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Follicular and Scarring Disorders in Skin of Color: Presentation and Management

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Abstract

Skin of color, also known as ethnic skin, is described as skin of individuals of African, Asian, Hispanic, Native-American, Middle Eastern, and Pacific Island backgrounds. Differences in hair morphology, hair grooming, cultural practices, and susceptibility to keloid scarring exist within these populations and have been implicated in hair, scalp, and skin disorders. Acne keloidalis (AK), central centrifugal cicatricial alopecia (CCCA), dissecting cellulitis of the scalp (DCS), pseudofolliculitis barbae (PFB), traction alopecia (TA), and keloids are the most prevalent follicular and scarring disorders in skin of color. They have been associated with disfigurement, permanent hair loss, emotional distress, and decreased quality of life. Hair grooming practices, such as the use of chemical relaxers, heat straightening, and tight braiding and weaving can cause scalp irritation and follicular damage and are linked to the pathogenesis of some of these conditions. Consequently, patient education and behavior modifications are integral to the prevention and management of these disorders. Scarring disorders are also of concern in ethnic populations. Keloid scarring is more prevalent in individuals of African, Asian, and Hispanic descent. The scarring alopecia CCCA is almost exclusively seen in patients of African descent. Therapeutic regimens such as intralesional corticosteroids, surgical excision, and laser therapy can be effective for these follicular and scarring disorders, but carry a risk of dyspigmentation and keloid scarring. Ethnic skin and hair may present unique challenges to the clinician, and knowledge of these differences is essential to providing quality care.

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References

  1. Lindelof B, Forslind B, Hedblad MA, Kaveus U. Human hair form. Morphology revealed by light and scanning electron microscopy and computer aided three-dimensional reconstruction. Arch Dermatol. 1988;124(9):1359–63.

    CAS  PubMed  Google Scholar 

  2. Montagna W, Carlisle K. The architecture of black and white facial skin. J Am Acad Dermatol. 1991;24(6 Pt 1):929–37.

    CAS  PubMed  Google Scholar 

  3. Vernall DG. A study of the size and shape of cross sections of hair from four races of men. Am J Phys Anthropol. 1961;19:345–50.

    CAS  PubMed  Google Scholar 

  4. Ackerman AB, Walton NW, Jones RE, Charissi C. Hot comb alopecia/follicular degeneration syndrome in African-American women is traction alopecia. Dermatopathol Prac Concept. 2000:6–21

  5. Taylor SC. Skin of color: biology, structure, function, and implications for dermatologic disease. J Am Acad Dermatol. 2002;46(2 Suppl Understanding):S41–62.

    PubMed  Google Scholar 

  6. Chike-Obi CJ, Cole PD, Brissett AE. Keloids: pathogenesis, clinical features, and management. Semin Plast Surg. 2009;23(3):178–84. doi:10.1055/s-0029-1224797.

    PubMed Central  PubMed  Google Scholar 

  7. Kaposi M. Pathology and treatment of diseases of the skin for practitioners and students. New York: William Wood and Co; 1895.

  8. Kundu RV, Patterson S. Dermatologic conditions in skin of color: part II. Disorders occurring predominately in skin of color. Am Fam Physician. 2013;87(12):859–65.

    PubMed  Google Scholar 

  9. Dinehart SM, Tanner L, Mallory SB, Herzberg AJ. Acne keloidalis in women. Cutis. 1989;44(3):250–2.

    CAS  PubMed  Google Scholar 

  10. Ogunbiyi A, George A. Acne keloidalis in females: case report and review of literature. J Natl Med Assoc. 2005;97(5):736–8.

    PubMed Central  PubMed  Google Scholar 

  11. Kelly AP. Pseudofolliculitis barbae and acne keloidalis nuchae. Dermatol Clin. 2003;21(4):645–53.

    PubMed  Google Scholar 

  12. Salami T, Omeife H, Samuel S. Prevalence of acne keloidalis nuchae in Nigerians. Int J Dermatol. 2007;46(5):482–4. doi:10.1111/j.1365-4632.2007.03069.x.

    PubMed  Google Scholar 

  13. Sperling LC, Homoky C, Pratt L, Sau P. Acne keloidalis is a form of primary scarring alopecia. Arch Dermatol. 2000;136(4):479–84.

    CAS  PubMed  Google Scholar 

  14. Herzberg AJ, Dinehart SM, Kerns BJ, Pollack SV. Acne keloidalis. Transverse microscopy, immunohistochemistry, and electron microscopy. Am J Dermatopathol. 1990;12(2):109–21.

    CAS  PubMed  Google Scholar 

  15. Goette DK, Berger TG. Acne keloidalis nuchae. A transepithelial elimination disorder. Int J Dermatol. 1987;26(7):442–4.

    CAS  PubMed  Google Scholar 

  16. Khumalo NP, Gumedze F, Lehloenya R. Folliculitis keloidalis nuchae is associated with the risk for bleeding from haircuts. Int J Dermatol. 2011;50(10):1212–6. doi:10.1111/j.1365-4632.2010.04655.x.

    PubMed  Google Scholar 

  17. Burkhart CG, Burkhart CN. Acne keloidalis is lichen simplex chronicus with fibrotic keloidal scarring. J Am Acad Dermatol. 1998;39(4 Pt 1):661.

    CAS  PubMed  Google Scholar 

  18. Koehn GG. Skin injuries in sports medicine. J Am Acad Dermatol. 1991;24(1):152.

    CAS  PubMed  Google Scholar 

  19. Knable AL Jr, Hanke CW, Gonin R. Prevalence of acne keloidalis nuchae in football players. J Am Acad Dermatol. 1997;37(4):570–4.

