Similar problems can affect women on the chin, sideburns, neck, chest, abdomen, legs and in the bikini area from tweezing, waxing, shaving and sometimes even depilatories. The sensations experienced by the razor bump (ingrown hair) sufferer are constant itching, tingling, burning, soreness, swelling and sometimes real pain. Symptoms can be mildly annoying and localized for some, and severe and extensive for others.

Pseudofolliculitis barbae is a chronic condition that can persist as long as the individual shaves, waxes, threads, and/or tweezes. Obviously, the problem can be dealt with by just allowing the hair to grow out. As the hair grows longer, it simply pops out the follicular opening and new “bumping up” ceases because the individual has stopped shaving, waxing or tweezing. This option, however, is not always practical due to the pressure of one’s employer, lifestyle, beauty and grooming customs.

Strict grooming regulations have been historically imposed by law enforcement agencies, fire departments, parcel delivery services and the military. These and other industries have traditionally insisted on the clean shaven look, and this has caused suffering and disfigurement to thousands of black and bump-prone men. In recent years, consciousness has gradually increased and some rules are slowly changing. Some branches of the military, most notably the Navy, are allowing extremely bump-prone men to sport a short, neatly groomed beard.

For decades, viable solutions to this universal problem eluded the medical, esthetic and drug store markets, and continue to do so on a wide-scale basis. Most physicians have relied unsuccessfully on topical steroids, retinoid creams and systematic antibiotics.

Over-the-counter and mailorder systems have utilized single edge blades, weak cortisone creams, bromelain enzymes, abrasive scrubs and alcohol-based salicylic acid solutions. While these methods can help improve the condition, they rarely offer total clearing or longterm relief. As a result, this all-too-common skin disorder presents a wide open arena for knowledgeable esthetic practitioners. Clinical skin care pros can dispense exfoliating, calming and antibacterial professional products (exfoliating masks and scrubs, AHA exfoliants, BPO, skin brighteners, acetyl salicylate solutions and hydrocortisone) and have the skill to release ingrown hairs correctly in a safe setting.

Shaving Habits: We instruct our clients to shave in the direction of hair growth with a single-edge disposable blade like the PFB Bump Fighter or Bic for Sensitive Skin, which is used once or twice and discarded after use. Examine the shaving area and determine which areas are less “bumped up” than others. Carefully imitate the shaving method and direction you use on the clearest areas, and repeat the same process on the entire shaving area.

Do not repeatedly go over the same area in a back-and-forth motion in an effort to get a closer shave. Use fragrance-free shaving creams, mild shaving soaps and gels containing benzoyl peroxide or alpha or beta hydroxy acid, which work well with single-edge disposable blades. The blade should be used no more than once or twice.

If the preferred shaving method involves an electric razor, we prefer the traditional barber’s trimmer, called a T-edger or liner, which gives a close, more precise shave that larger clippers. An example of this compact trimmer is the Wahl, designed for black men who shave, but Oster, Andes and other trimmers work equally well. Professional disinfectant spray (Clippercide or Oster) must be used before and after shaving to disinfect and lubricate the blades.

We include wives, mothers and girlfriends in the consultation. They are often the ones who wield the sewing needles and tweezers, or observe the picking, digging, unhooking, tweezing and other types of skin tampering habits at home. Tampering with the skin of introduces secondary bacteria and leads to inflammation, delayed healing, scarring and larger, thickened dark spots. Tweezing, threading and waxing trap recently removed hairs deep below the skin line, and set them up to become trapped again and again as they re-grow.

Avoid rotary shavers that cut beard hair at too many different angles, seriously compounding the problem. The skin should never be stretched to obtain a closer shave. When the skin bounces back, newly-shaved hair will be situated (and later trapped) below the skin line. The same principal applies to twin, triple, four and five-blade razors; the first blade stretches the skin, while the second (third, fourth and fifth) blade(s)s shave(s) way too close.

Depilatory creams and shaving powders should be discouraged once one of our anti-bacterial, keratolytic topicals is applied nightly in the bump prone area without irritation. Use of depilatories leads to dark hyperpigmentation of the lower face and neck, sometimes called “shadowing”, caused by chemical irritation and subsequent sun exposure. Melanin-suppressing skin lighteners should be introduced gradually in the absence of irritation and allergy. During the day, gentle skin brigheners, greaseless anti-inflammatory creams and oil-free full-spectrum sunscreens are vital to correcting and discouraging beard discoloration.

Electrolysis: Those with chronic “trouble spots” (often on the neck or cheeks where tweezing was performed repeatedly) might want to explore the “blend method” of electrolysis for problem areas. The electrologist should be skilled and experienced in the treatment of black, bump-prone clients with curved, often scarred, hair follicles. The curved follicle, healing process, risk of scarring and hyperpigmentation, as well as inflammatory reaction to the temporary “trauma” of electrolysis can differ radically from other races.

Laser hair removal has become increasingly popular in recent years to gradually and permanently reduce hair on the face and body. It is important that candidates do their homework to steer clear of the risks related to lasers, especially scarring and hyperpigmentation on darker skin tones.

Laser practitioners must:

(a) Use the safest, most appropriate laser for darker skin tones, like the YAG Q-switched neodymium yttrium aluminum garnet laser that produces a 1064nm wavelength of laser light.

(b) Be well-trained and experienced in the use of that laser.

