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[News] Stroke continues to be a major disease within black communities.  African-American
men between the ages of 35-54 years have 4x greater risk of stroke than any other
race. Find out more about this disease and other neurological diseases affecting black
people in our neurology page.[Site of the Month] Visit the Alzheimer's Disease Education Ceter to find out about this disease. [Events]  July is the month for: Alzheimer's Awareness Week Sickle Cell Awareness Day
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Fillers
Keloids Following any injury to the skin, a series of steps are set in motion leading to the production of scar tissue. When these steps are abnormal, exuberant wound healing takes place leading to keloid formation. Keloids appear as raised, firm skin tissue that extends outside the confines of the site of the initial inciting trauma. The tendency to form keloids may be inherited, but broadly speaking people of color appear to be at greater risk. Infact, studies indicate that keloids occur up to 3 to 18 times more often in black persons as compared to white persons. Keloids generally occur many months to years after the initial injury or trauma (apparent or unapparent). When keloids form, they are often very challenging to treat. For this reason, it is advisable for blacks to avoid non-essential surgical and cosmetic procedures-I have personally seen many cases of keloids arising on the earlobes as a result of ear piercing in adults during my dermatological practice. With regard to cosmetic procedures, it is always advisable to discuss the risk of keloidal scarring and other complications with your pysician before embarking on any procedure, this is especially important for those individuals with a personal or family history of keloidal scarring. For a more in-depth review of keloids please read our review on this topic in our skin section. Laser Hair removal Up until recent years, most of the published studies on laser therapy have focused on Caucasian skin. However, there is now an increasing amount of data on the use of lasers in blacks and other people of color. Such lasers are commonly referred to as ‘color-blind’ lasers in the lay media, and they can be used for treating a range of conditions. Herein, I will discuss their use for hair removal in blacks. Prior to the development of ‘color- blind’ lasers, the ideal candidate for laser hair removal was a fair-skinned person with dark hair. The reason was that the contrast in the pigmentation between superficial layers of the skin (fair) and deeper hair follicles (dark) ensured that the laser energy reached its target (hair follicle) and was not absorbed by pigment in the superficial layers of the skin. In blacks, this theory did not hold true and the concern was that there was a risk that laser energy will be absorbed by the melanin pigment in the surface of the skin, prior to reaching its target in deeper layers of skin (hair follicles). This will produce complications such as scarring and pigmentary changes. The work of dedicated pioneers in this field demonstrated that the problem alluded to above could be reduced by using 1) longer wavelength lasers, 2) longer pulse duration of the lasers and 3) effective cooling of the skin while performing laser hair removal. This led to the development of ‘color-blind lasers’ and currently in the U.S. the Food and Drug Administration has approved the Nd:YAG (1064nm) and Diode (810nm) lasers for hair removal in darker skin types. These lasers may be used by dermatologists as an adjunctive treatment for hirsutism (excessive hair growth, especially on the face of women), pseudofolliculitis barbae (shaving bumps) and acne keloidalis nuchae (please visit our skin section for an in-depth discussion of these skin disorders). Pre-procedure Broadly speaking, prior to undertaking laser hair removal it is important that your physician performs a test spot, allowing a 48-hour interval to assess your response to this test laser. By doing this, the physician can determine the most appropriate and safest settings for the hair removal laser. It is important that your physician performs a test spot that is in the same or similar area to be treated, with close match with regard to skin color, sun exposure and hair density. A thorough medical history should also be undertaken prior to performing laser hair removal, this includes documentation and discussion about a personal or family history of keloid scarring and of active or chronic herpes viral infection (cold sores). A positive history of such herpes infection may lead your physician to give you prophylactic antiviral medication. The use of isotretinoin (used to treat acne) is thought to be a contraindication for performing laser hair removal. In this situation, the current recommendation is to stop this medication for 6 months prior to performing laser hair removal. Procedure During the procedure, the area to be treated will be wiped clean by your practitioner. Once the laser hair removal is undertaken, there may be a slight level of discomfort. This can be minimized by the use of topical anesthetic agents or cooling of the skin. If topical anesthetic agents are used, it is important that they are wiped away before laser hair removal is performed. Appropriate goggles should also be worn by both the treating physician and the patient. With treatment of the upper lip or chin, the enamel of the teeth should also be protected. During the procedure significant pain may indicate that the settings used for the laser is too high and for this reason such discomfort should be communicated to your physician. Adverse effects Adverse effects can be minimized, provided care is taken during the procedure to ensure safe settings of the laser are used, in association with appropriate cooling techniques. If adverse effects occur, the range of reactions that may be observed include crusting, scabbing and blistering of the skin, pigmentary alterations of the skin, scarring and folliculitis (inflammation of the hair follicles). Although the advent of color-blind lasers enables blacks and other people of color to undertake laser hair removal, my personal opinion is that before embarking on laser hair removal:
Final
point
Send your comments about this review article to comments@blackhealthmatters.com Scientific References
Written by Dr Ophelia Dadzie BSc, MBBS,
MRCP (UK) |
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World
AIDS day in December was a special opportunity 
Soft tissue fillers are a group of synthetic and natural agents, which may be injected
or inserted into the skin for cosmetic and medical reconstructive reasons. This
includes their use to minimize facial wrinkles and to volumize the lips. Medical
indications for the use of soft tissue fillers includes the treatment of HIV
associated facial lipo-atrophy (loss of fat). The field of soft tissue fillers
is continuously changing, as new products are developed and marketed worldwide.
Broadly speaking, soft tissue fillers can be classified into two categories;
biodegradable vs. non-biodegradable, based on the ability of the human body to
break them down. Differences exists in their derivation (natural vs. synthetic),
clinical indications, duration of effect and efficacy. Furthermore, it is important
to note that similar products maybe marketed around the world using different
brand names. Prior to undertaking soft tissue augmentation, it is advisable that
people of color discuss with their dermatologist the pros and cons of this procedure.
It is also advisable to seek a dermatologist who is familiar with the use of
soft tissue fillers in people of color, to minimize the risk of complications.
Table 1 and 2 provides a brief overview of some commonly utilized soft tissue
fillers.