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INTRODUCTION

KEY POINTS

  • Pseudofolliculitis barbae (PFB) is a common dermatologic disorder of the hair follicles affecting people with skin of color who shave.

  • Darkly pigmented men with coarse, tightly curled hair are especially affected by PFB.

  • The primary lesions of PFB are papules and pustules in the beard area that cause cosmetic disfigurement, including scarring, postinflammatory hyperpigmentation, secondary infection, and keloid formation.

  • Chronic PFB of the shaved areas may produce fine linear depressed scars, also known as grooves.

  • The anterior neck, submandibular chin, and lower jaw are the next most common areas for PFB.

  • Therapy for PFB with over-the-counter depilatories and/or specific shaving techniques has been used with success, as have topical combination creams.

  • Hair-removal lasers and electrolysis increasingly are used for the treatment of PFB and are showing great effectiveness when used in combination with topical treatment.

  • Shave bumps

  • Razor bumps

  • Barber’s bumps

  • Barber’s itch

  • Ingrown hairs

  • Folliculitis barbae traumatica

  • Sycosis barbae

  • Pili incarnati

  • Chronic scarring pseudofolliculitis of the Negro beard.

SYNONYMS

Pseudofolliculitis barbae (PFB) is a common inflammatory skin problem affecting up to 60% of people with skin of color who have coarse, tightly curled hair and shave close to the skin1 [Figure 39-1]. It can occur in any race and in either sex. In addition to the beard area, the pubic area [Figure 39-2], scalp, and legs also may develop PFB, particularly if they are shaved often.

FIGURE 39-1.

Moderate pseudofolliculitis barbae (with more than a dozen but less than 100 papules and pustules) of the chin and neck of a darkly pigmented man.

FIGURE 39-2.

A darkly pigmented man with folliculitis secondary to shaving his suprapubic area.

Strauss and Kligman2 coined the term pseudofolliculitis barbae in 1956. PFB is particularly troubling for affected men, especially those in the military,3 law enforcement, or occupations that require workers to be clean shaven.

EPIDEMIOLOGY AND PATHOGENESIS

In a randomly sampled test population of 156 individuals at two U.S. Army hospitals in Germany, a much higher incidence of PFB was noted in the skin of color population (82%) as compared to the Caucasian population (18%).4 These finding were felt to be within the previously reported PFB occurrence range of 45% to 85% in the skin of color population.5 However, PFB can occur in any race and in either sex regardless of whether the person has dark pigmentation.5

The pathogenesis of this disorder has been shown to involve both transfollicular and extrafollicular penetration of the skin by a hair. With shaving, the razor produces short, sharp, and pointed hairs that penetrate the skin either in an extra- or transfollicular manner. Tightly ...

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