eMedicine Specialties > Dermatology > Diseases of the Adnexa

Pseudofolliculitis of the Beard

Author: Thomas G Greidanus, MD, Chair, Department of Emergency Medicine, Parkview Medical Center
Coauthor(s): Beth Honl, MD, Dermatology Associates, PC; Private Practice
Contributor Information and Disclosures

Updated: Mar 27, 2009

Introduction

Background

Pseudofolliculitis barbae (PFB) or shaving bumps is a foreign body inflammatory reaction involving papules and pustules. It primarily affects curly haired males who shave.1 Pseudofolliculitis barbae can also affect some white men and hirsute black women. Pseudofolliculitis pubis is a similar condition occurring after pubic hair is shaved.

Pathophysiology

Two mechanisms are involved in the pathogenesis of pseudofolliculitis barbae: (1) extrafollicular penetration occurs when a curly hair reenters the skin, and (2) transfollicular penetration occurs when the sharp tip of a growing hair pierces the follicle wall.

Black men who shave are predisposed to this condition because of their tightly curved hair. The sharp pointed hair from a recent shave briefly surfaces from the skin and reenters a short distance away. Several methods of close shaving result in a hair cut below the surface. These methods include pulling the skin taut while shaving, shaving against the grain, plucking hairs with tweezers, removing hairs with electrolysis, and using double- or triple-bladed razors. The close shave results in a sharp tip below the skin surface, which is then more likely to pierce the follicular wall, causing pseudofolliculitis barbae with transfollicular penetration.2

Frequency

United States

About 10-80% of adult black men have pseudofolliculitis barbae, particularly those who shave closely on a regular basis. It is a significant problem in black men in the military where regulations require a clean-shaven face.3

Mortality/Morbidity

Although usually not regarded as a serious medical problem, pseudofolliculitis barbae can cause cosmetic disfigurement. The papules can lead to scarring, postinflammatory hyperpigmentation, secondary infection, and keloid formation.

Race

Pseudofolliculitis barbae is found mostly in black men.

Sex

Men with facial hair comprise most patients, although hirsute women can also develop pseudofolliculitis barbae. Both sexes can develop pseudofolliculitis pubis. Common sites in black women and those of ethnic backgrounds characterized by darker skin include the pubic and axillary areas because these are more frequent sites of hair removal in this population.

Age

Pseudofolliculitis barbae affects men with facial hair (postpuberty).

Clinical

History

  • Patients complain of a painful acneiform eruption that occurs after shaving.
  • The patient's shaving history, including the method and the frequency, may reveal an improper shaving technique.
  • The method for preparation of the beard, the use of medications or depilatories, and the use of hair-releasing procedures should be discussed with the patient.

Physical

  • The primary lesion is a flesh-colored or erythematous papule with a hair shaft in its center. If the hair shaft is gently lifted up, the free end of the hair comes out of the papule.
  • These inflammatory papules are seen in shaved areas adjacent to the follicular ostia.
Pseudofolliculitis barbae on the neck of a black ...

Pseudofolliculitis barbae on the neck of a black man.

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Pseudofolliculitis barbae on the neck of a black ...

Pseudofolliculitis barbae on the neck of a black man.

  • Pustules and abscess formation can occur from secondary infection.
  • Postinflammatory hyperpigmentation, scarring, and keloid formation may occur in chronic or improperly treated cases.

Causes

  • African Americans are genetically predisposed to pseudofolliculitis barbae because of the curvature of their hair follicles. Improper shaving techniques and the desire for a clean-shaven appearance can result in ingrown hairs via extrafollicular or transfollicular penetration.

More on Pseudofolliculitis of the Beard

Overview: Pseudofolliculitis of the Beard
Differential Diagnoses & Workup: Pseudofolliculitis of the Beard
Treatment & Medication: Pseudofolliculitis of the Beard
Follow-up: Pseudofolliculitis of the Beard
Multimedia: Pseudofolliculitis of the Beard
References
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References

  1. Crutchfield CE 3rd. The causes and treatment of pseudofolliculitis barbae. Cutis. Jun 1998;61(6):351-6. [Medline].

  2. Quarles FN, Brody H, Johnson BA, et al. Pseudofolliculitis barbae. Dermatol Ther. May-Jun 2007;20(3):133-6. [Medline].

  3. Garcia-Zuazaga J. Pseudofolliculitis barbae: review and update on new treatment modalities. Mil Med. Jul 2003;168(7):561-4. [Medline].

  4. Olsen EA. Methods of hair removal. J Am Acad Dermatol. Feb 1999;40(2 Pt 1):143-55; quiz 156-7. [Medline].

  5. Childs ND. Tretinoin, hydrocortisone cream controls PFB. Skin and Allergy News. 1999;30(5):20.

  6. Kligman AM, Mills OH Jr. Pseudofolliculitis of the beard and topically applied tretinoin. Arch Dermatol. Apr 1973;107(4):551-2. [Medline].

  7. Taylor S. Open-Label Case Study on Triple-Combination Cream in Patients with Pseudofolliculitis Barbae. J Am Acad Dermatol. 2005;52:P169.

  8. Brown LA Jr. Pathogenesis and treatment of pseudofolliculitis barbae. Cutis. Oct 1983;32(4):373-5. [Medline].

  9. Leyden JJ. Topical treatment for the inflamed lesion in acne, rosacea, and pseudofolliculitis barbae. Cutis. Jun 2004;73(6 Suppl):4-5. [Medline].

  10. Callender V, Young CM. Combination Laser and Eflornithine HCL 13.9% Cream: A First-line Therapy for Fitzpatrick Type IV-VI Patients With Excessive Facial Hair. J Am Acad Dermatol. Mar 2005;52(3) suppl:P209.

  11. Chuh A, Zawar V. Epiluminescence dermatoscopy enhanced patient compliance and achieved treatment success in pseudofolliculitis barbae. Australas J Dermatol. Feb 2006;47(1):60-2. [Medline].

  12. Bridgeman-Shah S. The medical and surgical therapy of pseudofolliculitis barbae. Dermatol Ther. 2004;17(2):158-63. [Medline].

  13. Kauvar AN. Treatment of pseudofolliculitis with a pulsed infrared laser. Arch Dermatol. Nov 2000;136(11):1343-6. [Medline].

  14. Perry PK, Cook-Bolden FE, Rahman Z, Jones E, Taylor SC. Defining pseudofolliculitis barbae in 2001: a review of the literature and current trends. J Am Acad Dermatol. Feb 2002;46(2 Suppl Understanding):S113-9. [Medline].

  15. Schulze R, Meehan KJ, Lopez A, et al. Low-fluence 1,064-nm laser hair reduction for pseudofolliculitis barbae in skin types IV, V, and VI. Dermatol Surg. Jan 2009;35(1):98-107. [Medline].

  16. Ross EV, Cooke LM, Timko AL, Overstreet KA, Graham BS, Barnette DJ. Treatment of pseudofolliculitis barbae in skin types IV, V, and VI with a long-pulsed neodymium:yttrium aluminum garnet laser. J Am Acad Dermatol. Aug 2002;47(2):263-70. [Medline].

  17. Alexander AM. Evaluation of a foil-guarded shaver in the management of pseudofolliculitis barbae. Cutis. May 1981;27(5):534-7, 540-2. [Medline].

  18. Alexander AM, Delph WI. Pseudofolliculitis barbae in the military. A medical, administrative and social problem. J Natl Med Assoc. Nov 1974;66(6):459-64, 479. [Medline].

  19. Brauner GJ, Flandermeyer KL. Pseudofolliculitis barbae. Medical consequences of interracial friction in the US Army. Cutis. Jan 1979;23(1):61-6. [Medline].

  20. Coquilla BH, Lewis CW. Management of pseudofolliculitis barbae. Mil Med. May 1995;160(5):263-9. [Medline].

  21. Galaznik JG. A Pseudofolliculitis Barbae clinic for the black male who has to shave. J Am Coll Health. Dec 1984;33(3):126-7. [Medline].

  22. Halder RM. Pseudofolliculitis barbae and related disorders. Dermatol Clin. Jul 1988;6(3):407-12. [Medline].

  23. Nidecke A. Saving face: help black men avoid pseudofollicultis barbae. Skin and Allergy News. 1998;29 (10):46.

  24. Scheinfeld NS. Pseudofolliculitis barbae. Skinmed. May-Jun 2004;3(3):165-6. [Medline].

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Further Reading

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Keywords

pseudofolliculitis of the beard, pseudofolliculitis barbae, pili incarnati, folliculitis barbae traumatica, chronic scarring pseudofolliculitis of the negro beard, shaving bumps, razor bumps, ingrown hairs, pseudofolliculitis pubis

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Contributor Information and Disclosures

Author

Thomas G Greidanus, MD, Chair, Department of Emergency Medicine, Parkview Medical Center
Disclosure: Nothing to disclose.

Coauthor(s)

Beth Honl, MD, Dermatology Associates, PC; Private Practice
Beth Honl, MD is a member of the following medical societies: American Academy of Dermatology and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Leonard Sperling, MD, Chair, Professor, Department of Dermatology, Uniformed Services University of the Health Sciences
Leonard Sperling, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey Meffert, MD, Assistant Clinical Professor of Dermatology, University of Texas Health Science Center-San Antonio
Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

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