    PubMed  Google Scholar 

  20. Beckett N, Lawson C, Cohen G. Electrosurgical excision of acne keloidalis nuchae with secondary intention healing. J Clin Aesthet Dermatol. 2011;4(1):36–9.

    PubMed Central  PubMed  Google Scholar 

  21. Quarles FN, Brody H, Badreshia S, Vause SE, Brauner G, Breadon JY, et al. Acne keloidalis nuchae. Dermatol Ther. 2007;20(3):128–32. doi:10.1111/j.1529-8019.2007.00123.x.

    PubMed  Google Scholar 

  22. Callender VD, Young CM, Haverstock CL, Carroll CL, Feldman SR. An open label study of clobetasol propionate 0.05% and betamethasone valerate 0.12% foams in the treatment of mild to moderate acne keloidalis. Cutis. 2005;75(6):317–21.

    PubMed  Google Scholar 

  23. Esmat SM, Abdel Hay RM, Abu Zeid OM, Hosni HN. The efficacy of laser-assisted hair removal in the treatment of acne keloidalis nuchae; a pilot study. Eur J Dermatol. 2012;22(5):645–50. doi:10.1684/ejd.2012.1830.

    PubMed  Google Scholar 

  24. Dragoni F, Bassi A, Cannarozzo G, Bonan P, Moretti S, Campolmi P. Successful treatment of acne keloidalis nuchae resistant to conventional therapy with 1064-nm ND:YAG laser. G Ital Dermatol Venereol. 2013;148(2):231–2.

    CAS  PubMed  Google Scholar 

  25. Gloster HM Jr. The surgical management of extensive cases of acne keloidalis nuchae. Arch Dermatol. 2000;136(11):1376–9.

    PubMed  Google Scholar 

  26. Glenn MJ, Bennett RG, Kelly AP. Acne keloidalis nuchae: treatment with excision and second-intention healing. J Am Acad Dermatol. 1995;33(2 Pt 1):243–6.

    CAS  PubMed  Google Scholar 

  27. Sperling LC, Skelton HG 3rd, Smith KJ, Sau P, Friedman K. Follicular degeneration syndrome in men. Arch Dermatol. 1994;130(6):763–9.

    CAS  PubMed  Google Scholar 

  28. LoPresti P, Papa CM, Kligman AM. Hot comb alopecia. Arch Dermatol. 1968;98(3):234–8.

    CAS  PubMed  Google Scholar 

  29. Sperling LC, Solomon AR, Whiting DA. A new look at scarring alopecia. Arch Dermatol. 2000;136(2):235–42.

  30. Olsen EA, Bergfeld WF, Cotsarelis G, Price VH, Shapiro J, Sinclair R, et al. Summary of North American Hair Research Society (NAHRS)-sponsored Workshop on Cicatricial Alopecia, Duke University Medical Center, February 10 and 11, 2001. J Am Acad Dermatol. 2003;48(1):103–10. doi:10.1067/mjd.2003.68.

    PubMed  Google Scholar 

  31. Halder RM, Grimes PE, McLaurin CI, Kress MA, Kenney JA, Jr. Incidence of common dermatoses in a predominantly black dermatologic practice. Cutis. 1983;32(4):388, 390.

  32. Olsen EA, Callender V, McMichael A, Sperling L, Anstrom KJ, Shapiro J, et al. Central hair loss in African American women: incidence and potential risk factors. J Am Acad Dermatol. 2011;64(2):245–52. doi:10.1016/j.jaad.2009.11.693.

    PubMed  Google Scholar 

  33. Headington JT. Cicatricial alopecia. Dermatol Clin. 1996;14(4):773–82.

    CAS  PubMed  Google Scholar 

  34. Nicholson AG, Harland CC, Bull RH, Mortimer PS, Cook MG. Chemically induced cosmetic alopecia. Br J Dermatol. 1993;128(5):537–41.

    CAS  PubMed  Google Scholar 

  35. Kyei A, Bergfeld WF, Piliang M, Summers P. Medical and environmental risk factors for the development of central centrifugal cicatricial alopecia: a population study. Arch Dermatol. 2011;147(8):909–14. doi:10.1001/archdermatol.2011.66.

    PubMed  Google Scholar 

  36. Khumalo NP, Gumedze F. Traction: risk factor or coincidence in central centrifugal cicatricial alopecia? Br J Dermatol. 2012;167(5):1191–3

  37. Olsen EA, Callender V, McMichael A, Sperling L, Anstrom KJ, Shapiro J, et al. Central hair loss in African American women: incidence and potential risk factors. J Am Acad Dermatol. 2011;64(2):245–52. doi:10.1016/j.jaad.2009.11.693.

    PubMed  Google Scholar 

  38. Dlova NC, Forder M. Central centrifugal cicatricial alopecia: possible familial aetiology in two African families from South Africa. Int J Dermatol. 2012;51(Suppl 1):17–20, 23. doi:10.1111/j.1365-4632.2012.05557.x.

  39. Dlova NC, Jordaan FH, Sarig O, Sprecher E. Autosomal dominant inheritance of central centrifugal cicatricial alopecia in black South Africans. J Am Acad Dermatol. 2014;. doi:10.1016/j.jaad.2013.11.035.

    Google Scholar 

  40. Callender VD, McMichael AJ, Cohen GF. Medical and surgical therapies for alopecias in black women. Dermatol Ther. 2004;17(2):164–76. doi:10.1111/j.1396-0296.2004.04017.x.

