PSEUDOFOLLICULITIS BARBAE

By Gary M. White, MD

Pseudofolliculitis barbae Multiple pustules in the beard secondary to ingrowing hairs.


Pseudofolliculitis barbae (PFB) is an inflammatory, acneiform and scarring process common in the beard area of darker-skinned men. It seems to be caused by short and recently shaved whiskers that curve back into the skin, causing a foreign body response. An unusual single-nucleotide polymorphism, which gives rise to a disruptive Ala12Thr substitution in the 1A alpha-helical segment of the companion layer-specific keratin K6hf of the hair follicle, is partially responsible for the phenotypic expression and represents an additional genetic risk factor for PFB.

Clinical

The classic patient is a young black man who gets papules and pustules in the beard area. Close inspection shows a curled whisker associated with each lesion. Over time, scarred tracks develop with each whisker, making shaving even more difficult. Acne keloidalis nuchae is often associated.

Treatment

Growing a beard is curative. Even a short beard is excellent. If this is not possible, various tips may allow for a relatively close shave.

Hair releasing is critically important and must be done instead of plucking hairs. Hair releasing means removing the end of any whiskers buried in papules or pustules. It may be done with a toothpick by the patient or a needle by the physician. The patient may need to release hairs every two to three days.

A depilatory may be used, but many find these too irritating.

Laser hair removal may be helpful. For darker-skinned patients, the longer pulsed lasers (e.g. 1064 nm or 810 nm) may be used.

If inflammatory pustules or papules are present, topical benzoyl peroxide or a combination BP/clindamycin product may be recommended. At topical retinoid QHS may be helpful, especially if there is post inflammatory hyperpigmentation.

Eflornithine 12% BID for 16 weeks was shown in one study to work synergistically with laser hair removal [JAAD 2012].

Additional Pictures

Hirsutism | Ingrown Hairs | PFB in a woman
Hirsutism, ingrown hairs and pseudofolliculitis barbae in a woman

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