Pseudofolliculitis barbae | |
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Other names | Barber's itch, folliculitis barbae traumatica, razor bumps, scarring pseudofolliculitis of the beard, shave bumps |
A severe case of Pseudofolliculitis barbae | |
Pronunciation | |
Specialty | Dermatology |
Pseudofolliculitis barbae (PFB) is a type of irritant folliculitis that commonly affects people who have curly or coarse facial hair. [1] It occurs when hair curls back into the skin after shaving, causing inflammation, redness, and bumps. [2] [3] This can lead to ingrown hairs, scarring, and skin discoloration. PFB can be treated with various methods, including changing shaving habits, using topical creams or ointments, and undergoing laser hair removal. Prevention measures include proper shaving techniques, using sharp razors, and avoiding too close a shave.
It was first described in 1956. [4]
Razor burn is a lesser condition caused by shaving, characterized by mild to moderate redness and irritation on the surface of the skin. Unlike PFB, it is usually transient and there is no infection involved.
There is also a condition called folliculitis barbae. The difference between the two is the cause of the inflammation in the hair follicles. Where folliculitis barbae is caused by viral or bacterial infections, pseudofolliculitis is created by irritation from shaving and ingrown hairs.
Pseudofolliculitis nuchae, a related condition, occurs on the back of the neck, often along the posterior hairline, when curved hairs are cut short and allowed to grow back into the skin. Left untreated, this can develop into acne keloidalis nuchae, a condition in which hard, dark keloid-like bumps form on the neck. Both occur frequently in black men in the military. It is so common in the U.S. military that the services have protocols for its management. [5]
Pseudofolliculitis barbae (PFB) is most common on the face, but it can also happen on other parts of the body where hair is shaved or plucked, especially areas where hair is curly and the skin is sensitive, such as genital shaving (more properly termed pseudofolliculitis pubis or PFP). [6]
After a hair has been shaved, it begins to grow back. Curly hair tends to curl into the skin instead of straight out of the follicle, leading to an inflammation reaction. PFB can make the skin look itchy and red, and in some cases, it can even look like pimples. These inflamed papules or pustules can form especially if the area becomes infected. [7]
This is especially a problem for some men who have naturally coarse or tightly curling thick hair. Curly hair increases the likelihood of PFB by a factor of 50. [8] If left untreated over time, this can cause keloid scarring in the beard area. [9]
Pseudofolliculitis barbae can further be divided into two types of ingrown hairs: transfollicular and extrafollicular. The extrafollicular hair is a hair that has exited the follicle and reentered the skin. The transfollicular hair never exits the follicle, but because of its naturally curly nature curls back into the follicle, causing fluid build-up and irritation. [9]
A common polymorphism in a keratin gene (K6hf) has been linked to PFB, suggesting that it may be a genetic risk factor. [10] This sequence change leads to an amino acid substitution in the highly conserved helix initiation motif of the K6hf rod domain. [8] Carriers of the A12T polymorphism are six times more likely to develop PFB compared with people homozygous for the wild-type K6hf sequence. [10] This suggests K6hf mutation structurally weakens the companion layer separating the inner and outer root sheath and increases the chances that a beard hair will in-grow. [10]
The most efficient prevention is to grow a beard. [11] For men who are required to, or simply prefer to shave, studies show the optimal length to be about 0.5 mm to 1 mm to prevent the hair growing back into the skin. [11] Using a beard trimmer at the lowest setting (0.5mm or 1mm) instead of shaving is an efficient alternative. The resulting faint stubble can be shaped using a standard electric razor on non-problematic areas (cheeks, lower neck).[ medical citation needed ]
Some men use electric razors to prevent PFB. Those who use a razor should use a single blade or special wire-wrapped blade to avoid shaving too closely, with a new blade each shave. [11] Shaving in the direction of hair growth every other day, rather than daily, may improve pseudofolliculitis barbae. If a blade must be used, softening the beard first with a hot, wet washcloth for five minutes or shave while showering in hot water can be helpful. Some use shaving powders (a kind of chemical depilatory) to avoid the irritation of using a blade. Barium sulfide-based depilatories are most efficient, but produce an unpleasant smell. [11]
The simplest treatment for PFB is to let the beard grow. [11] Complete removal of the hair from its follicle (epilation) is not recommended. Severe or transfollicular hairs may require removal by a dermatologist.[ medical citation needed ]
For most cases, completely avoiding shaving for three to four weeks allows all lesions to subside, and most extrafollicular hairs will resolve themselves within at least ten days. [11]
Medications may also be prescribed to speed healing of the skin. Clinical trials have shown glycolic acid–based peels to be an effective and well-tolerated therapy which resulted in significantly fewer PFB lesions on the face and neck. [11] The mechanism of action of glycolic acid is unknown, but it is hypothesized that straighter hair growth is caused by the reduction of sulfhydrylbonds in the hair shaft by glycolic acid, which results in reduced re-entry of the hair shaft into the follicular wall or epidermis. [11] Salicylic acid peels are also effective. [12] Prescription antibiotic gels (Benzamycin, Cleocin-T) or oral antibiotics are also used. Benzoyl peroxide may be used topically, combined or not with prescription antibiotics. [13] Tretinoin is a potent treatment that helps even out any scarring after a few months. It is added as a nightly application of tretinoin cream 0.05–0.1% to the beard skin while beard is growing out. Tea tree oil, witch hazel, and hydrocortisone are also noted as possible treatments and remedies for razor bumps.[ medical citation needed ]
Permanent removal of the hair follicle is the only definitive treatment for PFB. [11] Electrolysis is effective but limited by its slow pace, pain, and expense. Laser-assisted hair removal has proven effective and can last for years. [14] Laser therapies utilize melanin-selective photothermolysis to heat up hair shafts and damage follicular stem cells, which over time impairs hair growth. [15] [16] Common laser systems used to treat PFC are pulsed alexandrite (755 nm), diode (800–810 nm) and Nd:YAG (1064 nm) lasers. Nd:YAG lasers are indicated for darker-pigmented individuals. [17] Laser therapy for PFC requires typically requires at least six treatments spaced 4–6 weeks apart. [14] Side effects include erythema and skin discoloration.
