The Impact of Pseudofolliculitis Barbae

Pseudofolliculitis barbae (PFB), commonly known as “razor/shaving bumps,” is a chronic inflammatory disorder caused by close shaving of hair-bearing areas such as the chin, neck, and jawline. The close shaving of curly hair can result in the hair penetrating the wall of the follicle and extending into the dermis (similar to an ingrown hair), causing an inflammatory response. The condition is common among men of color including Black and Hispanic men. The use of razors with multiple blades, plucking of the hairs, and shaving against the grain of hair is known to precipitate the development of PFB.

How does this diagnosis impact people of color?

PFB disproportionately impacts people of color who are more likely to have curly hair, predisposing them to an inflammatory response when recently shaved hair re-enters the skin. It can lead to scarring, infection, hyperpigmentation, and keloid formation if left untreated. PFB can have a significant impact on an individual’s self-esteem, confidence, and quality of life.

What to look for:

PFB usually presents with pruritus or discomfort in recently shaved areas. Flesh-colored or erythematous pustules/papules develop a few days later with a centrally located hair shaft on areas of the skin that are shaved like the neck and beard area. The mustache area is often not affected. Hirsute women that shave may also present with PFB; pustules usually present on the chin.

If lesions become infected, pustules and abscess formation can occur. In chronic cases, postinflammatory hyperpigmentation, scarring, and/or keloid formation may be seen.

Diagnostic pearls:

The diagnosis for this condition is clinical. Examine for curved hairs that can be lifted from the papules with a fine needle. Newer lesions are generally erythematous to violaceous depending on one’s baseline skin color while older ones are often darker. Dermoscopy can be useful in diagnosing PFB. Findings will show extrafollicular penetration and follicular/perifollicular pustules with hyperkeratosis.

Patients with acne keloidalis nuchae may also have pseudofolliculitis barbae.

Differential:

A nonexhaustive differential for pseudofolliculitis barbae includes:

Treatment:

The best treatment for this condition is to stop shaving permanently or at least temporarily until the papules/pustules have cleared. If stopping shaving is not possible, there are specialized razors that can be used for a less close shave, preventing the hairs from growing inward. A sharp, single-blade razor, an electric razor, or hair clippers at the highest setting can also be used to prevent close shaving. Shaving should also be done in the direction of the hair growth.

Patients who present with secondary infections or severe inflammation can be treated with the various treatments including appropriate antibiotics, corticosteroids, or benzoyl peroxide.  Definitive treatment of PFB involves removal of the hair follicle through the use of tweezers, wax, laser hair removal, or electrolysis.

References:

American College of Osteopathic Dermatology. “Pseudofolliculitis barbae”. Accessed March 24, 2021: https://www.aocd.org/page/pseudofolliculitisb

Ogunbiyi A. Pseudofolliculitis barbae; current treatment options. Clin Cosmet Investig Dermatol. 2019;12:241-247. Published 2019 Apr 16. doi:10.2147/CCID.S149250

The Project IMPACT blog series was created to highlight dermatologic conditions that affect people of color.

LEARN MORE