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.

Skin Problems in Skin Problems in Men of Color Men of Color

By: Carlton Moses Jr.By: Carlton Moses Jr.Mentor: Dr. Andrew F. Alexis Mentor: Dr. Andrew F. Alexis

St. Luke’s Roosevelt Hospital CenterSt. Luke’s Roosevelt Hospital CenterUniversity Hospital of Columbia University University Hospital of Columbia University

College of Physicians and SurgeonsCollege of Physicians and Surgeons

Learning ObjectiveLearning Objective

Describe the common clinical Describe the common clinical presentation of Pseudofolliclitis presentation of Pseudofolliclitis Barbae (PFB) and Acne Keloidalis Barbae (PFB) and Acne Keloidalis Nuchae (AKN) in men of color.Nuchae (AKN) in men of color.

Describe the differential diagnosis Describe the differential diagnosis for PFB and AKN.for PFB and AKN.

Explain the Medical and Surgical Explain the Medical and Surgical management for patients with PFB management for patients with PFB and AKN.and AKN.

Pseudofolliculitis Barbae Pseudofolliculitis Barbae

PFB is a Chronic Inflammatory disorder of the PFB is a Chronic Inflammatory disorder of the hair-bearing skin.hair-bearing skin.

PFB occurs as a consequence of hair removal PFB occurs as a consequence of hair removal when tightly coiled hair shafts, after being when tightly coiled hair shafts, after being shaved or plucked, reenter the epidermis or shaved or plucked, reenter the epidermis or penetrate the hair follicle wall causing penetrate the hair follicle wall causing inflammation.inflammation.

What Is Actually Going What Is Actually Going on?on?

The Skin The Skin

The Epidermis The Epidermis

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

What Do These Cells What Do These Cells Do ?Do ?

Keratinocyte - helps to waterproof, defend Keratinocyte - helps to waterproof, defend and and immunise. immunise.

Melanocytes - are located at the base of Melanocytes - are located at the base of the skin, and protects the melanin the skin, and protects the melanin pigments, which are responsible for the pigments, which are responsible for the absorption of Ultraviolet light. absorption of Ultraviolet light.

Langerhans and Granstein - arise from the Langerhans and Granstein - arise from the bone marrow, and help the immune bone marrow, and help the immune responses of the skin, and usually act as responses of the skin, and usually act as markers of antigens, which are attacked markers of antigens, which are attacked by the T-Lymphocyte immunity cells. by the T-Lymphocyte immunity cells.

5 Layers of the Epidermis5 Layers of the Epidermis

The Epidermis consist of 5 layers:The Epidermis consist of 5 layers: Stranum corneumStranum corneum Stranum spinosum Stranum spinosum Stranum lucidium Stranum lucidium Stranum garnulosum Stranum garnulosum Stranum basale Stranum basale

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

Stranum corneumStranum corneum:  The top layer :  The top layer consists of 25 layers of dead cells, filled consists of 25 layers of dead cells, filled with tough keratin the substance that with tough keratin the substance that makes nails, and used in protective makes nails, and used in protective chainsaw suits. These are continuously chainsaw suits. These are continuously being shed and replaced. It serves as an being shed and replaced. It serves as an effective barrier against light, heat, effective barrier against light, heat, bacteria and chemicals. In the bacteria and chemicals. In the manufacture of these cells, a process manufacture of these cells, a process called keratinisation, new cells are called keratinisation, new cells are pushed up from the basal layers. The pushed up from the basal layers. The period between forming and shedding period between forming and shedding takes about two weeks.takes about two weeks.

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

Stranum spinosum:Stranum spinosum: This layer This layer contains many sided cells that fit contains many sided cells that fit together.together.

Stranum lucidium: Stranum lucidium: This layer is This layer is found only in thick skin, such as the found only in thick skin, such as the palm and soles. palm and soles. They contain clear dead cells called They contain clear dead cells called eleidin, which is eventually eleidin, which is eventually transformed into keratin. transformed into keratin.

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

Stranum garnulosum:Stranum garnulosum: The second layer The second layer consists of 4 rows of flattened cells that consists of 4 rows of flattened cells that contain forms of stained keratin. This contain forms of stained keratin. This provides a waterproofing protein. They provides a waterproofing protein. They are in a vigorous state of degradation. are in a vigorous state of degradation.