    PubMed  Google Scholar 

  41. Callender VD, Wright DR, Davis EC, Sperling LC. Hair breakage as a presenting sign of early or occult central centrifugal cicatricial alopecia: clinicopathologic findings in 9 patients. Arch Dermatol. 2012;148(9):1047–52. doi:10.1001/archdermatol.2011.3428.

    PubMed  Google Scholar 

  42. Whiting DA, Olsen EA. Central centrifugal cicatricial alopecia. Dermatol Ther. 2008;21(4):268–78. doi:10.1111/j.1529-8019.2008.00209.x.

    PubMed  Google Scholar 

  43. Stefanato CM. Histopathology of alopecia: a clinicopathological approach to diagnosis. Histopathology. 2010;56(1):24–38. doi:10.1111/j.1365-2559.2009.03439.x.

    PubMed  Google Scholar 

  44. Miteva M, Tosti A. ‘A detective look’ at hair biopsies from African-American patients. Br J Dermatol. 2012;166(6):1289–94. doi:10.1111/j.1365-2133.2012.10892.x.

    CAS  PubMed  Google Scholar 

  45. Racz E, Gho C, Moorman PW, Noordhoek Hegt V, Neumann HA. Treatment of frontal fibrosing alopecia and lichen planopilaris: a systematic review. J Eur Acad Dermatol Venereol. 2013;27(12):1461–70. doi:10.1111/jdv.12139.

    CAS  PubMed  Google Scholar 

  46. Otberg N, Kang H, Alzolibani AA, Shapiro J. Folliculitis decalvans. Dermatol Ther. 2008;21(4):238–44. doi:10.1111/j.1529-8019.2008.00204.x.

    PubMed  Google Scholar 

  47. Samrao A, Price VH, Zedek D, Mirmirani P. The “Fringe Sign”—a useful clinical finding in traction alopecia of the marginal hair line. Dermatol Online J. 2011;17(11):1.

  48. Olsen EA. Female pattern hair loss and its relationship to permanent/cicatricial alopecia: a new perspective. Journal of Investigative Dermatology Symposium Proceedings/the Society for Investigative Dermatology, Inc [and] European Society for Dermatological Research. 2005;10(3):217-21. doi:10.1111/j.1087-0024.2005.10109.x.

  49. McMichael AJ. Hair and scalp disorders in ethnic populations. Dermatol Clin. 2003;21(4):629–44.

    PubMed  Google Scholar 

  50. Chicarilli ZN. Follicular occlusion triad: hidradenitis suppurativa, acne conglobata, and dissecting cellulitis of the scalp. Ann Plast Surg. 1987;18(3):230–7.

    CAS  PubMed  Google Scholar 

  51. Spitzer L. Dermatitis follicularis et parifollicularis conglobata. Dermatol Ztschr. 1903;10:109

  52. Scott DA. Disorders of the hair and scalp in blacks. Dermatol Clin. 1988;6(3):387–95.

    CAS  PubMed  Google Scholar 

  53. Stites PC, Boyd AS. Dissecting cellulitis in a white male: a case report and review of the literature. Cutis. 2001;67(1):37–40.

    CAS  PubMed  Google Scholar 

  54. Lally A, Wojnarowska F. Hypertrophic pseudofolliculitis in white renal transplant recipients. Clin Exp Dermatol. 2007;32(3):268–71. doi:10.1111/j.1365-2230.2007.02386.x.

    CAS  PubMed  Google Scholar 

  55. Greenblatt DT, Sheth N, Teixeira F. Dissecting cellulitis of the scalp responding to oral quinolones. Clin Exp Dermatol. 2008;33(1):99–100. doi:10.1111/j.1365-2230.2007.02598.x.

    CAS  PubMed  Google Scholar 

  56. Ramesh V. Dissecting cellulitis of the scalp in 2 girls. Dermatologica. 1990;180(1):48–50.

    CAS  PubMed  Google Scholar 

  57. Arneja JS, Vashi CN, Gursel E, Lelli JL. Management of fulminant dissecting cellulitis of the scalp in the pediatric population: case report and literature review. Can J Plast Surg. 2007;15(4):211–4.

    PubMed Central  PubMed  Google Scholar 

  58. Ramasastry SS, Granick MS, Boyd JB, Futrell JW. Severe perifolliculitis capitis with osteomyelitis. Ann Plast Surg. 1987;18(3):241–4.

    CAS  PubMed  Google Scholar 

  59. Ongchi DR, Fleming MG, Harris CA. Sternocostoclavicular hyperostosis: two cases with differing dermatologic syndromes. J Rheumatol. 1990;17(10):1415–8.

    CAS  PubMed  Google Scholar 

  60. Curry SS, Gaither DH, King LE Jr. Squamous cell carcinoma arising in dissecting perifolliculitis of the scalp. A case report and review of secondary squamous cell carcinomas. J Am Acad Dermatol. 1981;4(6):673–8.

    CAS  PubMed  Google Scholar 

  61. Lim DT, James NM, Hassan S, Khan MA. Spondyloarthritis associated with acne conglobata, hidradenitis suppurativa and dissecting cellulitis of the scalp: a review with illustrative cases. Curr Rheumatol Rep. 2013;15(8). doi:10.1007/s11926-013-0346-y.

  62. Williams CN, Cohen M, Ronan SG, Lewandowski CA. Dissecting cellulitis of the scalp. Plast Reconstr Surg. 1986;77(3):378–82.

