Updated: 9/22/2017

Pseudofolliculitis Barbae

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Snapshot
  • A 27-year-old woman presents to her gynecologist for evaluation of bumps in her pubic area. She recently tried shaving her pubic hair. A day after she shaved, she noticed red bumps that are pruritic and painful. On physical exam, there are dozens of 1-2 mm hyperpigmented firm papules. She is counseled on available topical therapies to minimize symptoms and advised to use other methods of hair removal, such as waxing.
Introduction
  • Clinical definition
    • chronic inflammatory disorder of hair follicle related to shaving, characterized by painful and pruritic papules
      • “razor bumps”
      • “shave bumps”
      • “ingrown hairs”
  • Epidemiology
    • demographics
      • male > female
      • often affects African Americans
    • location
      • hair-bearing areas
    • risk factors
      • shaving
      • tightly curled hair
  • Pathogenesis
    • pseudofolliculitis barbae is NOT a true folliculitis
    • inflammatory reaction occurs when hair shaft transects the wall of the hair follicle or when the hair shaft enters the epidermis
      • entrapment of short hairs causes inflammatory response
  • Prognosis
    • often recurs
Presentation
  • Symptoms
    • skin lesions are painful and pruritic
  • Physical exam
    • firm and skin-colored or hyperpigmented papules and pustules
      • there may be loops of hair emerging from the follicular orifice
      • located on cheeks, jaw, or neck (in hair-bearing areas)
Studies
  • Labs
    • none
  • Biopsy
    • not necessary unless clinical diagnosis is unclear
  • Histology
    • intraepidermal neutrophils
    • abscess formation in dermis
    • granulomatous inflammation with foreign-body giant cells around the penetrating hair
Differential
  • Folliculitis
  • Cutaneous sarcoidosis
    • does not have embedded hairs and lesions may be outside of hair-bearing areas
Treatment
  • Conservative
    • other methods of hair removal
      • indication
        • to avoid shaving as this causes pseudofolliculitis barbae
      • modalities
        • depilatory hair removal
        • laser hair removal
        • waxing
  • Medical
    • topical therapy
      • indication
        • to reduce symptoms
      • drugs (all topical)
        • retinoids
        • corticosteroids
        • antibiotics
        • eflornithine
        • alpha-hydroxy acids (chemical exfoliants)
Complications
  • Scarring or keloid formation
  • Secondary bacterial infection

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