Pseudofolliculitis Barbae


Pseudofolliculitis Barbae, Razor Bumps

  • Pathophysiology
  1. As per the name, not a Folliculitis
  2. Tightly curled hair penetrates skin when closely shaved
    1. Results in local, foreign-body inflammatory response
  • Epidemiology
  1. Most common in black men (45-85% Prevalence) and hispanic men
  2. Women may also be affected in areas of shaving
  • Signs
  1. Hyperpigmented Papules and Pustules in beard and other areas of shaving
    1. Dermoscopy can visualize follicular penetration by hairs
  2. Distribution
    1. Men: Beard area
    2. Women: Face, axilla and suprapubic region
  • Management
  • General Measures
  1. Most effective treatment and prevetion of recurrence is to stop hair removal
    1. Avoid shaving for at least 8 weeks after diagnosis
  2. Consider permanent hair reduction (e.g. Chemical Peel, laser therapy)
    1. See Hair Removal Technique
    2. Laser Hair Removal with adjunctive eflornithine 13.9% (Vaniqa) may offer best results
      1. Amer (2021) Dermatol Ther 34(2): e14859 [PubMed]
  3. Optimize shaving technique
    1. Avoid a close shave (leave hairs at least 0.5 mm long)
      1. Consider electric razors set to leave 1 to 3 mm
      2. Otherwise use hair clippers or a single-blade razor
      3. Replace razors after 5 uses
    2. Depilatories (e.g. barium sulfide powder, Calcium thioglycolate cream) may be used if not irritating
    3. Shave in Hair Growth direction (with the grain)
    4. Avoid pulling skin taught while shaving
    5. Avoid plucking hair
    6. Use short, slow strokes with razor in a single pass over an area
    7. Loosen embedded hairs prior to shaving (e.g. brush, apply compresses, or rub with towel)
      1. Warm compress, circular massage for 5 minutes over shaved area to release embedded hairs
      2. After shaving, apply cool compresses for 5 minutes
    8. Avoid dry shaving (apply a preshave oil or shaving cream first)
    9. Shave at least every 1 to 3 days
      1. Prevents Hair Shafts from growing long enough to curl back and penetrate skin
  • Management
  • Medications
  1. Low to medium potency Topical Corticosteroids applied immediately after shaving
  2. Topical Benzoyl Peroxide 2.5% applied in morning
  3. Combination Clindamycin 1% and Benozyl Peroxide 5% gel applied twice daily for 6 weeks
    1. Cook (2004) Cutis 73(6 suppl): 18-24 [PubMed]
  4. Topical Retin A 0.025% applied at night
  5. Antibiotics indicated if secondary infection
  • Complications
  1. Postinflammatory Hyperpigmentation
  2. Hypertrophic Scars or Keloids
  3. Secondary infection of injured Hair Follicles
    1. Folliculitis Barbae
    2. Sycosis Barbae