Pseudofolliculitis Barbae - Western SummaryWestern Medicine Summary

Western Medicine

Western Summary

Pseudofolliculitis barbae is a condition where new shaved hairs that are growing lead to inflamed bumps and pimples. This tends to occur in men in the beard area. 

Symptoms

This is an inflammatory response in and around hair follicles that manifest as inflamed red bumps, pus-filled bumps, nodules, and scars.[1] In people with darker skin, these areas of inflammation can leave behind dark spots, known as post-inflammatory hyperpigmentation, and these spots can persist for weeks or even months before they improve. 

 

Causes

After hair is shaved or removed from the skin (ie: waxing, depilatory, etc), it is thought to have difficulty penetrating the skin surface as it grows back, thus turning in on itself to create an “ingrown” hair. A hair that penetrates the hair follicle at an oblique angle at any point as it grows back can cause the same reaction.[2] The body responds to this dysfunctional hair regrowth with varying degrees of inflammation and even scarring. 

This occurs in areas of shaving, most often the face, neck and scalp. Those with coarse or curly hair are more likely to develop this condition. 

Treatments

Not shaving or not removing hair is the only way to truly prevent dysfunctional hair regrowth and the associated inflammation. If shaving must continue, a close shave should be avoided and shaving should be performed in the same direction of the hair growth rather than against the grain. 

  • Steroids: Steroids can reduce the inflammation that develops in the pimples.
  • Antibiotics: Antibiotics have an anti-inflammatory effect and help reduce any bacterial overgrowth that can occur in the ingrown hair. 
  • Salicylic acid: This medication helps to reduce the thickening that can occur around the hair follicle.
  • Benzoyl peroxide: This topical has an antibacterial effect and can reduce bacterial overgrowth. 
  • Eflornithine: This is a medication that can reduce the hair growth rate and has been shown to improve pseudofolliculitis barbae.[3] 
  • Antibiotics: In cases that are resistant to topical treatments, oral antibiotics can be more effective in controlling the inflammation due to their ability to reduce bacterial overgrowth and their antiinflammatory effects. 
  • Lasers: Depending on the hair and skin type and color, laser therapy might be a possible option to help target hairs and prevent it from growing back as thick. 
  • Steroids: Intralesional injection of corticosteroids can help reduce inflammation in deep nodules or inflamed bumps. 
  • Electrolysis and surgical depilation can be an effective option,[2] especially if laser treatments are not a good option. 

1.    Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology. Elsevier Limited; 2012.

2.    Alexis A, Heath CR, Halder RM. Folliculitis keloidalis nuchae and pseudofolliculitis barbae: are prevention and effective treatment within reach? Dermatol Clin.2014;32(2):183-191; PMID: 24680005.

3.    Xia Y, Cho S, Howard RS, et al. Topical eflornithine hydrochloride improves the effectiveness of standard laser hair removal for treating pseudofolliculitis barbae: A randomized, double-blinded, placebo-controlled trial. Journal of the American Academy of Dermatology.2012;67(4):694-699; PMID.