    CAS  PubMed  Google Scholar 

  63. Scheinfeld NS. A case of dissecting cellulitis and a review of the literature. Dermatol Online J. 2003;9(1):8.

  64. Bjellerup M, Wallengren J. Familial perifolliculitis capitis abscedens et suffodiens in two brothers successfully treated with isotretinoin. J Am Acad Dermatol. 1990;23(4 Pt 1):752–3.

    CAS  PubMed  Google Scholar 

  65. Jacobs F, Metzler G, Kubiak J, Röcken M, Schaller M. New approach in combined therapy of perifolliculitis capitis abscedens et suffodiens. Acta Derm Venereol. 2011;91(6):726–7. doi:10.2340/00015555-1146.

    PubMed  Google Scholar 

  66. Stein LL, Adams EG, Holcomb KZ. Inflammatory tinea capitis mimicking dissecting cellulitis in a postpubertal male: a case report and review of the literature. Mycoses. 2013;56(5):596–600. doi:10.1111/myc.12082.

    PubMed  Google Scholar 

  67. Gerami P, Rosen S, Kuzel T, Boone SL, Guitart J. Folliculotropic mycosis fungoides: an aggressive variant of cutaneous T-cell lymphoma. Arch Dermatol. 2008;144(6):738–46. doi:10.1001/archderm.144.6.738.

    PubMed  Google Scholar 

  68. Annessi G. Tufted folliculitis of the scalp: a distinctive clinicohistological variant of folliculitis decalvans. Br J Dermatol. 1998;138(5):799–805.

    CAS  PubMed  Google Scholar 

  69. Sperling LC. Scarring alopecia and the dermatopathologist. J Cutan Pathol. 2001;28(7):333–42.

    CAS  PubMed  Google Scholar 

  70. Branisteanu DE, Molodoi A, Ciobanu D, Badescu A, Stoica LE, Branisteanu D, et al. The importance of histopathologic aspects in the diagnosis of dissecting cellulitis of the scalp. Rom J Morphol Embryol. 2009;50(4):719-24.

  71. Rakowska A, Slowinska M, Kowalska-Oledzka E, Warszawik O, Czuwara J, Olszewska M, et al. Trichoscopy of cicatricial alopecia. J Drugs Dermatol. 2012;11(6):753–8.

    PubMed  Google Scholar 

  72. Rodney IJ, Onwudiwe OC, Callender VD, Halder RM. Hair and scalp disorders in ethnic populations. J Drugs Dermatol. 2013;12(4):420–7.

    PubMed  Google Scholar 

  73. Khaled A, Zeglaoui F, Zoghlami A, Fazaa B, Kamoun MR. Dissecting cellulitis of the scalp: response to isotretinoin. J Eur Acad Dermatol Venereol. 2007;21(10):1430–1. doi:10.1111/j.1468-3083.2007.02239.x.

    CAS  PubMed  Google Scholar 

  74. Karpouzis A, Giatromanolaki A, Sivridis E, Kouskoukis C. Perifolliculitis capitis abscedens et suffodiens successfully controlled with topical isotretinoin. Eur J Dermatol. 2003;13(2):192–5.

    PubMed  Google Scholar 

  75. Georgala S, Korfitis C, Ioannidou D, Alestas T, Kylafis G, Georgala C. Dissecting cellulitis of the scalp treated with rifampicin and isotretinoin: case reports. Cutis. 2008;82(3):195–8.

    PubMed  Google Scholar 

  76. Kobayashi H, Aiba S, Tagami H. Successful treatment of dissecting cellulitis and acne conglobata with oral zinc. Br J Dermatol. 1999;141(6):1137–8.

    CAS  PubMed  Google Scholar 

  77. Adrian RM, Arndt KA. Perifolliculitis capitis: successful control with alternate-day corticosteroids. Ann Plast Surg. 1980;4(2):166–9.

    CAS  PubMed  Google Scholar 

  78. Onderdijk AJ, Boer J. Successful treatment of dissecting cellulitis with ciprofloxacin. Clin Exp Dermatol. 2010;35(4):440. doi:10.1111/j.1365-2230.2009.03514.x.

  79. Navarini AA, Trüeb RM. 3 cases of dissecting cellulitis of the scalp treated with adalimumab: control of inflammation within residual structural disease. Arch Dermatol. 2010;146(5):517–20. doi:10.1001/archdermatol.2010.16.

    PubMed  Google Scholar 

  80. Sukhatme SV, Lenzy YM, Gottlieb AB. Refractory dissecting cellulitis of the scalp treated with adalimumab. J Drugs Dermatol. 2008;7(10):981–3.

    PubMed  Google Scholar 

  81. Brandt HRC, Malheiros APR, Teixeira MG, Machado MCR. Perifolliculitis capitis abscedens et suffodiens successfully controlled with infliximab. Br J Dermatol. 2008;159(2):506–7. doi:10.1111/j.1365-2133.2008.08674.x.

    CAS  PubMed  Google Scholar 

  82. Boyd AS, Binhlam JQ. Use of an 800-nm pulsed-diode laser in the treatment of recalcitrant dissecting cellulitis of the scalp. Arch Dermatol. 2002;138(10):1291–3.

    PubMed  Google Scholar 

  83. Chinnaiyan P, Tena LB, Brenner MJ, Welsh JS. Modern external beam radiation therapy for refractory dissecting cellulitis of the scalp. Br J Dermatol. 2005;152(4):777–9. doi:10.1111/j.1365-2133.2005.06536.x.