(c) Disclose exactly what that laser can and cannot do for you, i.e. delete light, gray or white hair, and tell you how often you must go for treatment, usually every 4 to 5 weeks.

(d) Be experienced working with your ethnic skin type.

(e) Be able to address pre-laser pain management, disclosure of permanent cosmetic tattoos, reduction of post-laser inflammation, the need for melanin suppression (to control pigmentation) and sun protection/sun avoidance, removal of mineral make-up and physical sunblock before laser treatment, and be able to treat post-laser skin issues if they arise.

©2010, 2011 Kathryn Khadija Leverette

The material on this website is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment.

Acne keloidalis nuchae (deep pockets of inflammation buried under keloid scars), also called acne keloiditis (sore, pustular bumps) or AKN, affects the occipital scalp area, back of the neck, and in some cases, the entire scalp. This condition usually first appear and then flare up when black men get their hair cut close to the scalp with unsanitized clippers and trimmers.

A painful and disfiguring scalp problem, it’s fueled by low haircuts, failure to disinfect equipment, the rapid spread of bacteria and chronic inflammation. Lesions frequently erupt, ooze and bleed during sleep and after showering. Left untreated, they often “morph” into raised scars that swell, throb, itch, spread, and cause permanent disfiguring scars and hair loss in the involved area.

Contaminated equipment and frequent haircuts in non-compliant barbershops, or by unlicensed roving neighborhood ‘barbers’ or jailhouse barbers, put men at a higher risk for AKN. It‘s not uncommon for contaminated clippers, trimmers, blades and attachments to have been used on tens of dozens of clients without being properly sanitized.

In the late 50s and 60s, most black men sported the low “quo vadis” hairstyle, and I can’t recall seeing a single case of AKN on any of my homeys back in the day. More recently, one of my longtime clients, a successful rapper/producer, relocated to the East Coast. He frequented two barbershops while he lived in Oakland and never suffered from AKN. Shortly after he moved, he got on a plane and came by to see me. Almost overnight, his smooth scalp had become unsightly and inflamed because his new barber failed to sanitize his equipment between clients.

Most short hairstyles, from the old school fades to the low, tapered and bald looks, require maintenance on a weekly or biweekly basis to look well-groomed. Frequent haircuts, bigger crowds in barbershops and busy barbers skipping the sanitation process between clients, helps spread the bacteria that causes AKN and the chronic inflammation that incites the development of permanent keloid scars.

AKN rarely occurs, or worsens if it exists, when folks (a) cut their own hair, sanitize religiously and don’t share clippers, (b) take their own equipment to the barbershop, or (c) go to a shop that is diligent about sanitizing. I’ve discovered, with very few exceptions, that barbers either have a low-to-non-existent incidence of AKN, or it occurs on a daily basis, spreading like wildfire to the shop’s clients. Either barbers sanitize thoroughly, or they don’t.

Traditional medicine provides either minimal relief or disappointing results in the vast majority of cases. Standard medical treatment includes (a.) oral antibiotics, systemic drugs used to treat a localized follicular disorder, (b.) retinoid creams, peeling agents that lack anti-bacterial and anti-inflammatory properties, (c.) a series of painful corticosteroid (Kenalog) injections into the bumps, designed to shrink scar tissue with often disappointing results, often worsening the condition, and (d.) scar revision surgery, designed to remove the entire involved area with a single incision, many if which become thick, protruding, cigar-shaped hypertrophic scars when   they heal.

As an inner-city skin care professional who has managed hundreds of AKN cases, I’ve helped countless men control, and sometimes even “erase” this preventable condition. During the initial consultation, I describe this scenario: “So, you go into the shop because you need a haircut or maybe just a quick taper and line. Several licensed barbers are buzzing away at a dozen scalps before one of them turns, looks directly at you and says: ‘Next!….I mean you, bra.’ And, after they call you to the chair, do you always witness a thorough sanitation of every clipper and liner blade and attachment before you get a haircut or a line? Well, do you?” This quick speech is usually met with stunned silence.

Exercise your rights. Insist that your barber follow standard sanitation procedures and disinfect combs, brushes and plastic clipper attachments in Barbicide and thoroughly spray clipper and trimmer blades, scissors, guards, metal attachments and even that little brush used to remove hair from clipper blades, between each and every client.

Early detection and appropriate treatment are crucial to the clearing process and will prevent scarring and hair loss. Try to compromise on that totally bald look for a while. Allow your hair to grow out a bit and wear that “low” style for a quick minute to speed up the healing process.

Important: Unhealthy lifestyle habits can aggravate AKN, including picking, scratching, rubbing with a towel and other forms of skin tampering, tight baseball caps, direct sun, obesity or being overweight, marijuana, extreme stress, lack of sleep, slacking up on corrective home care, and dietary iodides, including salt, milk, cheese, fast food, processed food, soups, sports drinks and salty snacks.

Follow prescribed home treatment exactly as directed, make important lifestyle changes, keep your weight in check, avoid direct sun, and call a halt to all the picking, rubbing and scratching. If you do, your mild-to-moderate case will improve dramatically. Even a severe case of AKN will begin to calm down.

Professional treatments can help exfoliate smaller bumps and soften, thin out and lighten scar tissue. Frequent follow-up visits, emails and phone calls allow us to evaluate your progress and product usage and monitor your lifestyle until clearing is achieved and maintained.

©2000, 2001, 2003, 2003, 2004, 2005, 2006 Kathryn Leverette

The material on this website is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment.