Pseudofolliculitis barbae, more commonly referred to as “razor bumps”, is an extremely common condition affecting mostly the beard, neck, bikini area, posterior scalp and lower legs . Studies have estimated that 45-83% of African American men are affected by this problem. However, it can be seen in anyone with curlier hair that is cut short on the face, neck, lower leg and bikini region.
Pseudofolliculitis barbae is an extremely aggravating problem, not just symptomatically, but also cosmetically, leaving blemishes in the skin.
It can be caused by various different depilatory mechanisms, including shaving, tweezing, plucking, waxing, and electrolysis. The short hairs curl back into the skin and act as a foreign body. This leads to chronic inflammation and infection. Shaving against the grain and pulling the skin tight while shaving can exacerbate the condition.
So, what can you do to prevent this problem?
Laser hair removal is the gold standard for treating this problem. Permanently destroying the hair follicles resolves the problem. Laser hair removal works in all skin types; although, we recommend the long-pulsed neodymium:Yag laser for darker skin types. It takes 5-8 treatments to permanently reduce the majority of hair in a treated area. The substantial reduction in hair greatly diminishes the pain associated with the condition and the discoloration will improve over months.
Lasers do have limitations. They work only on dark hair. The laser light is absorbed by the pigment in hair follicles. If there is no pigment, such as gray or blond hair, the laser will not work and should not be done. In addition, the procedure is not covered by insurance companies. Lasers are safe, but it is vital that the procedure is performed only by experienced operators.
If you cannot have lasers, what are your alternatives?
Other methods of hair removal or depilation, include chemical depilatory agents. More commonly known products include, Nair, Neet, and Magic Suave. They contain barium sulfide and calcium thioglycolate, which dissolve the hair follicles. Only use these when the skin is clear. Leave these on for less time than recommended as they can cause chemical burns.
In general, if you can stop trying to get rid of the hair, even for up to 6 months; this can lead to a cure, or at the very least, significant improvement. Growing the beard out, typically leads to resolution. However, for many individuals this is not a viable option.
Therefore, the following recommendations can be trialed:
Try to avoid shaving for several weeks to one month or until all lesions have resolved, while applying a mild topical antibiotic to calm the lesions. If it is not possible to avoid shaving for that period of time, try shaving every other day, instead of daily.
We recommend trimming the beard area with clippers or scissors to prevent a shave closer than 1 mm of hair. However, if a blade must be used, I would suggest applying a warm compress to the face for about 5 minutes to soften the hairs. Then, apply a shaving gel that is lubricating. Do not stretch the skin, and shave with the grain of the hair. Only use one stroke over each area.
There are various ways to treat the bumps. Typically we will give a mild topical steroid to use immediately after shaving. Active lesions can be treated with topical glycolic acid lotion, antibiotics (often combined with benzoyl peroxide), and retinoids to reduce the bumps. In moderate to severe cases, oral antibiotics may be warranted.
In summary, pseudofolliculitis barbae is a common, painful, and often disfiguring condition. Currently we have several excellent treatment options. We recommend you discuss these options with your dermatologist to see which one will work best for you.
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