    CAS  PubMed  Google Scholar 

  84. Krasner BD, Hamzavi FH, Murakawa GJ, Hamzavi IH. Dissecting cellulitis treated with the long-pulsed Nd:YAG laser. Dermatol Surg. 2006;32(8):1039–44. doi:10.1111/j.1524-4725.2006.32227.x.

    CAS  PubMed  Google Scholar 

  85. Scheinfeld NSMD. A case of dissecting cellulitis and a review of the literature. Dermatol Online J. 2003;9(1):8.

  86. Housewright CD, Rensvold E, Tidwell J, Lynch D, Butler DF. Excisional surgery (scalpectomy) for dissecting cellulitis of the scalp. Dermatol Surg. 2011;37(8):1189–91. doi:10.1111/j.1524-4725.2011.02049.x.

    CAS  PubMed  Google Scholar 

  87. Bellew SG, Nemerofsky R, Schwartz RA, Granick MS. Successful treatment of recalcitrant dissecting cellulitis of the scalp with complete scalp excision and split-thickness skin graft. Dermatol Surg. 2003;29(10):1068–70.

    PubMed  Google Scholar 

  88. Kundu RV, Patterson S. Dermatologic conditions in skin of color: part II. Disorders occurring predominately in skin of color. Am Fam Physician. 2013;87(12):859–65.

    PubMed  Google Scholar 

  89. Fox H. Observations on skin diseases in the Negro. J Cutan Dis. 1908;26:67–79

  90. Kligman AM, Strauss JS. Pseudofolliculitis of the beard. AMA Arch Dermatol. 1956;74(5):533–42.

    CAS  Google Scholar 

  91. Ribera M, Fernandez-Chico N, Casals M. Pseudofolliculitis barbae. Actas Dermo Sifiliograficas. 2010;101(9):749–57.

    CAS  PubMed  Google Scholar 

  92. Alexander AM, Delph WI. Pseudofolliculitis barbae in the military. A medical, administrative and social problem. J Natl Med Assoc. 1974;66(6):459–64, 79.

  93. Bridgeman S. The medical and surgical therapy of pseudofolliculitis barbae. Dermatol Ther. 2004;17(2):158–63. doi:10.1111/j.1396-0296.2004.04016.x.

    Google Scholar 

  94. Garcia RL, White JW Jr. Pseudofolliculitis barbae in a woman. Arch Dermatol. 1978;114(12):1856.

    CAS  PubMed  Google Scholar 

  95. Perry PK, Cook-Bolden FE, Rahman Z, Jones E, Taylor SC. Defining pseudofolliculitis barbae in 2001: a review of the literature and current trends. J Am Acad Dermatol. 2002;46(2 Suppl Understanding):S113–9.

    PubMed  Google Scholar 

  96. Dunn JF Jr. Pseudofolliculitis barbae. Am Fam Physician. 1988;38(3):169–74.

    PubMed  Google Scholar 

  97. Winter H, Schissel D, Parry DAD, Smith TA, Liovic M, Birgitte Lane E et al. An unusual Ala12Thr polymorphism in the 1A alpha-helical segment of the companion layer-specific keratin K6hf: evidence for a risk factor in the etiology of the common hair disorder pseudofolliculitis barbae. J Invest Dermatol. 2004;122(3):652–7. doi:10.1111/j.0022-202X.2004.22309.x.

  98. McLean WHI. Close shave for a keratin disorder-K6hf polymorphism linked to pseudofolliculitis barbae. J Invest Dermatol. 2004;122(3):xi–xiii. doi:10.1111/j.0022-202X.2004.22351.x.

  99. Daniel A, Gustafson CJ, Zupkosky PJ, Candido A, Kemp HR, Russell G, et al. Shave frequency and regimen variation effects on the management of pseudofolliculitis barbae. J Drugs Dermatol. 2013;12(4):410–8.

    PubMed  Google Scholar 

  100. Kindred C, Oresajo CO, Yatskayer M, Halder RM. Comparative evaluation of men’s depilatory composition versus razor in black men. Cutis. 2011;88(2):98–103.

    PubMed  Google Scholar 

  101. Perricone NV. Treatment of pseudofolliculitis barbae with topical glycolic acid: a report of two studies. Cutis. 1993;52(4):232–5.

    CAS  PubMed  Google Scholar 

  102. Cook-Bolden FE, Barba A, Halder R, Taylor S. Twice-daily applications of benzoyl peroxide 5%/clindamycin 1% gel versus vehicle in the treatment of pseudofolliculitis barbae. Cutis. 2004;73(6 Suppl):18–24.

    PubMed  Google Scholar 

  103. Ross EV, Cooke LM, Timko AL, Overstreet KA, Graham BS, Barnette DJ. Treatment of pseudofolliculitis barbae in skin types IV, V, and VI with a long-pulsed neodymium:yttrium aluminum garnet laser. J Am Acad Dermatol. 2002;47(2):263–70.

    PubMed  Google Scholar 

  104. Weaver SM 3rd, Sagaral EC. Treatment of pseudofolliculitis barbae using the long-pulse Nd:YAG laser on skin types V and VI. Dermatol Surg. 2003;29(12):1187–91.

    PubMed  Google Scholar 

  105. Battle EF Jr, Hobbs LM. Laser-assisted hair removal for darker skin types. Dermatol Ther. 2004;17(2):177–83. doi:10.1111/j.1396-0296.2004.04018.x.

