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Chapter 24: Pseudofolliculitis Barbae

INTRODUCTION

KEY POINTS

  • Pseudofolliculitis barbae is a chronic follicular disorder more commonly seen in men and hirsute women of color.

  • In the mild stage, it can present as perifollicular papules. In lighter skin, it can be pink to red, while in darker skin, it can range from skin colored to pink-brown or dark brown.

  • Chronic disease can include keloids, hypertrophic and atrophic scarring, and postinflammatory pigment alteration.

image

FIGURE 24-1.

Pink to pink-brown perifollicular papules with background hyperpigmentation along the anterior neck. Note the lack of inflammation in the areas of longer hair on the chin. (Reproduced with permission from Wolff K, Johnson RA, Saavedra AP, et al. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology, 8th ed. New York, NY: McGraw Hill; 2017, Figure 31-22.)

A patient with pink to red and brown colored papules and dark patches showing hyperpigmentation in the neck. The papules in the chin region appear smaller without any inflammation.
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FIGURE 24-2.

Skin-colored to dark-brown perifollicular papules densely scattered along the hair-bearing areas of the face in a young Black man. Note the diffuse background of hyperpigmentation from chronic inflammation, which is sharply demarcated from normal skin along the lateral neck and cheek. Also note the lack of these changes in areas with longer hair periorally. (Reproduced with permission from Kang S, Amagai M, Bruckner AL, et al. Fitzpatrick’s Dermatology, 9th ed. New York, NY: McGraw Hill; 2019, Figure 150-7.)

A patient with brown skin with skin colored and hyperpigmented dark brown papules on the areas of the face with hair. This area also has a hyperpigmented dark brown background.
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FIGURE 24-3.

Dark-brown hyperpigmented macules and fine papules signifying postinflammatory pigmentary changes form pseudofolliculitis barbae in a Black woman. (Reproduced with permission from Kang S, Amagai M, Bruckner AL, et al. Fitzpatrick’s Dermatology, 9th ed. New York, NY: McGraw Hill; 2019, Figure 90-4.)

The image shows a photograph depicting hirsutism of the chin with associated pseudo-folliculitis barbae.
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FIGURE 24-4.

Pink to pink-brown hypertrophic keloids on the jawline induced by pseudofolliculitis barbae. (Reproduced with permission from Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color, 2nd ed. New York, NY: McGraw Hill; 2016, Figure 39-5.)

A patient exhibits several, irregular shaped, pink to skin colored thick, raised scar like tissue growth along the jawline.
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FIGURE 24-5.

Skin colored large keloid along the jawline secondary to pseudofolliculitis barbae. (Reproduced with permission from Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color, 2nd ed. New York, NY: McGraw Hill; 2016, Figure 39-6.)

A patient presents with a large sized, oval, skin colored tissue growth along the jawline.
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FIGURE 24-6.

Dark brown hyerprtrophic scarring with areas of atrophy and postinflammatory hypopigmentation signifying a range chronic changes from pseudfolliculitis barbae. (Reproduced with permission from Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly's Dermatology for Skin of Color, 2nd ed. New York, NY: McGraw Hill; 2016, Figure 39-7.)

A patient with chronic pseudofolliculitis barbae exhibits thick, raised, hyperpigmented patches, interspersed with indentation and hypopigmented spots in the jawline.
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FIGURE 24-7.

Dense proliferation of dark brown papules along the jawline and neck demonstrating active and severe ...

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