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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. Skin Problems in Men of Color. Learning Objective.

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Skin Problems in Men of Color

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  1. 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 Skin Problems in Men of Color

  2. Learning Objective 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.

  3. Pseudofolliculitis Barbae • 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.

  4. What Is Actually Going on?

  5. The Skin

  6. The Epidermis The Epidermis consist of four basic cell parts Keratinocyte Melanocytes Langerbans Granstein

  7. What Do These Cells Do ? 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.

  8. 5 Layers of the Epidermis The Epidermis consist of 5 layers: Stranum corneum Stranum spinosum Stranum lucidium Stranum garnulosum Stranum basale

  9. What’s the Function of each layer? 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.

  10. What’s the Function of each layer? Cont’ 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.

  11. What’s the Function of each layer? Cont’ 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.

  12. Etiology and Pathogenesis A Key Factor in the etiology of PFB if the unique structure of the hair follicle in people of color.

  13. 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

  14. Folliculitis Cont’ • 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.

  15. Hair Follicle

  16. Nestin-GFP expression in hair follicle stem cells during hair cycle

  17. More Hair Follicle

  18. Acne Keloidalis Nuchae 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.

  19. Acne Keloidalis Nuchae Examples

  20. 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.

  21. How the Data will be Recorded

  22. 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]. • Brown LA Jr: Pathogenesis and treatment of pseudofolliculitis barbae. Cutis 1983 Oct; 32(4): 373-5[Medline]. • Childs ND: Tretinoin, hydrocortisone cream controls PFB. Skin and Allergy News 1999; 30(5): 20. • Coquilla BH, Lewis CW: Management of pseudofolliculitis barbae. Mil Med 1995 May; 160(5): 263-9[Medline]. • Crutchfield CE 3rd: The causes and treatment of pseudofolliculitis barbae. Cutis 1998 Jun; 61(6): 351-6[Medline]. • Galaznik JG: A Pseudofolliculitis Barbae clinic for the black male who has to shave. J Am Coll Health 1984 Dec; 33(3): 126-7[Medline]. • Garcia-Zuazaga J: Pseudofolliculitis barbae: review and update on new treatment modalities. Mil Med 2003 Jul; 168(7): 561-4[Medline]. • Halder RM: Pseudofolliculitis barbae and related disorders. Dermatol Clin 1988 Jul; 6(3): 407-12[Medline]. • Kauvar AN: Treatment of pseudofolliculitis with a pulsed infrared laser. Arch Dermatol 2000 Nov; 136(11): 1343-6[Medline]. • Kligman AM, Mills OH Jr: Pseudofolliculitis of the beard and topically applied tretinoin. Arch Dermatol 1973 Apr; 107(4): 551-2[Medline]. • Leyden JJ: Topical treatment for the inflamed lesion in acne, rosacea, and pseudofolliculitis barbae. Cutis 2004 Jun; 73(6 Suppl): 4-5[Medline]. • Nidecke A: Saving face: help black men avoid pseudofollicultis barbae. Skin and Allergy News 1998; 29 (10): 46. • 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].

  23. Acknowledgments 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

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