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Basics ⬇

Other Information ⬆

Pseudofolliculitis Barbae (PFB)

Pathogenesis

  • Tightly coiled hairs emerge from curved hair follicles (Illus. 19.2).

  • When shaved, the hair becomes a sharp tip that curves downward as it grows and reenters the epidermis; or, the sharpened hair may grow parallel to the skin and penetrate it resulting in an inflammatory foreign body-like reaction.

  • Furthermore, newly erupting hairs from below may pierce and aggravate areas that are already inflamed.

Clinical Manifestations

  • Lesions consist of inflammatory papules and pustules typically found on the beard, neck, and submental areas (Fig. 19.21).

  • Ultimately, persistent flesh-colored papules that represent hypertrophic scars and postinflammatory pigmented lesions become prominent clinical features.

  • On close inspection, tight, curly hairs can be seen penetrating the skin (Fig. 19.22).

Diagnosis

  • Diagnosis is apparent on clinical examination.

Diagnosis-icon.jpg Differential Diagnosis

Acne Vulgaris

  • Lesions are usually not confined to the neck; however, the distinction from PFB may be difficult.

Bacterial Folliculitis

  • As with acne, folliculitis may look exactly like PFB.

Management-icon.jpg Management

Preventive Measures

  • Discontinuance of shaving is helpful; however, this is generally not a choice desired by most patients.

  • Patients may avoid close shaving by using a guarded razor (e.g., PFB Bump Fighter). This razor is covered with a plastic coating that prevents the razor from contacting the skin directly. The use of an electric razor is another method that reduces the closeness of the shave.

  • Hairs may be lifted with a fine needle or a toothpick before they penetrate the skin (Fig. 19.23).

  • Patients should be advised not to pluck hairs because new hairs will again grow from below and penetrate a site that is already inflamed.

Treatment

  • Treatment is difficult.

  • Nonfluorinated, class 5 or 6 topical steroids are used for inflammation and itching.

  • Topical antibiotics such as Benzamycin, BenzaClin, or Duac gel (these combine clindamycin and benzoyl peroxide) applied once daily to the affected areas often reduces inflammation.

  • Systemic antibiotics such as minocycline or doxycycline are helpful when marked inflammation and pustulation are present.

  • Chemical depilatories such as Magic Shave and Royal Crown powders are effective in removing and softening hairs; the main disadvantages are that they are irritating and they have an unpleasant odor.

  • Hair destruction using an extended-pulse width laser has been shown to be effective.

  • Eflornithine hydrochloride 13.9% (Vaniqa) is an enzyme inhibitor that slows hair growth (discussed in Chapter 20: Hirsutism).

  • Electrolysis is difficult to use on inflammatory foci as well as on curly hair, but it can be partially effective as an adjunctive treatment method.

SEE PATIENT HANDOUT “Pseudofolliculitis Barbae (Razor Bumps)” IN THE COMPANION eBOOK EDITION.