Pseudofolliculitis of the Beard

Pseudofolliculitis of the Beard

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Pseudofolliculitis barbae (PFB) or shaving bumps is a foreign body inflammatory reaction involving papules and pustules. It primarily affects curly haired males who shave. [1] Pseudofolliculitis barbae can also affect some white men and hirsute black women. Pseudofolliculitis pubis is a similar condition occurring after pubic hair is shaved.

Two mechanisms are involved in the pathogenesis of pseudofolliculitis barbae: (1) extrafollicular penetration occurs when a curly hair reenters the skin, and (2) transfollicular penetration occurs when the sharp tip of a growing hair pierces the follicle wall.

Black men who shave are predisposed to this condition because of their tightly curved hair. The sharp pointed hair from a recent shave briefly surfaces from the skin and reenters a short distance away. Several methods of close shaving result in a hair cut below the surface. These methods include pulling the skin taut while shaving, shaving against the grain, plucking hairs with tweezers, removing hairs with electrolysis, and using double- or triple-bladed razors. The close shave results in a sharp tip below the skin surface, which is then more likely to pierce the follicular wall, causing pseudofolliculitis barbae with transfollicular penetration. [2, 3]

African Americans are genetically predisposed to pseudofolliculitis barbae because of the curvature of their hair follicles. Improper shaving techniques and the desire for a clean-shaven appearance can result in ingrown hairs via extrafollicular or transfollicular penetration.

About 10-80% of adult black men have pseudofolliculitis barbae, particularly those who shave closely on a regular basis. [4] It is a significant problem in black men in the military where regulations require a clean-shaven face. [5]

Pseudofolliculitis barbae is found mostly in black men.

Men with facial hair comprise most patients, although hirsute women can also develop pseudofolliculitis barbae. Both sexes can develop pseudofolliculitis pubis. Common sites in black women and those of ethnic backgrounds characterized by darker skin include the pubic and axillary areas because these are more frequent sites of hair removal in this population.

Pseudofolliculitis barbae affects men with facial hair (postpuberty).

Although usually not regarded as a serious medical problem, pseudofolliculitis barbae can cause cosmetic disfigurement. The papules can lead to scarring, postinflammatory hyperpigmentation, secondary infection, and keloid formation. No cure exists, but effective treatment is available. If the patient is able to grow a beard, the problem usually disappears (except for any residual scarring).

Instruct the patient to stop shaving for 3-4 weeks. This gives adequate time for the hair follicles to grow to a length where ingrown hairs will spring free.

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Quarles FN, Brody H, Johnson BA, et al. Pseudofolliculitis barbae. Dermatol Ther. 2007 May-Jun. 20(3):133-6. [Medline].

Kindred C, Oresajo CO, Yatskayer M, Halder RM. Comparative evaluation of men’s depilatory composition versus razor in black men. Cutis. 2011 Aug. 88(2):98-103. [Medline].

Adotama P, Tinker D, Mitchell K, Glass DA 2nd, Allen P. Barber Knowledge and Recommendations Regarding Pseudofolliculitis Barbae and Acne Keloidalis Nuchae in an Urban Setting. JAMA Dermatol. 2017 Dec 1. 153 (12):1325-1326. [Medline].

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Chuh A, Zawar V. Epiluminescence dermatoscopy enhanced patient compliance and achieved treatment success in pseudofolliculitis barbae. Australas J Dermatol. 2006 Feb. 47(1):60-2. [Medline].

Kaliyadan F, Kuruvilla J, Al Ojail HY, Quadri SA. Clinical and Dermoscopic Study of Pseudofolliculitis of the Beard Area. Int J Trichology. 2016 Jan-Mar. 8 (1):40-2. [Medline].

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Childs ND. Tretinoin, hydrocortisone cream controls PFB. Skin and Allergy News. 1999. 30(5):20.

Kligman AM, Mills OH Jr. Pseudofolliculitis of the beard and topically applied tretinoin. Arch Dermatol. 1973 Apr. 107(4):551-2. [Medline].

Taylor S. Open-Label Case Study on Triple-Combination Cream in Patients with Pseudofolliculitis Barbae. J Am Acad Dermatol. 2005. 52:P169.

Callender V, Young CM. Combination Laser and Eflornithine HCL 13.9% Cream: A First-line Therapy for Fitzpatrick Type IV-VI Patients With Excessive Facial Hair. J Am Acad Dermatol. Mar 2005. 52(3) suppl:P209.

Brown LA Jr. Pathogenesis and treatment of pseudofolliculitis barbae. Cutis. 1983 Oct. 32(4):373-5. [Medline].

Leyden JJ. Topical treatment for the inflamed lesion in acne, rosacea, and pseudofolliculitis barbae. Cutis. 2004 Jun. 73(6 Suppl):4-5. [Medline].

Alexander AM, Delph WI. Pseudofolliculitis barbae in the military. A medical, administrative and social problem. J Natl Med Assoc. 1974 Nov. 66(6):459-64, 479. [Medline].

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Bridgeman-Shah S. The medical and surgical therapy of pseudofolliculitis barbae. Dermatol Ther. 2004. 17(2):158-63. [Medline].

Kauvar AN. Treatment of pseudofolliculitis with a pulsed infrared laser. Arch Dermatol. 2000 Nov. 136(11):1343-6. [Medline].

Perry PK, Cook-Bolden FE, Rahman Z, Jones E, Taylor SC. Defining pseudofolliculitis barbae in 2001: a review of the literature and current trends. J Am Acad Dermatol. 2002 Feb. 46(2 Suppl Understanding):S113-9. [Medline].

Robins P, Battle EF Jr, Alexis AF, Cook-Bolden F, Alqubaisy Y, McLeod MP, et al. Unique laser techniques in patients with skin of color. J Drugs Dermatol. 2011 Dec 1. 10(12):4-26. [Medline].

Schulze R, Meehan KJ, Lopez A, et al. Low-fluence 1,064-nm laser hair reduction for pseudofolliculitis barbae in skin types IV, V, and VI. Dermatol Surg. 2009 Jan. 35(1):98-107. [Medline].

Ross EV, Cooke LM, Timko AL, Overstreet KA, Graham BS, Barnette DJ. Treatment of pseudofolliculitis barbae in skin types IV, V, and VI with a long-pulsed neodymium:yttrium aluminum garnet laser. J Am Acad Dermatol. 2002 Aug. 47(2):263-70. [Medline].

Emer JJ. Best practices and evidenced-based use of the 800 nm diode laser for the treatment of pseudofolliculitis barbae in skin of color. J Drugs Dermatol. 2011 Dec. 10(12 Suppl):s20-2. [Medline].

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Thomas G Greidanus, MD Emergency Physician, Parkview Medical Center

Thomas G Greidanus, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Association for Physician Leadership, American College of Emergency Physicians, American Medical Association, Colorado Medical Society

Disclosure: Nothing to disclose.

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Jaggi Rao, MD, FRCPC Clinical Professor of Medicine, Division of Dermatology and Cutaneous Sciences, Director of Dermatology Residency Program, University of Alberta Faculty of Medicine and Dentistry

Jaggi Rao, MD, FRCPC is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, Canadian Medical Association, Pacific Dermatologic Association, Royal College of Physicians and Surgeons of Canada, Canadian Medical Protective Association, Canadian Dermatology Association

Disclosure: Nothing to disclose.

Beth Honl, MD Dermatology Associates, PC; Private Practice

Beth Honl, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association

Disclosure: Nothing to disclose.

Pseudofolliculitis of the Beard

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