be taken:

  • Avoid close cuts.  You can obtain a neat look without cutting so close to the skin that the hair follicle is irritated.   Allow hair to remain at least as long as a grain of rice so that it will not grow inward.  This will avoid the ingrown hairs which lead to razor bumps.

Treatment.  Treatment of AKN is similar to treatment for PFB. Topical antibiotics and  retinoids are utilized. Additionally, if firm papules or keloids are present, cortisone injections are often used.

Notes:

For scientific information on Pseudofolliculitis barbae, refer to Dr. Taylor’s papers:
Pseudofolliculitis Barbae in Skin of Color. J Am Acad DermatoI46(S2): 113-119,2002 (Perry P, Cook-Bolden F, Taylor SC, Rahman Z, Jones E).

Twice-daily applications of benzoyl peroxide 5%/clindamycin 1% gel versus vehicle in the treatment of pseudofolliculitis barbae. Cutis 73(S6): 18-24, 2004 (Cook-Bolden FE, Barba A, Halder R, Taylor S).

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