Summer Edition, Volume 1, Issue 1: What Every Black Person Should Know About the Skin, Hair and Nails...

What Every Black Person Should Know About the Skin, Hair and Nails

MOLES ON THE FACE…

When I sat down to write this article in the first edition of Shades magazine, my challenge was how to convey my life experience from my birth in Haskell, Oklahoma to my present occupation as a practicing (Black) dermatologist.

Maybe I should relate my earlier years growing up on my Grandfathers’ farm in Haskell, or relocating to Muskogee, to finish high school and the “Manual Training” High School in 1969. During that formative time, I suffered from a skin condition that basically made my personal and social life difficult in many ways. 

The story of the day that changed my life happened on a hot Saturday, summer day in July 1970, where I attended Brown University under a seven year Bachelor of Arts, Master of Medical Science and Medical Doctor Program.  I was working on my Masters research project in a lab at Roger Williams Hospital in Providence, R.I. That day Dr. A. Paul Kelly, a Black Dermatologist was taking a short cut through my lab. He noticed the “Rash” on my face and neck, diagnosed it as Tinea Versicolor and recommended a four day treatment of Selsun Blue. The same rash that I had been told I would have the rest of my life by 5 or 6 other (non-dermatologic) doctors was clear in a week. Not only was my rash clear, but a Black doctor (a dermatologist) was responsible for my life-changing experience (for my “cure”) through a chance meeting (destiny?).

Although my main interest had been medical research, from that point on, I wanted to be a dermatologist. After graduating from Brown in 1977 with all three degrees, I completed my one year medical internship at the Washington Hospital Center in Washington, D.C.  After my internship I started my three years of Dermatology Residency Specialty training at Barnes Hospital, Washington University Medical Center, in St. Louis, Missouri, considered one of the top 5 dermatology programs in the country in June, 1978. Over those next 3 years I experienced a wide range of dermatologic problems/disorders in a diverse patient population, which even today, I still find amazing. 

I graduated from Barnes as the first Black resident to enter and complete their program in May, 1981. In August 1981, I started my dermatologic practice in Oklahoma City as the first Black Dermatologist in Oklahoma.

Over these 37 years (1978 to 2015), I have evaluated and managed a diversity of dermatologic disorders in whatever ethnicity walked in my door. However, as a Black Dermatologist, I have personal and experiential insight into disorders of skin of color. I’ve learned over the years that in order to provide the best and proper treatment to Black patients, I usually have to address misinformation, misconceptions and outright lies about Black skin, hair and nails. 

In this and future articles I will detail disorders/conditions unique to pigmented or black (dark) toned skin while addressing many of these misconceptions from my perspective. Disorders and problems, as Lupus, hair loss in Black women, Vitiligo, Keloids, laser hair removal for unwanted facial hair in women, razor bumps (ingrown hairs) in Black men and women. If you have a question send it to Shades and we will address it. Our goal is to provide you experienced information and education.

You may be one of the number of Africans American women and men who have dark growths on the face, which you call “moles”. These growths, in fact, usually are not moles at all, but represent a skin condition almost unique to blacks called dermatosis papulosa nigra (DPN)…. (to a lesser degree, other peoples of color have this condition as the Asian, Mexican, Native American, and Native African.) Because DPN is a hereditary skill condition, persons with DPN usually will give a history of a grandparent, parent, brother or sister with similar bumps on the face. ..and can also occur on other body areas, as the neck and trunk.

DPN appears as dark (more black than brown) small pinpoint growths or a flat brown blotch. Most DPN get larger with time. The growth may stop at apple seed size or may continue reaching a size of a half-dollar. New DPN develop with time and through continued growth, separate bumps merge to form a single large plaque (raised rough area on the skin). I’ve actually removed lesions the size of my hand that have merged together over a number of years.

In my experience, pregnancy can cause an increase in both number and size of the growths. DPN most commonly occurs on the face (cheeks, forehead, eyelids) and neck.. However, some people have many DPN on the trunk (back, chest and stomach). The first DPN may appear as early as puberty and even as young as seven years old.

A similar condition occurring on the trunk producing greasy brownish black stuck-on bumps is seborrheic keratosis (SK).  It is now generally accepted that DPNs are SKs of the face and neck areas. SK usually starts after age 30. Both DPN and SK are excessive thickening of the top layer of skin (epidermis). Although they may look like a true mole, which is a cluster of pigment cells, a SK is on the skin and not in the skin. Other skin lesions most be differentiated from SKs as warts, true moles (nevi) and especially Melanoma.

Both DPN and SK can be itchy and very easily irritated by you or your clothes rubbing against them. Unfortunately, an irritated SK can resemble and must be distinguished from Malignant Melanoma that can develop from a true mole. Although not nearly as present as in fair skin, Malignant Melanoma does occur in African Americans.  Although it is uncommon, its incidence is increasing. Melanoma type of skin cancer can be fatal if not diagnosed and completely excised at the earliest time. Careful and experienced examination of the growth usually provides separation between DPN/SK and Malignant Melanoma.

DPN/SK can and should be treated. This is true especially when they grow quickly, turn colors especially black or cause symptoms as itching, bleeding or get irritated rubbing on clothing or jewelry.  Or if no symptoms you may desire removal because they are of cosmetic concern. In my years of experience in many cases the best form of treatment is very gentle freezing of the bumps using liquid nitrogen (cryosurgery). Freezing does sting! I advise patients that the stinging is temporary especially for small lesions but can be longer for larger lesions, but usually subsides in a few minutes. Topical anesthetics can be used to reduce this discomfort after cryosurgery.  The SK turns reddish and hive-like, and over time with instructed care “peels” off the skin. Although I’m sure it sounds scary this technique is much safer with better results for skin of color than removal by electro surgery or “burning it off!”.

In experienced hands, the growths come off after freezing usually in five to twelve  days, leaving a temporary light or dark spot that usually returns to the normal skin color over several months. However, there’s more of a tendency for the skin to hyperpigment (turn dark) from freezing removal of the SK. Although time can blend to normal in many cases, I usually recommend a topical blending skin care regiment to expedite this process and to improve overall skin clarity. Minimal discomfort is felt during freezing. Even very small growths can be removed earlier using micro-tip applicators. The sooner the removal the better.

However, snip or shave removal excision of elevated skin “tag” growths on the eyelids and neck or underarms or breasts is a good therapy for this type. Flat brown spots may be removed with some of the newer lasers for pigmented lesions. I have used 532 nm lasers for removal of these lesions. With laser removal the brown spot usually darkens and peels off from the skin in 2-5 days. Like freezing, discoloration from removal is usually mild and blends in over time.

Once removed that DPN/SK is gone forever. Unfortunately, most people continue to grow new lesions requiring treatment every several years.

Therefore, if you are one of the millions of African Americans with DPN/SK or have close relatives with this condition, tell them.

• They are not “moles
• Removal is quick and easy
• The end result is very good.