    PubMed  Google Scholar 

  106. Smith EP, Winstanley D, Ross EV. Modified superlong pulse 810 nm diode laser in the treatment of pseudofolliculitis barbae in skin types V and VI. Dermatol Surg. 2005;31(3):297–301

  107. Emer JJ. Best practices and evidenced-based use of the 800 nm diode laser for the treatment of pseudofolliculitis barbae in skin of color. J Drugs Dermatol. 2011;10(12 Suppl):s20–2.

    PubMed  Google Scholar 

  108. Xia Y, Cho S, Howard RS, Maggio KL. Topical eflornithine hydrochloride improves the effectiveness of standard laser hair removal for treating pseudofolliculitis barbae: a randomized, double-blinded, placebo-controlled trial. J Am Acad Dermatol. 2012;67(4):694–9. doi:10.1016/j.jaad.2011.10.029.

    CAS  PubMed  Google Scholar 

  109. Rodney IJ, Onwudiwe OC, Callender VD, Halder RM. Hair and scalp disorders in ethnic populations. J Drugs Dermatol. 2013;12(4):420–7.

    PubMed  Google Scholar 

  110. Kanwar AJ, Kaur S, Basak P, Sharma R. Traction alopecia in Sikh males. Arch Dermatol. 1989;125(11):1587.

  111. Hantash BM, Schwartz RA. Traction alopecia in children. Cutis. 2003;71(1):18–20.

    PubMed  Google Scholar 

  112. Samrao A, Chen C, Zedek D, Price VH. Traction alopecia in a ballerina: clinicopathologic features. Arch Dermatol. 2010;146(8):930–1. doi:10.1001/archdermatol.2010.183.

    PubMed  Google Scholar 

  113. Trüeb RM. “Chignon alopecia”: a distinctive type of nonmarginal traction alopecia. Cutis. 1995;55(3):178–9.

    PubMed  Google Scholar 

  114. Karimian-Teherani D, El Shabrawi-Caelen L, Tanew A. Traction alopecia in two adolescent Sikh brothers-an underrecognized problem unmasked by migration. Pediatr Dermatol. 2011;28(3):336–8. doi:10.1111/j.1525-1470.2011.01241.x.

    PubMed  Google Scholar 

  115. James J, Saladi RN, Fox JL. Traction alopecia in Sikh male patients. J Am Board Fam Med. 2007;20(5):497–8. doi:10.3122/jabfm.2007.05.070076.

    PubMed  Google Scholar 

  116. Rudolph RI, Klein AW, Decherd JW. Corn-row alopecia. Arch Dermatol. 1973;108(1):134.

    CAS  PubMed  Google Scholar 

  117. Lipnik MJ. Traumatic alopecia from brush rollers. Arch Dermatol. 1961;84:493–5.

    CAS  PubMed  Google Scholar 

  118. Rucker Wright D, Gathers R, Kapke A, Johnson D, Joseph CLM. Hair care practices and their association with scalp and hair disorders in African American girls. J Am Acad Dermatol. 2011;64(2):253–62. doi:10.1016/j.jaad.2010.05.037.

  119. Khumalo NP, Jessop S, Gumedze F, Ehrlich R. Determinants of marginal traction alopecia in African girls and women. J Am Acad Dermatol. 2008;59(3):432–8. doi:10.1016/j.jaad.2008.05.036.

    PubMed  Google Scholar 

  120. Donovan JC, Mirmirani P. Transversely sectioned biopsies in the diagnosis of end-stage traction alopecia. Dermatol Online J. 2013;19(4):11.

  121. Fox GN, Stausmire JM, Mehregan DR. Traction folliculitis: an underreported entity. Cutis. 2007;79(1):26–30.

    PubMed  Google Scholar 

  122. Callender VD, McMichael AJ, Cohen GF. Medical and surgical therapies for alopecias in black women. Dermatol Ther. 2004;17(2):164–76. doi:10.1111/j.1396-0296.2004.04017.x.

    PubMed  Google Scholar 

  123. Khumalo NP, Ngwanya RM. Traction alopecia: 2 % topical minoxidil shows promise. Report of two cases. J Eur Acad Dermatol Venereol. 2007;21(3):433–4

  124. Ozçelik D. Extensive traction alopecia attributable to ponytail hairstyle and its treatment with hair transplantation. Aesthetic Plast Surg. 2005;29(4):325–7. doi:10.1007/s00266-005-0004-5.

    PubMed  Google Scholar 

  125. Naylor MC, Brissett AE. Current concepts in the etiology and treatment of keloids. Facial Plast Surg. 2012;28(5):504–12. doi:10.1055/s-0032-1325644.

    CAS  PubMed  Google Scholar 

  126. Kelly AP. Medical and surgical therapies for keloids. Dermatol Ther. 2004;17(2):212–8. doi:10.1111/j.1396-0296.2004.04022.x.

    PubMed  Google Scholar 

  127. Alhady SM, Sivanantharajah K. Keloids in various races. A review of 175 cases. Plast Reconstr Surg. 1969;44(6):564–6.

    CAS  PubMed  Google Scholar 

  128. Ramakrishnan KM, Thomas KP, Sundararajan CR. Study of 1,000 patients with keloids in South India. Plast Reconstr Surg. 1974;53(3):276–80.

    CAS  PubMed  Google Scholar 

  129. Lee TY, Chin GS, Kim WJ, Chau D, Gittes GK, Longaker MT. Expression of transforming growth factor beta 1, 2, and 3 proteins in keloids. Ann Plast Surg. 1999;43(2):179–84.

    CAS  PubMed  Google Scholar 

  130. Marneros AG, Krieg T. Keloids—clinical diagnosis, pathogenesis, and treatment options. J Dtsch Dermatol Ges. 2004;2(11):905–13.

