Pseudofolliculitis of the Beard Medication

Updated: Feb 07, 2019
  • Author: Thomas G Greidanus, MD; Chief Editor: Dirk M Elston, MD  more...
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Medication Summary

Hydrocortisone cream is effective in reducing inflammation. Topical and oral antibiotics are used when secondary infection is evident. Tretinoin has shown promise in early pseudofolliculitis barbae. Chemical depilatories are preferential to shaving for some patients.

Chemical depilatories are effective alternatives to shaving for some patients. They work by breaking disulfide bonds in hair follicles. Barium sulfide is a fast-acting depilatory powder that is mixed with water to form a paste. Similarly, calcium thioglycolate is an effective depilatory that is left on for 10-15 minutes for effective hair removal.



Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting. Topical preparations reduce bacterial populations and secondary infection.


Tetracycline is used orally to treat secondary infection. It treats gram-positive and gram-negative organisms, as well as mycoplasmal, chlamydial, and rickettsial infections. It inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunits.

Erythromycin topical (AkneMycin, Ery)

Topical erythromycin 2% inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. It is used for staphylococcal and streptococcal infections.


Retinoid-like Agents

Class Summary

These agents decrease the cohesiveness of abnormal hyperproliferative keratinocytes, and they may reduce the potential for malignant degeneration. They modulate keratinocyte differentiation. They have been shown to reduce the risk of skin cancer formation in patients who have undergone renal transplantation.

Tretinoin topical (Retin-A, Atralin, Tretin-X, Refissa)

Topical tretinoin inhibits microcomedo formation and eliminates existing lesions. It makes keratinocytes in sebaceous follicles less adherent and easier to remove. Applied topically, it reduces outbreaks of mild pseudofolliculitis barbae. It is available as 0.025%, 0.05%, and 0.1% creams and as 0.01% and 0.025% gels.



Class Summary

These agents are used to reduce inflammation and irritation. These agents have anti-inflammatory properties and cause profound and varied metabolic effects. They modify the body's immune response to diverse stimuli.

Hydrocortisone 1% topical (Cortaid, Westcort, Colocort, Caldecort, Cortizone-10)

Hydrocortisone 1% topical cream is an adrenocorticosteroid derivative suitable for application to skin or external mucous membranes. It has mineralocorticoid and glucocorticoid effects, resulting in anti-inflammatory activity. It is effective when used topically on a short-term basis.

Eflornithine HCL (Vaniqa)

Oral eflornithine inhibits ornithine decarboxylase, which affects the rate of hair growth (anagen phase). It slows hair growth, and some reports indicate miniaturization of hair growth to areas treated. It may take 4-8 weeks for improvement; however, the condition may return to pretreatment levels 8 weeks after discontinuance of therapy.