Pseudofolliculitis is a common, chronic inflammatory disorder that presents with inflammatory papules and pustules in the beard distribution of males, particularly those with darker skin phototypes and tightly coiled hair. Nonetheless, pseudofolliculitis can present in any skin that is regularly shaved and in all skin phototypes. In females it is most commonly seen in the axillary and pubic areas. It tends to present in a more mild form in lighter skin phototypes.
Incidence: over 50% of African American males
Age: begins with shaving or plucking
Race: more common in beard distribution of males with darker skin phototypes
Precipitating factors: shaving in any region of the body
This disorder is induced by shaving. Shaving sharpens curled hair. Sharpened, tightly curled hairs pierce into the skin adjacent to the hair follicle and invade into the dermis producing an inflammatory reaction. It can also follow hair plucking, especially in females with hirsutism.
Hair penetration results in epidermal invagination with associated microabscess, mixed inflammatory infiltrate, and foreign body giant reaction at the tip of the invading hair. Dermal fibrosis may be observed.
Most commonly, it presents with follicular papules, pustules, and postinflammatory hyperpigmentation in the beard area and anterolateral neck of males and underarms and bikini areas of females. Papules can develop into cysts. Scar formation may be observed. The upper cutaneous lip is typically spared.
Acne vulgaris, folliculitis.
Begins with shaving or plucking and continues until cessation or modification in the hair removal technique.
The goal of the treatment is to prevent the formation of the papules, pustules, scarring, and postinflammatory hyperpigmentation associated with this disorder. There are multiple treatment options available to accomplish this goal. Cessation of shaving or plucking is the most successful treatment but it is impractical and undesirable for many patients. Laser therapy is highly effective with high patient satisfaction.
The most simple, inexpensive, and effective treatment for pseudofolliculitis is the cessation of shaving. Many patients will find this option undesirable or impractical.
Modification of Shaving Technique
A proper shaving technique may prevent or significantly decrease the risk of pseudofolliculitis. Among these practices are lifting, not plucking ingrown hairs, thoroughly wetting the area prior to applying shaving cream, using a sharp razor, shaving in the direction of the hair growth, and avoiding shaving in more ...