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pseudofolliculitis barbae

What is pseudofolliculitis barbae

Pseudofolliculitis barbae is also known as ‘shaving bumps’ or ‘razor bumps’, is inflammation of hair follicles and surrounding skin, caused by hairs trapped beneath the skin surface that affects men with tightly curved (or curly) hairs. When the tip of hair grows back under the skin or into the hair follicle, it is known as ingrown hair. If ingrown hair causes a reaction in the skin, it is known as razor bumps or pseudofolliculitis barbae. Pseudofolliculitis barbae is not an infection but rather a “foreign body” inflammatory reaction surrounding ingrown facial hairs, which results from shaving, much like the body would react to a splinter of wood in the skin. Pseudofolliculitis barbae can also occur on any body site where hair is shaved or plucked, including axilla, pubic area, and legs. It is also known as shaving rash or razor bumps. Pseudofolliculitis barbae may be worsened by methods used to achieve a close shave, such as pulling the skin tight while shaving, shaving against the “grain” or direction of hair growth, or using multi-blade razors.

Pseudofolliculitis barbae (razor bumps) usually affects more African American men than among Caucasian men who shave, although anyone with curly beard hair may be affected. Up to 80% of black men have this problem, but pseudofolliculitis barbae can also affect women of all races. Pseudofolliculitis barbae (razor bumps) may also occur in women who shave or pluck hair or undergo electrolysis. Recent research has confirmed a genetic predisposition to pseudofolliculitis barbae in the African population. A single nucleotide substitution in the hair follicle companion layer-specific keratin (K6hf) is shown to increase the chance of pseudofolliculitis barbae.

Folliculitis barbae and pseudofolliculitis barbae can co-exist. Folliculitis barbae is a type of folliculitis affecting the beard area due to infection with the bacteria Staphylococcus aureus. It occurs in men who shave and in men that do not shave. Deep-seated folliculitis barbae is called sycosis barbae and leads to scarring and areas of permanent hair loss.

Is pseudofolliculitis barbae hereditary?

No.

Can pseudofolliculitis barbae be cured?

Yes, if shaving, waxing or tweezing is stopped, though it may take 4-6 weeks for inflammation to settle and for the hairs to reach a length where ingrowth will not recur. If the practice of hair removal continues, the problem is likely to persist, although some measures can be taken to help.

Pseudofolliculitis barbae treatment tips

The only certain cure is to stop shaving, waxing or tweezing. Adjusting your shaving technique may sometimes help. There is no single technique that works for everyone because, for some people, the problem is due to hairs curling back into the skin, whilst for others, the cause is that hairs are cut so short that they retract. You should experiment to find the best method for yourself.

Wet shaving usually gives a closer shave than using an electric razor, but the choice is once again an individual one. Those who wet shave should avoid methods that give such a close shave that the hair retracts inside the follicle. The following is recommended:

  1. Shave in the direction of hair growth
  2. Avoid stretching the skin tight
  3. Use single blades
  4. Shave every second day rather than daily, if possible
  5. Aim for a stubble length of 1 mm, though the beard area will not look clean shaven
  6. Avoid plucking hairs

Other possibilities:

  • Ingrown hairs can be lifted out using a sterile needle, although this is not practical for those with widespread ingrown hairs. Brushing the skin gently with an abrasive sponge or toothbrush to ‘release’ the hair is less effective but quicker.
  • Some find that removing facial hair with a depilatory cream (a chemical that dissolves the hair) helps avoid ingrowing hair, but many find that these preparations irritate the skin.
  • Lasers and intense pulsed light can be used to reduce hair growth for prolonged periods but, in dark skin, there is a high risk of developing increased or decreased pigmentation of the skin.
  • Inflammation can be reduced by creams containing a steroid preparation, and antiseptic lotions reduce the risk of infection.
  • A short course of an oral antibiotic may be used to treat infection. Some antibiotics with additional anti-inflammatory effects may be used on a more long term basis in more severe cases.
  • Retinoid creams or retinoid/antibiotic combinations may occasionally be prescribed by your doctor or dermatologist.

Pseudofolliculitis barbae causes

Pseudofolliculitis barbae is due to shaving, particularly close shaving, because the cut hair may retract beneath the skin surface. Usually the hair has been cut too short resulting in the hair shaft retracting back into the hair follicle (ingrown hair). As the hair grows it can then break into the wall of the hair follicle, enter the surrounding skin and result in inflammation. It can also occur in skin folds and scars. It occurs mainly in people with curly hair because the curl of the hair means that the sharp pointed end of a recently shaved hair comes out from the skin and re-enters the skin close by causing a foreign body inflammatory reaction.