In 1991, the Eighth Circuit Court of Appeals found that Domino's Pizza's policy of not allowing beards for employees created a disparate impact by excluding a quarter of black men from employment, but not an equivalent number of white men, thus violating Title VII of the Civil Rights Act of 1964. [18] In contrast, in 1993, the Eleventh Circuit Court of Appeals upheld the Atlanta fire department's "no-beard" policy because it was justified by a "business necessity", in that case the fact that even short beards interfered with firefighters' use of self-contained breathing apparatus. [19]
Pili multigemini, also known as "compound hairs," is a malformation characterized by the presence of bifurcated or multiple divided hair matrices and papillae, giving rise to the formation of multiple hair shafts within the individual follicles.
Hair removal, also known as epilation or depilation, is the deliberate removal of body hair or head hair.
Shaving is the removal of hair, by using a razor or any other kind of bladed implement, to slice it down—to the level of the skin or otherwise. Shaving is most commonly practiced by men to remove their facial hair and by women to remove their leg and underarm hair. A man is called clean-shaven if he has had his beard entirely removed.
Keloid, also known as keloid disorder and keloidal scar, is the formation of a type of scar which, depending on its maturity, is composed mainly of either type III (early) or type I (late) collagen. It is a result of an overgrowth of granulation tissue at the site of a healed skin injury which is then slowly replaced by collagen type I. Keloids are firm, rubbery lesions or shiny, fibrous nodules, and can vary from pink to the color of the person's skin or red to dark brown in color. A keloid scar is benign and not contagious, but sometimes accompanied by severe itchiness, pain, and changes in texture. In severe cases, it can affect movement of skin. In the United States keloid scars are seen 15 times more frequently in people of sub-Saharan African descent than in people of European descent. There is a higher tendency to develop a keloid among those with a family history of keloids and people between the ages of 10 and 30 years.
Waxing is the process of hair removal from the root by using a covering of a sticky substance, such as wax, to adhere to body hair, and then removing this covering and pulling out the hair from the follicle. New hair will not grow back in the previously waxed area for four to six weeks, although some people will start to see regrowth in only a week due to some of their hair being on a different human hair growth cycle. Almost any area of the body can be waxed, including eyebrows, face, pubic hair, legs, arms, back, abdomen, chest, knuckles, and feet. There are many types of waxing suitable for removing unwanted hair.
Intense pulsed light (IPL) is a technology used by cosmetic and medical practitioners to perform various skin treatments for aesthetic and therapeutic purposes, including hair removal, photorejuvenation as well as to alleviate dermatologic diseases such as acne. IPL is increasingly used in optometry and ophthalmology as well, to treat evaporative dry eye disease due to meibomian gland dysfunction.
Folliculitis is the infection and inflammation of one or more hair follicles. The condition may occur anywhere on hair-covered skin. The rash may appear as pimples that come to white tips on the face, chest, back, arms, legs, buttocks, or head.
Laser hair removal is the process of hair removal by means of exposure to pulses of laser light that destroy the hair follicle. It had been performed experimentally for about twenty years before becoming commercially available in 1995-1996. One of the first published articles describing laser hair removal was authored by the group at Massachusetts General Hospital in 1998. Laser hair removal is widely practiced in clinics, and even in homes using devices designed and priced for consumer self-treatment. Many reviews of laser hair removal methods, safety, and efficacy have been published in the dermatology literature.
