Pseudofolliculitis barbae; current treatment options

Adebola Ogunbiyi, Adebola Ogunbiyi

Abstract

Pseudofolliculitis barbae (PFB) is a chronic inflammatory disorder of follicular and perifollicular skin characterized by papules, pustules, and post-inflammatory hyperpigmentation. It occurs more frequently in men of African and Asian descent. The etiology of PFB is multifactorial. Shaving or plucking the hair precipitates the onset of an inflammatory reaction that results from the penetration of the adjacent skin by the growing sharp tips. The curved shape of the hair follicle allows for the downward curvature and penetration of the growing hair tips into the skin. The onset of the foreign body reaction leads to itching and the development of papules, pustules, and post-inflammatory hyperpigmentation, especially in the beard area although other shaved areas of the body may be affected. Keloids have also been known to develop after the onset of PFB, giving rise to extensive unsightly scars. Diagnosis is clinical. Cessation of shaving or removal of the involved hair follicles usually terminates the development of PFB. Individuals with the single nucleotide substitution in the hair follicle companion layer specific keratin gene (K6hf) have a six fold increased chance of developing PFB.

Keywords: pathogenesis; pseudofolliculitis barbae; treatment.

Conflict of interest statement

Disclosure The author received honorarium from Proctor and Gamble while carrying out the study. The author reports no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Penetration of sharptipped hairs into the skin (A) and multiple extrafollicular penetration with papules (B).
Figure 2
Figure 2
Extra-follicular and transfollicular penetration.
Figure 3
Figure 3
Transfollicular penetration.
Figure 4
Figure 4
Trapped hair separating from the papule.
Figure 5
Figure 5
Multiple sharp, beveled hair tips after a dry shave.
Figure 6
Figure 6
Papules and pustules on the anterior neck, chin, and cheeks (A); PFB affecting mainly the anterior neck region (B); keloids resulting from lesions from PFB (C). Abbreviation: PFB, pseudofolliculitis barbae.
Figure 7
Figure 7
Use of depilatories produced two crooked blunt tips unlikely to cause penetration in a patient with existing papules.
Figure 8
Figure 8
Treatment algorithm for PFB. Reprinted from Coley MK, Kelly Alexis AF. Pseudofolliculitis barbae and acne keloidalis nuchae. In Alexis AF, Barbosa VH, editors. Skin of Color: a practical guide to dermatologic diagnosis and treatment, 1st edition. New York: Springer; 2013:127 with permission from Springer Nature. Abbreviation: PFB, pseudofolliculitis barbae.

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Source: PubMed

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