Pseudofolliculitis barbae may be a chronic inflammatory skin condition caused by ingrown hairs. It's most frequently triggered by hair removal, particularly shaving, because shaving cuts the hair into a pointy tip that will more easily penetrate the skin. After all, it grows. Pseudofolliculitis barbae commonly develops within the beard area of men, but it can occur altogether sexes and in any area where thick or coarse hair grows.

Pseudofolliculitis barbae is more commonly referred to as razor bumps, shaving bumps, or ingrown hairs.

Pseudofolliculitis Barbae Symptoms

Pseudofolliculitis barbae affects the hair follicles and surrounding skin in areas where terminal hair (the thicker, coarser hair that begins to develop after puberty) grows.

It's commonest in the beard area (the lower cheeks, jawline, chin, and neck). Pseudofolliculitis also can appear on the rear of the neck, within the pubic area (especially if the hair is groomed), and infrequently on the underarms, arms, or legs.

This condition develops after hair has been removed by either shaving (most commonly) or waxing.

Symptoms include:


  • Red, inflamed bumps (called papules) which will be sore or painful
  • Itching
  • Pustules (inflamed bumps with a white or yellow "head" that's crammed with pus)

These symptoms develop or worsen, within each day or two after shaving.

More serious inflamed skin lesions, like nodules and abscesses, may develop if the follicle becomes infected. Staphylococcus aureus is that the commonest culprit.

Pseudofolliculitis also causes darkening of the skin in affected areas, a condition called post-inflammatory hyperpigmentation. Hypertrophic (raised scars) or keloid scars also can develop in people that are susceptible to them.

Causes

There are three main factors that, together, trigger pseudofolliculitis development. They are:


  • Having curly hair
  • Being genetically susceptible to the condition
  • Your current hair grooming method

Pseudofolliculitis develops when terminal hair doesn't get older and out of the follicle normally through the opening at the skin's surface, also referred to as the pore. Instead, the hair grows laterally, underneath the skin's surface, through the follicle wall, and into the encompassing skin tissue. this is often referred to as transfollicular penetration.

Sometimes the hair will exit the pore normally, but do a pointy "U-turn" and grow back to the skin from the surface. this is often called extrafollicular penetration.

Either way, the skin now sees the hair as a far off invader and therefore the body attacks it.

Curly Hair

Although it can happen in any hair type, pseudofolliculitis is far and away more common in people with naturally curly hair. Tightly curled hair is more likely to twist back to the skin instead of growing up and out of the follicle.

As such, pseudofolliculitis barbie is incredibly common in black men and men who have curly facial hair. It's estimated that up to 83% of all African American men develop pseudofolliculitis barbae.

Genetic Predisposition

Interestingly, some people are more susceptible to developing pseudofolliculitis barbae beyond just hair texture. a crucial 2004 study published within the Journal of Investigative Dermatology found that folks who had one nucleotide substitution during a specific keratin gene (K6hf) were sixfold more likely to develop pseudofolliculitis barbae than those without now mutation.

Shaving

Even with the opposite factors, it's shaving (and less often waxing) that's the initial trigger which ultimately causes pseudofolliculitis to develop.

Hair stretches, just a touch, when shaving, especially if the skin is pulled taut. because the razor cuts, the hair pulls back and retracts into the follicle. this is often why the skin feels perfectly smooth without a touch of stubble: the hair shaft has been cut not at the skin's surface but slightly below.

While this makes for a pleasant, close call, it also sets up the right scenario for pseudofolliculitis to develop. Shaving creates a pointy, angled point at the ideas of the hair where it's been cut. This sharp point can more easily pierce the skin because the hair grows.

Hair that's thick and coarse, being more robust than fine vellus hair, also can penetrate the skin more easily.

So, because shaving cuts hair into a skin-piercing point, and cuts it below the skin's surface where it can easily curl back to the skin instead of get older and out of the pore, it's the most trigger factor for pseudofolliculitis barbae development.

Other Possible Triggers

Pseudofolliculitis barbae is more common in women with polycystic ovary syndrome (PCOS), and other hormonal disorders that cause hirsutism, or excessive facial hair. it's also more common in perimenopausal and menopausal women.

Other risk factors for pseudofolliculitis include taking cyclosporine, and corticosteroids in renal transplant patients.

Diagnosis

Pseudofolliculitis is diagnosed supported a review of symptoms and a visible inspection of the skin. there's no specific test for diagnosing pseudofolliculitis.

Your physician may check out your skin employing a dermoscopy. A dermoscopy, a handheld instrument almost like a hand glass, is employed to magnify the skin up to 10 times and allows the physician to ascertain ingrown hairs under the skin's surface. they appear like dark grey or black lines or spots under the skin.

Very rarely, your doctor may swab your skin to see for bacteria infection.

In general, pseudofolliculitis is straightforward to diagnose, but other skin conditions cause inflamed bumps. Skin conditions that resemble pseudofolliculitis barbae include:


  • Tinea barbae: Tinea, better referred to as ringworm, maybe a mycosis. It can occur anywhere on the skin. When it appears within the beard area it's called barber's itch.
  • Razor burn: Razor burn also appears after shaving, typically immediately after, and causes redness, burning, pain, and inflamed bumps. Unlike pseudofolliculitis, razor burn isn't caused by ingrown hairs, but rather irritation from the friction caused by shaving. Razor burn improves each day or two after shaving, while pseudofolliculitis worsens a couple of days after shaving.
  • Acne vulgaris: Pseudofolliculitis looks remarkably almost like acne, and is usually confused with this skin issue. But there are differences between an hair and a pimple. More tellingly, pseudofolliculitis only appears within the areas where the hair is thick or coarse, especially if you're shaving therein area. Acne occurs over the whole face.

Treatment

The best treatment for pseudofolliculitis is prevention. Arguably, the foremost effective thanks to prevent these ingrown hairs is to completely stop shaving (or using other sorts of hair removal) and let the hair grow out.

At first, this might cause a rise in symptoms because the hair that has already been shaved is trying to grow out can become trapped under the skin. Over time, though, the skin improves because the grown-out hair stays above the skin's surface. There's much less chance for ingrown hairs to develop.

When you completely stop shaving, marked improvement is usually seen in about three months.

In many cases, stopping shaving will completely clear up pseudofolliculitis barbae. At now, any treatment for post-inflammatory hyperpigmentation or scars are often started.

But, in many cases, letting hair grow out isn't an option. you'll have employment that needs you to be clean-shaven, or longer hair simply isn't desired. If that's where you're at, other treatment options will be used.

Adopt Proper Shaving Techniques

If you're susceptible to pseudofolliculitis barbae, proper shaving techniques will help to avoid irritation and reduce hair development. the following pointers are often used for all areas of the body, not just the face.


  • Pre Shave, hydrate the hair to melt. this will be through with a warm, damp towel (like how your skin is prepped for shave within the barbershop). At home, it's more practical to shave immediately after showering. this enables the skin and hair to be hydrated and softened. Shaving hair that's well-hydrated is more likely to supply a blunt tip, instead of a pointy end.
  • Use moisturizing shaving soap or gels to offer a shave with less drag. Friction can irritate the skin.
  • Don't pull the skin taut when shaving. this provides you a better shave, but an in-depth shave isn't what you are going for. When the skin is pulled taut, the hair is cut so close that it stretches then retracts under the skin's surface. This makes ingrown hairs far more likely because the hair grows out.
  • Use one blade razor instead of one with multiple blades. Along an equivalent line, with a multiple blade razor, one blade pulls and stretches the hair while the opposite blade cuts the hair short enough to retract below the skin's surface. you'll also get good results switching to an electrical razor instead of a blade.
  • Shave within the direction of hair growth instead of against the grain. Doing this would possibly not offer you as close of a shave, so you will not feel completely smooth. But again that's the goal⁠—to keep the hair just above the surface of the skin so there's less chance of it turning and growing into the skin's tissue.
  • Shave less frequently, if possible. Again, this enables the hair to remain a touch on the longer side, reducing hair development.
  • Use clippers rather than a razor. this does not offer you an in-depth, clean shave, but rather keeps hair very short but above the skin's surface. It's recommended that you simply leave the hair a minimum of 1 millimeter long. (Think of shaving to only leave a 5 o'clock shadow.)

Chemical Depilatories

If you are not getting adequate results, even with careful shaving techniques, you'll wish to undertake chemical depilatories.

Chemical depilatories work by dissolving the hair shaft so that the hair is often rinsed or wiped away. this is not a permanent means of getting obviate hair; it'll grow back. But when it does, the hair itself features a softer, finer tip that's less ready to pierce the skin's tissue and thus less likely to become ingrown.

The downside is depilatories are messy and smelly. they will even be irritating for a few people, causing burning and stinging during use. If you're particularly sensitive, they'll also cause dermatitis.

Always use depilatories with care, and follow all directions on the package.

