by Kathryn Khadija Leverette
Occurring in the occipital scalp area, the back of the neck, and in some cases, the entire scalp, acne keloiditis (inflamed and pustular) and acne keloidalis (inflamed and scarred), usually appear spontaneously after black men get their hair cut close to the scalp using unsanitized clipper and T-edgers. It is not uncommon for clippers, edgers, blades and attachments to have been used on tens of dozens of clients before them.

Shorter hairstyles, starting several years ago with the high-top fade and evolving into the low Louisville styles and bald look, require maintenance on a weekly or biweekly basis. Getting haircuts more often, bigger crowds in barbershops due to the popularity of low and bald hairstyles, and an alarming lack of barbershop sanitation of clippers and attachments between clients, spreads bacteria and incites severe inflammation. Constant and prolonged inflammation, worsened by frequent visits to barbershops, unlicensed roving neighborhood "barbers" or jailhouse barbers that skip sanitation techniques, can lead to keloid disease of the scalp and permanent hair loss.

Coming up in the early to mid-60s, I lived in the Hancock Park district of Los Angeles and attended Los Angeles High School of TV's Room 222 fame, but long before they filmed Room 222. Way back in the day, a few Black men wore the "do rag" over long processed waves, but the majority wore the popular low "quo vadis" hairstyle, especially students, athletes and most of the African-American work force. I can’t recall seeing a single case of acne keloiditis on my homeys back then. But, this is now………

Acne keloiditis rarely occurs, or worsens if it exists, when folks (a.) cut their own hair and don't share clippers, (b.) take their own clippers and T-edgers 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 acne keloiditis, or it is rampant among patrons and a daily occurrence. Either a barber sanitizes thoroughly, or he (she) doesn’t! Period.

One successful rapper/producer, who relocated several years ago from Oakland to Atlanta, is one of my longtime clients. He frequented only two barbershops in Oakland and never suffered from acne keloiditis. A short period of time after he relocated, he got back on a plane and came back to see me. His normally smooth bald head had become unsightly and painful almost overnight.

A painful and disfiguring scalp problem, acne keloiditis is a chronic disorder fueled by lack of barbershop sanitation and the resulting inflammation. It often causes severe hypertrophic (raised) scarring (acne keloidalis), keloids that swell, bleed, itch and grow like wildfire, and permanent hair loss in the involved area. it is not uncommon for this condition to cause inflamed lesions to erupt and bleed during sleep and after showering. Traditional medical treatment gives 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.) Retin-A™ cream, a peeling agent that lacks 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, including a dramatic worsening of the condition, and (d.) scar revision surgery, designed to remove the entire involved area with a single incision, which almost always creates a thick, permanent, protruding, cigar-shaped hypertrophic scar in its wake. The result is much worse than the original condition in virtually every case.

As an inner-city skin care professional who has managed thousands of acne keloiditis cases over the last two decades, I have been able to help countless men control, and even "erase" this preventable condition. During the initial consultation, I describe the following scenario: "So, you go into the shop ‘cause it’s almost Friday night and you’re ready to party, and you gotta look good. Or, you just need a taper and a line. Four or five licensed barbers are buzzing away at a dozen scalps before one of them turns, looks directly at you and says: ‘Next!....Yeh, I mean you, brotha.’ And, after they call you to the chair, do you witness a thorough sanitation of every clipper and T-edger blade, guard and attachment each and every time you get a haircut or a line? Well, do you?" My little speech is usually met with stunned silence. I come back with: "HELLO!" (Can I get a witness here?)
Exercise your right to insist on standard State Law-required barbershop sanitation procedures, including disinfecting all combs, brushes and plastic clipper attachments in Barbicide and thoroughly spraying Clippercide or Oster Clipper Disinfectant on all clipper and T-edger blades, scissors, guards, metal attachments, etc. between each and every client.

Try to compromise on totally bald styles for a while. Wear a "low" style for a quick minute, which will speed up the healing process and not aggravate the condition. If you allow your hair to grow out a bit, use our anti-bacterial, exfoliating and anti-inflammatory products, avoid direct sun exposure, and stop picking and scratching, a mild-to-moderate case will improve dramatically.

However, several factors can dramatically worsen this condition. These include picking, scratching, rubbing with a towel, and other forms of skin tampering, tight dirty baseball caps, direct sun, obesity or being overweight by 20 lbs or more, marijuana, extreme stress, lack of sleep, slacking up on home care, running out of products, and dietary iodides (salt, dairy, cheese,  fast food, processed food, salty snacks).

If home care products are used faithfully as directed, even severe cases can benefit from biweekly scar treatments, which help exfoliate smaller bumps and soften, thin out and lighten scar tissue. Sometimes, silicone gel and additional special products are necessary. Early detection, insisting on strict barbershop sanitation, daily home treatment, and exfoliating scar treatments can be the key to controlling acne this condition.

Follow-up visits and treatments should be scheduled every two weeks until clearing and control have been achieved. Always bring your home care products with you. Ask for information about our clinic scar treatments to boost your efforts at home. If you live out of the area, call every two to four weeks and before you reorder your products. We are available by phone (during office hours) and by email (seven days a week) to answer your questions and address your concerns. 
©2000, 2001, 2003, 2003, 2004, 2005, 2006 Kathryn Leverette