HEALTH and ILLNESS in the Black Population ■ 285
carotene deposits can also cause the sclera to appear yellow. The buccal mucosa and the palms of the hands and soles of the feet may appear yellow.
Several skin conditions are of importance in Black patients (Sykes & Kelly, 1979):
1. Keloids. Keloids are scars that form at the site of a wound and grow beyond the normal boundaries of the wound. They are sharply elevated and irregular and continue to enlarge.
2. Pigmentary disorders. Pigmentary disorders, areas of either postin- flammatory hypopigmentation or hyperpigmentation, appear as dark or light spots.
3. Pseudofolliculitis. “Razor bumps” and “ingrown hairs” are caused by shaving too closely with an electric razor or straight razor. The sharp point of the hair, if shaved too close, enters the skin and induces an immune response as to a foreign body. The symptoms include papules, pustules, and sometimes even keloids.
4. Melasma. The “mask of pregnancy,” melasma, is a patchy tan to dark brown discoloration of the face more prevalent in dark pregnant women.
Hair Care Needs. The care of the hair of Blacks is not complicated, but special consideration must be given to help maintain its healthy condition (Bloch & Hunter, 1981):
1. The hair’s dryness or oiliness must be assessed, as well as its texture (straight or extra curly) and the patient’s hairstyle preference.
2. The hair must be shampooed as needed and groomed according to the person’s preference.
3. Hair must be combed well, with the appropriate tools, such as a “pic” or comb with big teeth, before drying to prevent tangles.
4. If the hair is dry and needs oiling, the preparations that the person generally uses for this purpose ought to be on hand.
5. Once dry, the hair is ready to be styled (curled, braided, or rolled) as the person desires.
Additional Considerations. The majority of the members of the health care profession are steeped in a middle-class White value system. In clinical settings, providers are being helped to become familiar with and understand the value systems of other ethnic and socioeconomic groups. They are being taught to recognize the symptoms of illness in Blacks and to provide proper skin and hair care. The following are guidelines that a health care provider can follow in caring for members of the Black community:
1. The education of an ever-increasing number of Blacks in the health professions must continue to be encouraged.
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2. The needs of the patient must be assessed realistically. 3. When a treatment or special diet is prescribed, every attempt must be
made to ascertain whether it is consistent with the patient’s physical needs, cultural background, income, and religious practices.
4. The patient’s belief in and practice of folk medicine must be respected; the patient must not be criticized for these beliefs. Every effort should be made to assist the patient to combine folk treatment with standard Western treatment, as long as the two are not antagonistic. Many people who have a strong belief in folk remedies continue to use them with or without medical sanction.
5. Providers should be familiar with formal and informal sources of help in the Black community. The formal sources consist of churches, social clubs, and community groups. The informal ones include the women who provide care for members of their community in an informal way.