    PubMed  Google Scholar 

  131. Saed GM, Ladin D, Olson J, Han X, Hou Z, Fivenson D. Analysis of p53 gene mutations in keloids using polymerase chain reaction-based single-strand conformational polymorphism and DNA sequencing. Arch Dermatol. 1998;134(8):963–7.

    CAS  PubMed  Google Scholar 

  132. Gao FL, Jin R, Zhang L, Zhang YG. The contribution of melanocytes to pathological scar formation during wound healing. Int J Clin Exp Med. 2013;6(7):609–13.

    PubMed Central  PubMed  Google Scholar 

  133. Marneros AG, Norris JE, Olsen BR, Reichenberger E. Clinical genetics of familial keloids. Arch Dermatol. 2001;137(11):1429–34.

    CAS  PubMed  Google Scholar 

  134. Marneros AG, Norris JE, Watanabe S, Reichenberger E, Olsen BR. Genome scans provide evidence for keloid susceptibility loci on chromosomes 2q23 and 7p11. J Invest Dermatol. 2004;122(5):1126–32. doi:10.1111/j.0022-202X.2004.22327.x.

    CAS  PubMed  Google Scholar 

  135. Yan X, Gao JH, Chen Y, Song M, Liu XJ. [Preliminary linkage analysis and mapping of keloid susceptibility locus in a Chinese pedigree]. Zhonghua zheng xing wai ke za zhi = Zhonghua zhengxing waike zazhi =. Chin J Plast Surg. 2007;23(1):32–5.

    Google Scholar 

  136. Bayat A, Arscott G, Ollier WE, Ferguson MW, Mc Grouther DA. Description of site-specific morphology of keloid phenotypes in an Afrocaribbean population. Br J Plast Surg. 2004;57(2):122–33. doi:10.1016/j.bjps.2003.11.009.

    CAS  PubMed  Google Scholar 

  137. Love PB, Kundu RV. Keloids: an update on medical and surgical treatments. J Drugs Dermatol. 2013;12(4):403–9.

    CAS  PubMed  Google Scholar 

  138. Nemeth AJ. Keloids and hypertrophic scars. J Dermatol Surg Oncol. 1993;19(8):738–46.

    CAS  PubMed  Google Scholar 

  139. Juckett G, Hartman-Adams H. Management of keloids and hypertrophic scars. Am Fam Physician. 2009;80(3):253–60.

    PubMed  Google Scholar 

  140. Ogawa R. The most current algorithms for the treatment and prevention of hypertrophic scars and keloids. Plast Reconstr Surg. 2010;125(2):557–68. doi:10.1097/PRS.0b013e3181c82dd5.

    CAS  PubMed  Google Scholar 

  141. Lee JY, Yang CC, Chao SC, Wong TW. Histopathological differential diagnosis of keloid and hypertrophic scar. Am J Dermatopathol. 2004;26(5):379–84.

    PubMed  Google Scholar 

  142. Lane JE, Waller JL, Davis LS. Relationship between age of ear piercing and keloid formation. Pediatrics. 2005;115(5):1312–4. doi:10.1542/peds.2004-1085.

    PubMed  Google Scholar 

  143. Gold MH, Foster TD, Adair MA, Burlison K, Lewis T. Prevention of hypertrophic scars and keloids by the prophylactic use of topical silicone gel sheets following a surgical procedure in an office setting. Dermatol Surg. 2001;27(7):641–4.

    CAS  PubMed  Google Scholar 

  144. O’Brien L, Jones DJ. Silicone gel sheeting for preventing and treating hypertrophic and keloid scars. Cochrane Database Syst Rev. 2013;9:CD003826. doi:10.1002/14651858.CD003826.pub3.

  145. Mustoe TA, Cooter RD, Gold MH, Hobbs FD, Ramelet AA, Shakespeare PG, et al. International clinical recommendations on scar management. Plast Reconstr Surg. 2002;110(2):560–71.

    PubMed  Google Scholar 

  146. Niessen FB, Spauwen PH, Schalkwijk J, Kon M. On the nature of hypertrophic scars and keloids: a review. Plast Reconstr Surg. 1999;104(5):1435–58.

    CAS  PubMed  Google Scholar 

  147. Shepherd JP, Dawber RP. The response of keloid scars to cryosurgery. Plast Reconstr Surg. 1982;70(6):677–82.

    CAS  PubMed  Google Scholar 

  148. Careta MF, Fortes AC, Messina MC, Maruta CW. Combined treatment of earlobe keloids with shaving, cryosurgery, and intralesional steroid injection: a 1-year follow-up. Dermatol Surg. 2013;39(5):734–8. doi:10.1111/dsu.12107.

    CAS  PubMed  Google Scholar 

  149. Barara M, Mendiratta V, Chander R. Cryotherapy in treatment of keloids: evaluation of factors affecting treatment outcome. J Cutan Aesthet Surg. 2012;5(3):185–9. doi:10.4103/0974-2077.101376.

    PubMed Central  PubMed  Google Scholar 

  150. Layton AM, Yip J, Cunliffe WJ. A comparison of intralesional triamcinolone and cryosurgery in the treatment of acne keloids. Br J Dermatol. 1994;130(4):498–501.

    CAS  PubMed  Google Scholar 

  151. Weshahy AH. Intralesional cryosurgery. A new technique using cryoneedles. J Dermatol Surg Oncol. 1993;19(2):123–6.

    CAS  PubMed  Google Scholar 

  152. Malhotra AK, Gupta S, Khaitan BK, Sharma VK. Imiquimod 5% cream for the prevention of recurrence after excision of presternal keloids. Dermatology. 2007;215(1):63–5. doi:10.1159/000102036.