Stranum basale:Stranum basale: This single layer This single layer pushes up towards the surface. The nuclei pushes up towards the surface. The nuclei disintegrate and disintegrate and become the next layer. Other cells may become the next layer. Other cells may arise and forms hair follicles or glands.arise and forms hair follicles or glands.

Etiology and Etiology and Pathogenesis Pathogenesis

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

Folliculitis Folliculitis

What is folliculitis?What is folliculitis?Folliculitis is an infection of the Folliculitis is an infection of the hair follicles. Each hair on your body hair follicles. Each hair on your body grows out of a tiny pouch called a grows out of a tiny pouch called a follicle. You can have folliculitis on follicle. You can have folliculitis on any part of your body that has hair. any part of your body that has hair. But it is most common on the face, But it is most common on the face, scalp, and areas rubbed by clothing, scalp, and areas rubbed by clothing, such as the thighs and groinsuch as the thighs and groin

Folliculitis Cont’ Folliculitis Cont’ What causes folliculitis?What causes folliculitis?

It is usually caused by bacteria, especially the It is usually caused by bacteria, especially the type called staph (type called staph (StaphylococcusStaphylococcus). It can also ). It can also be caused by yeast and another type of be caused by yeast and another type of fungus. Folliculitis caused by a fungus is most fungus. Folliculitis caused by a fungus is most often seen in people who have trouble fighting often seen in people who have trouble fighting infections because they have an impaired infections because they have an impaired immune system.immune system.Often folliculitis develops because you have Often folliculitis develops because you have damaged your hair follicles. Shaving or damaged your hair follicles. Shaving or wearing clothes that rub the skin can irritate wearing clothes that rub the skin can irritate the follicles. They can also become blocked or the follicles. They can also become blocked or irritated by substances like sweat, machine irritated by substances like sweat, machine oils, or makeup. Once the follicles are injured, oils, or makeup. Once the follicles are injured, they are more likely to become infected. they are more likely to become infected.

Hair Follicle Hair Follicle

Nestin-GFP expression in Nestin-GFP expression in hair follicle stem cells hair follicle stem cells

during hair cycle during hair cycle

More Hair FollicleMore Hair Follicle

Acne Keloidalis Nuchae Acne Keloidalis Nuchae

Acne keloidalis nuchae (AKN) Acne keloidalis nuchae (AKN) occurs when hairs on the back of the occurs when hairs on the back of the head and neck grow into the skin, head and neck grow into the skin, become inflamed, and cause scar become inflamed, and cause scar tissue tissue

AKN is more common in people with AKN is more common in people with stiff or curly hair and those with stiff or curly hair and those with darker skin. darker skin.

Acne Keloidalis Nuchae Acne Keloidalis Nuchae ExamplesExamples

Future Research Future Research

For Future Research Dr. Alexis and I For Future Research Dr. Alexis and I will try to find out which are the will try to find out which are the common skin diseases among not common skin diseases among not only African Americans, but of people only African Americans, but of people of all ethnic backgrounds and skin of all ethnic backgrounds and skin colors. We will do this by looking in colors. We will do this by looking in to records of the patients and to records of the patients and formulating a table including the formulating a table including the person's name , gender, diagnosis, person's name , gender, diagnosis, doctor who attended them, and doctor who attended them, and weather their follow-up patients or weather their follow-up patients or new. new.

How the Data will be How the Data will be RecordedRecorded

Race Gender Diagnosis New Follow up Doctor Date of Visit

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Acknowledgments Acknowledgments Dr. Sat Bhattacharya Dr. Sat Bhattacharya Dr. Andrew Alexis Dr. Andrew Alexis Ms. Jasmyne Jones Ms. Jasmyne Jones Mrs. Cathleen Donovan; Med. Ed. Mrs. Cathleen Donovan; Med. Ed.

CoordinatorCoordinator Mrs. Linda Cooper Mrs. Linda Cooper Mr. Keifer Mr. Keifer Grover Cleveland High School Grover Cleveland High School MSKCC MSKCC Harlem Children Society Harlem Children Society St. Luke’s Roosevelt High SchoolSt. Luke’s Roosevelt High School