Keratosis pilaris is a common, autosomal-dominant, genetic condition of the skin's hair follicles characterized by the appearance of possibly itchy, small, gooseflesh-like bumps, with varying degrees of reddening or inflammation. It most often appears on the outer sides of the upper arms, thighs, face, back, and buttocks; KP can also occur on the hands, and tops of legs, sides, or any body part except glabrous (hairless) skin. Often the lesions can appear on the face, which may be mistaken for acne or folliculitis.
Acne keloidalis nuchae (AKN), also known as "acne keloidalis", "dermatitis papillaris capillitii", "folliculitis keloidalis", "folliculitis keloidis nuchae", and "nuchal keloid acne", is a destructive scarring folliculitis that occurs almost exclusively on the occipital scalp of people of African descent, primarily men.
A comedo is a clogged hair follicle (pore) in the skin. Keratin combines with oil to block the follicle. A comedo can be open (blackhead) or closed by skin (whitehead) and occur with or without acne. The word "comedo" comes from the Latin comedere, meaning "to eat up", and was historically used to describe parasitic worms; in modern medical terminology, it is used to suggest the worm-like appearance of the expressed material.
Acne is acneiform eruptions. It is usually used as a synonym for acne vulgaris, but may also refer to:
Ingrown hair is a condition where a hair curls back or grows sideways into the skin. The condition is most prevalent among people who have coarse or curly hair. It may or may not be accompanied by an infection of the hair follicle (folliculitis) or "razor bumps", which vary in size. While ingrown hair most commonly appears in areas where the skin is shaved or waxed, it can appear anywhere. Anything that causes the hair to be broken off unevenly with a sharp tip can cause ingrown hairs. Ingrown hairs are also caused because of lack of natural exfoliation in the skin.
Eosinophilic folliculitis is an itchy rash with an unknown cause that is most common among individuals with HIV, though it can occur in HIV-negative individuals where it is known by the eponym Ofuji disease. EF consists of itchy red bumps (papules) centered on hair follicles and typically found on the upper body, sparing the abdomen and legs. The name eosinophilic folliculitis refers to the predominant immune cells associated with the disease (eosinophils) and the involvement of the hair follicles.
Folliculitis decalvans is an inflammation of the hair follicle that leads to bogginess or induration of involved parts of the scalp along with pustules, erosions, crusts, ulcers, and scale. It begins at a central point and spreads outward, leaving scarring, sores, and, due to the inflammation, hair loss in its wake. No permanent cure has been found for this condition, but there is promise in a regimen of dual therapy with rifampin 300 mg twice daily and clindamycin 300 mg twice daily. This new treatment can be used to control the condition, and tests have indicated that after 3 to 5 months long uninterrupted courses of treatment, many patients have seen limited to no recurrence.
Pruritic folliculitis of pregnancy is a skin condition that occurs in one in 3000 people, about 0.2% of cases, who are in their second to third trimester of pregnancy where the hair follicle becomes inflamed or infected, resulting in a pus filled bump. Some dermatologic conditions aside from pruritic folliculitis during pregnancy include "pruritic urticarial papules and plaques of pregnancy, atopic eruption of pregnancy, pemphigoid gestationis, intrahepatic cholestasis of pregnancy, and pustular psoriasis of pregnancy". This pruritic folliculitis of pregnancy differs from typical pruritic folliculitis; in pregnancy, it is characterized by sterile hair follicles becoming inflamed mainly involving the trunk, contrasting how typical pruritic folliculitis is mainly localized on "the upper back, shoulders, and chest." This condition was first observed after some pregnant individuals showed signs of folliculitis that were different than seen before. The inflammation was thought to be caused by hormonal imbalance, infection from bacteria, fungi, viruses or even an ingrown hair. However, there is no known definitive cause as of yet. These bumps usually begin on the belly and then spread to upper regions of the body as well as the thighs.
Body grooming is the act of maintaining a clean appearance. It is typically associated with hair.
Sycosis vulgaris is a cutaneous condition characterized by a chronic infection of the chin or bearded region.
Prepubertal hypertrichosis, also known as childhood hypertrichosis, is a cutaneous condition characterized by increased hair growth, found in otherwise healthy infants and children. Prepubertal hypertrichosis is a cosmetic condition and does not affect any other health aspect. Individuals with this condition may suffer with low self esteem and mental health issues due to societal perceptions of what a "normal" appearance should be. The mechanism of prepubertal hypertrichosis is unclear, but causes may include genetics, systemic illnesses, or medications.
Irritant folliculitis is an inflammation of the hair follicle. It characteristically presents with small red bumps in the skin at sites of occlusion, pressure, friction, or hair removal; typically around the beard area in males, pubic area and lower legs of females, or generally the inner thighs and bottom. An associated itch may or may not be present. Pseudofolliculitis barbae is a type of irritant folliculitis in the beard area.