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Adotama P, Tinker D, Mitchell K, Glass DA, Allen P. Barber Knowledge and Recommendations Regarding Pseudofolliculitis Barbae and Acne Keloidalis Nuchae in an Urban Setting. JAMA Dermatol. 2017;153(12):1325–1326. doi:10.1001/jamadermatol.2017.3668
Pseudofolliculitis barbae (PFB) and acne keloidalis nuchae (AKN) are chronic inflammatory conditions affecting hair follicles common in men of color who are genetically inclined to have tightly curled hair.1 The incidence of PFB and AKN among African American men may be as high as 83.0% and 13.6%, respectively.2,3
The barbershop represents a distinctly important institution in the African American community and constitutes a culturally appropriate venue for barbers to provide men with health information.4
The knowledge and expertise afforded by barbers regarding dermatologic evaluation and intervention of common scalp and hair problems in this population has not been evaluated. The aim of this cross-sectional study was to assess barber perceptions and recommendations regarding PFB and AKN in predominantly African American barbershops.
This cross-sectional study was approved by the institutional review board at the University of Oklahoma Health Sciences Center, Oklahoma City. We collected a list of barbershops in the greater Oklahoma City area servicing predominantly African American clientele. No more than 2 barbers were selected at each shop. Each barber provided verbal consent and participated in a 20-question survey. Each barber was then given an educational pamphlet on PFB and AKN. The pamphlet showed digital images of these skin conditions and explained how to manage them or when to refer to a dermatologist. All the data was collected using REDCAP (Research Electronic Data Capture).
Fifty barbers from 37 barbershops in greater Oklahoma City were enrolled from April through May, 2017. Of these, 39 barbers (78%) properly identified PFB while only 22 (44%) were able to identify AKN from a photograph. Eight barbers (16%) confused PFB with tinea barbae, a fungal infection limited to the bearded region, and 15 (30%) confused AKN with tinea barbae.
Twenty-nine barbers (58%) indicated that they avoid cutting the hair of clients who have PFB and 23 (46%) avoid cutting hair of clients who have AKN. Among the respondents, 47 (94%) knew that razor use would aggravate AKN and 49 (98%) knew it would aggravate PFB. Nineteen barbers (38%) advised clients with PFB and 26 (52%) counseled clients with AKN to never shave at home. Twenty-two barbers (44%) counseled clients to shave with clippers at home for PFB and 14 (28%) for AKN (Figure). Recommendation to use chemical depilatories was not favored.
The majority of the barbers identified PFB. It was more difficult to identify AKN, with only 44% of participants recognizing this condition. Tinea barbae was a competing diagnosis for PFB (16%) and, more commonly, for AKN (30%). This suggests that more education for barbers regarding diagnosis and treatment of fungal infections is necessary. While 94% of barbers knew that razor use would worsen PFB and 98% knew that razor use would worsen AKN, their ideas on how to address these conditions differed widely (Figure). Avoiding shaving completely is a valid consideration and arguably the most effective way to treat both conditions; however, this approach severely limits styling and grooming practice options for a client. Dermatologists have an opportunity to educate barbers about various treatment options available, such as chemical depilatories, clippers use, or referral to a dermatologist for topical or oral prescription medications or laser hair removal.
A 2014 review of barber-administered health education programs in African American communities showed that educational training promotes positive health behaviors among customers.4 Barbers represent a unique resource to communicate medical information to clients. This opens a potential collaborative opportunity among barbers, clients, and health care professionals.
Limitations of this study include recall bias and generalizability because of data collection in a single city.
Barbers can identify PFB and, in fewer clients, AKN, and often advise them how to care for these medical conditions. The dermatologic community can offer appropriate guidance so that barbers can become a unique ally in recognizing and treating PFB and AKN.
Corresponding Author: Pamela Allen, MD, Department of Dermatology, University of Oklahoma Health Science Center, 619 NE 13th St, Oklahoma City, OK 73104 (email@example.com).
Accepted for Publication: July 30, 2017.
Published Online: October 18, 2017. doi:10.1001/jamadermatol.2017.3668
Author Contributions: Dr Adotama and Mr Tinker had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Adotama, Glass, Allen.
Acquisition, analysis, or interpretation of data: Adotama, Tinker, Mitchell.
Drafting of the manuscript: Adotama, Tinker, Mitchell.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Adotama, Tinker, Mitchell.
Administrative, technical, or material support: Adotama, Tinker, Mitchell.
Study supervision: Adotama, Tinker, Allen.
Conflict of Interest Disclosures: None reported.
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