Multiple curved whiskers diggin into the skin in a Black man.
Multiple curved whiskers diggin into the skin in a Black man.
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.
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.
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. See patient handout for specific suggestions.
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.
If inflammatory pustules or papules are present, topical benzoyl peroxide or a combination BP/clindamycin product may be recommended. A pustule may be cultured periodically to monitor for bacterial superinfection. At topical retinoid QHS may be helpful, especially if there is post inflammatory hyperpigmentation.
Laser hair removal may be helpful. For darker-skinned patients, the longer pulsed lasers (e.g. 1064 nm or 810 nm) may be used.
This patient was unusually Caucasian
This woman with hirsutism constantly plucked ingrown hairs, inducing more ingrown hairs with scarring and a picture similar to PFB.
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