Pseudofolliculitis Barbae (PFB)

 

 

DEFINITION

Pseudofolliculitis barbae is the response of the skin to an ingrown hair. It is a foreign body response. Pseudofolliculitis barbae is one of the most common skin complaints of black men, occurring in 45 to 80 percent of those men who shave.

 

WHAT CAUSES PFB?

Close shaving is the major cause. Close shaving causes the formation of ingrowing hairs, and the hairs grow backwards into the skin. As the hairs penetrate the skin, an allergic foreign body reaction causes the bumps and pustules which are characteristic of PFB.

 

HOW DOES PFB BEGIN AND PROGRESS?

Pseudofolliculitis barbae begins in two ways. First, involves the individual pulling his skin tight and shaving against the grain over the same area many times with a dull razor blade. A needle-like tip on the hair is created. Once the skin is released, the tip of the hair retracts beneath the surface of the skin. This sharp hair tip then pierces the under side of the skin. An allergic inflammatory reaction occurs that is seen as papules (little bumps on the skin) or pustules (papules filled with pus). These papules or pustules can then be further irritated by shaving which can lead to scarring. Second, a needle-like tip on the beard hair is created by shaving. This time the hair grows out normally, however, since black hair is curved, it then grows back toward the skin and pierces the skin to a depth of 2 to 3 mm. Again, papules or pustules are formed that can be further irritated by shaving.

 

WHERE DOES PFB OCCUR?

Pseudofolliculitis barbae occurs most often beneath the jaw on the neck. It is usually characterized by papules and pustules that vary in size from 2 to 4 mm. Discomfort varies from mild to severe when the hair is shaved. Hyperpigmentation (darkening of the skin) and occasionally keloid scarring (thick, ugly scars) can occur. Sometimes infection can also occur with staph or strep or other type of bacteria. A similar condition set off by hairs puncturing the skin can occur on the back of the neck, causing acne keloidalis nuchae.

HOW IS PFB TREATED?

 

1. Quit shaving for three to four weeks. This is the most effective treatment. Hairs buried in the skin will slowly come to the surface. Hairs that have curved back into the skin will spring free once they reach a length of about 10 mm. At first, growing a beard may make the condition worse since existing hair tips may reenter the skin. Given enough time the skin will heal itself. During this non shaving period, hair tips that have grown into the skin should be dislodged by using a firm instrument, such as a needle, under the loop of hair and pulling the hair free. Plucking the hair should be avoided since this can make the condition worse.

 

2. Electric barber clippers are highly recommended if daily grooming is needed. It is best to allow the beard to grow for a month to allow the skin to heal before beginning. Clippers are good since they do not cut the hairs too short. Daily use prevents the hairs from getting too long and piercing the skin. Clippers also have the advantage of not traumatizing papules or pustules. Electric razors should be avoided since they produce sharp hair tips that can penetrate the skin and they can traumatize the skin.

 

3. Chemical hair removers such as barium sulfide or calcium thioglycollate can be effective since they produce blunt tipped hairs and do not cut the hair beneath the skin surface. Chemical hair removers should not be used more often than every other or even every third day due to skin irritation. The possibility of skin irritation increases after prolonged use. Hair removers containing barium sulfide (Magic Shave) have a strong smell that may be annoying. Chemical hair removers containing calcium thioglycollate (Surgex cream) are less annoying and are usually the least irritating to the skin. After using a chemical hair remover, the face should be washed thoroughly, and over-the-counter corticosteroid lotion may be applied to soothe the skin.

 

4. Manual razors may be used in mild cases of pseudofolliculitis barbae. It is important not to pull the skin taut and not to shave against the grain. It is important to use a sharp razor each time you shave. Special razors are available, such as The Bump Fighter by Aveeno, that avoid shaving too close. Ask your pharmacist for this.

 

In addition to the methods mentioned above, extra steps can be taken to assist in the control of pseudofolliculitis barbae. Freeing of hairs embedded in the skin with a needle as mentioned above is important and should be done before any of the above shaving techniques. Rubbing the beard area in a circular pattern with a coarse sponge, a brush, or a rough washcloth may help dislodge embedded hair. This should be done before shaving and four or five more times throughout the day. Use of topical antibiotics, such as Cleocin T, or low-dose systemic antibiotics may help limit the inflammatory process. 3% benzoyl peroxide gel after shaving and 2.5% hydrocortisone lotion at night may be helpful in mild cases. Another treatment that may help is daily use of Retin-A 0.05%. Retin-A or Tazorac may allow buried hairs to be freed, and may toughen the skin. Successful management of pseudofolliculitis barbae depends largely on the patient's motivation. The most effective treatment is to quit shaving but this is not always possible or practical. The best therapeutic approach must be individualized to the patient and it may take several months to determine which combination of methods is best.