    CAS  PubMed  Google Scholar 

  153. Klumpar DI, Murray JC, Anscher M. Keloids treated with excision followed by radiation therapy. J Am Acad Dermatol. 1994;31(2 Pt 1):225–31.

    CAS  PubMed  Google Scholar 

  154. Guix B, Henriquez I, Andres A, Finestres F, Tello JI, Martinez A. Treatment of keloids by high-dose-rate brachytherapy: a seven-year study. Int J Radiat Oncol Biol Phys. 2001;50(1):167–72.

    CAS  PubMed  Google Scholar 

  155. Chen MA, Davidson TM. Scar management: prevention and treatment strategies. Curr Opin Otolaryngol Head Neck Surg. 2005;13(4):242–7.

    PubMed  Google Scholar 

  156. Mamalis AD, Lev-Tov H, Nguyen DH, Jagdeo JR. Laser and light-based treatment of Keloids—a review. J Eur Acad Dermatol Venereol. 2013;. doi:10.1111/jdv.12253.

    PubMed  Google Scholar 

  157. Norris JE. The effect of carbon dioxide laser surgery on the recurrence of keloids. Plast Reconstr Surg. 1991;87(1):44–9; discussion 50–3.

  158. Garg GA, Sao PP, Khopkar US. Effect of carbon dioxide laser ablation followed by intralesional steroids on keloids. J Cutan Aesthet Surg. 2011;4(1):2–6. doi:10.4103/0974-2077.79176.

    PubMed Central  PubMed  Google Scholar 

  159. Alster TS, Williams CM. Treatment of keloid sternotomy scars with 585 nm flashlamp-pumped pulsed-dye laser. Lancet. 1995;345(8959):1198–200.

    CAS  PubMed  Google Scholar 

  160. Asilian A, Darougheh A, Shariati F. New combination of triamcinolone, 5-Fluorouracil, and pulsed-dye laser for treatment of keloid and hypertrophic scars. Dermatol Surg. 2006;32(7):907–15. doi:10.1111/j.1524-4725.2006.32195.x.

    CAS  PubMed  Google Scholar 

  161. Shridharani SM, Magarakis M, Manson PN, Singh NK, Basdag B, Rosson GD. The emerging role of antineoplastic agents in the treatment of keloids and hypertrophic scars: a review. Ann Plast Surg. 2010;64(3):355–61. doi:10.1097/SAP.0b013e3181afaab0.

    CAS  PubMed  Google Scholar 

  162. Uyesugi B, Lippincott B, Dave S. Treatment of a painful keloid with botulinum toxin type A. American journal of physical medicine & rehabilitation/Association of Academic Physiatrists. 2010;89(2):153–5.

  163. Kontochristopoulos G, Stefanaki C, Panagiotopoulos A, Stefanaki K, Argyrakos T, Petridis A, et al. Intralesional 5-fluorouracil in the treatment of keloids: an open clinical and histopathologic study. J Am Acad Dermatol. 2005;52(3 Pt 1):474–9. doi:10.1016/j.jaad.2004.09.018.

    PubMed  Google Scholar 

  164. Nanda S, Reddy BS. Intralesional 5-fluorouracil as a treatment modality of keloids. Dermatol Surg. 2004;30(1):54–6; discussion 6–7.

  165. Gupta S, Kalra A. Efficacy and safety of intralesional 5-fluorouracil in the treatment of keloids. Dermatology. 2002;204(2):130–2 51830.

    CAS  PubMed  Google Scholar 

  166. Manuskiatti W, Fitzpatrick RE. Treatment response of keloidal and hypertrophic sternotomy scars: comparison among intralesional corticosteroid, 5-fluorouracil, and 585-nm flashlamp-pumped pulsed-dye laser treatments. Arch Dermatol. 2002;138(9):1149–55.

    CAS  PubMed  Google Scholar 

  167. Aggarwal H, Saxena A, Lubana PS, Mathur RK, Jain DK. Treatment of keloids and hypertrophic scars using bleom. J Cosmet Dermatol. 2008;7(1):43–9. doi:10.1111/j.1473-2165.2008.00360.x.

    PubMed  Google Scholar 

  168. Espana A, Solano T, Quintanilla E. Bleomycin in the treatment of keloids and hypertrophic scars by multiple needle punctures. Dermatol Surg. 2001;27(1):23–7.

    CAS  PubMed  Google Scholar 

  169. Bodokh I, Brun P. Treatment of keloid with intralesional bleomycin. Ann Dermatol Venereol. 1996;123(12):791–4.

    CAS  PubMed  Google Scholar 

  170. Naeini FF, Najafian J, Ahmadpour K. Bleomycin tattooing as a promising therapeutic modality in large keloids and hypertrophic scars. Dermatol Surg. 2006;32(8):1023–9; discussion 9–30. doi:10.1111/j.1524-4725.2006.32225.x.

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No sources of funding were used to prepare this review. Pamela Madu and Roopal Kundu have no conflicts of interest that are directly relevant to the content of this review.

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  1. Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Roopal V. Kundu

  2. University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Pamela Madu

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Madu, P., Kundu, R.V. Follicular and Scarring Disorders in Skin of Color: Presentation and Management. Am J Clin Dermatol 15, 307–321 (2014). https://doi.org/10.1007/s40257-014-0072-x

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