Gary J. Brauner, MD
Revised by: Raina Bembry, MD and Tejesh Patel, MD

What is the cause of Pseudofolliculitis barbae?
Pseudofolliculitis barbae (PFB) ,“razor bumps,” or “ingrown hairs” is a chronic inflammatory condition of the skin that often affects people of African descent and those with tightly curled and coiled hair who attempt to remove it by shaving or plucking.1 The term plucking refers to using tweezers, waxing, and even threading. It usually involves the beard area of men, but can occur in other shaved areas. It can affect women too.

There are two ways the inflammation can occur. When shaving is too close, the sharpened curved hair retracts below the surface of the skin and pierces the follicle wall from inside (transfollicular penetration).2 If shaving is infrequent, the hair may grow back in a curve towards the skin and can poke through from the outside (transepidermal or re-entry penetration).2

How do I know if I have pseudofolliculitis?
Painful bumps can appear and lead to long-lasting or permanent dark spots, scars, and even keloids in the sites of inflammation. The ingrown hairs may develop into pustules or become secondarily infected with bacteria. The shaved cheeks and front of the neck are usually involved, while the lip and back of the neck are usually spared. Similar bumps can occur in the bikini area or the armpits but are less common.

What are the best treatments for pseudofolliculitis?
The best treatment involves not shaving or plucking. Use of hair clippers is often suggested to prevent close shaving. If someone is required to shave, techniques can be used to limit irritation. Some techniques include: avoidance of pulling the skin tight when shaving; using a sharp, multi-blade razor; using shaving cream; shaving in the direction of hair growth; and taking short stokes.1 Treatments include: topical and intralesional steroid; oral and topical antibiotics; keratolytics (topicals that exfoliate); chemical depilatories (hair removal with creams) and laser hair removal.1,2 To limit unfavorable outcomes, laser hair removal devices should be operated by a medical provider knowledgeable about treating darkly pigmented skin.

 

References:

1. Bolognia J Schaffer JV Cerroni L. Dermatology. Fourth ed. Philadelphia: Elsevier; 2018. 
2. Dalia Y, Khatib J, Odens H, Patel T. Review of treatments for pseudofolliculitis barbae. Clin Exp Dermatol. 2023;48(6):591-598. doi:10.1093/ced/llad075