Topical Exfoliants and Keratolytics

Exfoliants are products that loosen and take away dead skin cells on the skin's surface, allowing them to slough away. Keratolytics are a kind of exfoliant that employment by softening keratin (the chief protein that creates up hair, skin, and nails) and dissolving the bonds that hold dead skin cells together.

Regular use of exfoliants products helps to enhance pseudofolliculitis barbae by reducing excess cells on the skin's surface that promote ingrown hairs. they're typically applied once or twice daily over all affected areas.

Options include:


  • Alpha-hydroxy acids, including glycolic acid: These are often found in over-the-counter (OTC) products and prescription creams. glycollic acid, especially when utilized in peels, softens the bonds of the hair shaft, making the hair less ready to penetrate the skin.
  • Salicylic acid: 2-hydroxybenzoic acid is found in OTC acne treatments. Stronger medications are often prescribed by a doctor. additionally to topical medications, 2-hydroxybenzoic acid peels are beneficial.
  • Topical retinoids: Topical retinoids included medications like Retin-A (tretinoin) and Tazorac (tazarotene). These medications are available by prescription only.

Lightly exfoliating with an OTC scrub daily can help lift hairs that are already above the skin's surface, preventing them from making a U-turn and growing back to the skin. OTC scrubs are best as a preventative in minor cases of pseudofolliculitis barbae, and as long as the skin isn't considerably inflamed.

Topical Steroids

Your doctor may recommend topical steroids for short-term treatment to alleviate moderate to severe inflammation.

Over-the-counter hydrocortisone cream can reduce itching and inflammation. If OTC options aren't enough, you'll be prescribed a stronger medication.

All topical steroids, including OTC hydrocortisone, should only be used on an as-needed basis and not as a long-term daily treatment, and only under the advice of a physician. Side effects include thinning of the skin and hyperpigmentation, which is far more common in black skin.

Procedural Treatments

These aren't used as a first-line defense against pseudofolliculitis. Instead, these procedures could also be tried if pseudofolliculitis is severe and not responding well to other treatments.


  • Laser hair removal: With laser hair removal, laser light is directed at the hair follicles. This light destroys the follicle, slowing hair growth or completely preventing it from ever regrowing.
  • Photodynamic therapy (PDT): During this procedure, a light-sensitizing fluid is applied to the skin. This area is then exposed to light. While this treatment is usually wont to treat acne and precancerous skin conditions, it is not often wont to treat pseudofolliculitis. However, it's shown promise in certain severe, hard-to-treat cases.

The drawback of those procedures is that the expense. In many cases, they're not covered by medical insurance and therefore the cost can make these treatments out of reach for a few.

There is also a time investment involved because, with both procedures, you'll need a series of treatments wiped out to ascertain any sort of result.

There is also the danger of hyperpigmentation (skin darkening) or hypopigmentation (skin lightening) with either procedure, especially for those with medium to dark skin tones.

Your physician can tell you if these procedures are appropriate for you.

Antibiotics

Antibiotics are prescribed on an as-needed basis to assist clear up any infection that has taken hold. Signs of infection include increased swelling, pain, warmth, and drainage of pus.

Antibiotics don't treat the underlying explanation for pseudofolliculitis, though, so these cannot be used because of the sole treatment. Instead, they're utilized in conjunction with other treatments.

Prognosis

The prognosis for pseudofolliculitis barbae is sweet, although you'll find yourself with some residual hyperpigmentation or scarring.

There is no cure for pseudofolliculitis, so you'll always be susceptible to developing ingrown hairs. It requires lifelong management to stay this skin condition cornered.

Coping

Having pseudofolliculitis barbae is often embarrassing also as uncomfortable. Because it most frequently appears on the face, it feels so "front and center." People with pseudofolliculitis say they often feel embarrassed or ashamed due to the condition. It can affect self-esteem and self-confidence.

The most important thing you'll do if you've got this condition is to start treatment. There are many various options and, in most cases, pseudofolliculitis barbae are often considerably improved within a couple of months with careful management.

In the meantime, a tinted moisturizer, concealer, or cosmetic foundation can help tone down redness and help camouflage discoloration while you're expecting treatments to figure.

While pseudofolliculitis barbae are often a difficult condition to manage, it's treatable. This presumably means an entire overhaul of your current grooming practices. It also means you'll be limited in your sort of facial hair or methods of hair removal on other areas of the body.

If you cannot get pseudofolliculitis in check with changing your shaving and skincare techniques, make a meeting together with your doctor. There are other treatment options available that will markedly improve this skin condition.