The injured follicles are highly susceptible to become infected, causing folliculitis barbae.

After shaving, patients may experience an acne-like eruption on the area that has been shaved, usually the face and neck of men.

  • Involvement of the skin under the jawline is typical, a site where the hair follicles grow in various directions.
  • Pseudofolliculitis barbae presents as ingrown hairs associated with flesh-coloured or red follicular papules, which may be itchy or tender.
  • Folliculitis barbae presents as painful pustules and can discharge pus.
  • Lesions may bleed when they are shaved.

Folliculitis barbae and pseudofolliculitis are aggravated by co-existent eczema/dermatitis.

Pseudofolliculitis barbae prevention

To prevent recurrence, follow a proper shaving regimen long term and consider hair removal. Methods may include:

  • Eflornithine cream
  • Chemical depilatories such as barium sulfide paste and calcium thioglycolate; these can be irritating
  • Intense pulsed light (IPL)
  • Laser hair removal, especially Nd:YAG and diode lasers, but there is a risk of causing white or dark marks in skin of colour.

Pseudofolliculitis barbae symptoms

Pseudofolliculitis barbae symptoms are skin-colored to red bumps or pimples of the shaved area, often with a hair visible in the center.

Pseudofolliculitis barbae complications

Complications of folliculitis and pseudofolliculitis barbae include:

  • Postinflammatory hyperpigmentation
  • Hypertrophic scarring and keloid formation
  • Temporary and permanent hair loss
  • Sycosis barbae – sinuses, abscesses and spreading infection due to infection and autoinflammatory reaction.

How is pseudofolliculitis barbae diagnosed?

Pseudofolliculitis barbae is a clinical diagnosis. Magnification, eg dermatoscopy, may be necessary to see the ingrown hairs. Folliculitis barbae is diagnosed by the presence of painful pustules.

Swabs may be taken for bacterial culture but are rarely necessary.

Pseudofolliculitis barbae treatment

Treatment for pseudofolliculitis barbae depends on the severity of the condition. If possible, let your beard grow for 30 days to eliminate ingrown hairs.

Medical treatment of pseudofolliculitis barbae:

  • Tretinoin cream used at night
  • Eflornithine cream to try and reduce hair growth
  • Topical or oral antibiotics. Oral tetracyclines are used to reduce inflammation.
  • Hydrocortisone cream can reduce mild inflammation and itching.
  • Topical acne treatments such as benzoyl peroxide and tretinoin are used to suppress follicular hyperkeratosis.
  • A combination of tretinoin, low-potency topical corticosteroid, and hydroquinone may be selected to decrease inflammation, hyperkeratosis and pigment production.
  • Photodynamic therapy has been successful.

Pseudofolliculitis barbae home remedies

A 100% effective treatment in treating pseudofolliculitis barbae or razor bumps is to let your beard grow. Once the hairs grow long enough, they will not grow back into the skin.

  • If you must continue shaving, initially let the beard grow for 30 days to eliminate ingrown hairs.
  • Use a polyester skin-cleansing pad (Buf-Puf™) twice a day. Or, use a moisturizing shaving foam.
  • Use of an electric shaver will help, as it does not cut as close as blades do. Special razors are commercially available.
  • If you must use a blade, before shaving, wash the face with a mild cleanser, such as Cetaphil® Moisturizing Lotion, then rinse. Massage the beard area gently in a circular motion with a warm, moist, soft washcloth. This will free up the hair tips so they can be cut with the shaver. The warm water will also soften the hairs, making them easier to cut. Lather the beard area with a non-irritating shaving gel, such as Aveeno® Therapeutic Shave Gel instead of cream, and shave in the direction of beard growth. After shaving is finished, rinse thoroughly with warm water and apply a mild moisturizing after shave lotion, such as Cetaphil lotion.
  • When you resume shaving, use a razor with a single blade. Razors with a double blade cut the hairs too short, allowing them to grow inward. Special “PFB” razors may also be tried, such as Aveeno PFB Bump Fighter Razor.
  • Shaving every other day, rather than daily, will help. Do not pull the skin taut shaving with a razor blade.
  • At night, apply a lotion containing glycolic acid to the affected areas. This exfoliates the surface skin cells and reduces the likelihood of new spots.

Some doctors recommend chemical shaving with products that contain calcium thioglycolate (Magic Shave) or barium sulfide. These chemicals dissolve the hair but may be irritating.

Consider laser hair removal. In some cases, this is the most effective measure.

If none of the home remedies help and you must continue shaving, seek medical help.

Health Jade Team

The author Health Jade Team

Health Jade