What Is It, Treatment, and More
Author: Anna Hernández, MD
Editors: Alyssa Haag, Emily Miao, PharmD
Illustrator: Jillian Dunbar
Copyeditor: David G. Walker
What is pseudofolliculitis barbae?
Pseudofolliculitis barbae (PFB), most often known as razor bumps, is a chronic inflammatory skin condition caused primarily by removal of hair and most commonly facial hair. Although it typically affects the beard area, it can also develop in other areas where hair is frequently shaved or plucked, such as the armpits, groin, and legs. This condition is more common in people who naturally have tightly coiled hair, such as Black people of African descent or Hispanic people. Although PFB is not life-threatening, it can cause complications, such as secondary bacterial infections, hypertrophic scarring, and post-inflammatory skin color changes that can lead to significant cosmetic concerns.
What causes pseudofolliculitis barbae?
Pseudofolliculitis barbae typically develops after shaving or undergoing other forms of hair removal in predisposed individuals. Specifically, PFB occurs when freshly cut hairs do not grow out of the hair follicles like they naturally would. Instead, they curl in on themselves and penetrate the skin a short distance away from the hair follicle, a condition known as extrafollicular penetration. The ingrown hairs then produce a foreign-body inflammatory reaction that is responsible for the formation of the typical skin lesions. In other cases, emerging hairs fail to exit through the skin and continue to grow downwards into the dermis, causing an inflammatory reaction. This is known as transfollicular penetration.Although pseudofolliculitis barbae can occur with any hair type, it is more common in individuals with naturally coarse or tightly coiled hair. This is because tightly coiled hair is more likely to twist back into the skin rather than straight out of the hair follicle. Other risk factors include having a genetic predisposition and shaving regularly.
What are the signs and symptoms of pseudofolliculitis barbae?
Individuals with pseudofolliculitis barbae often experience pain with shaving, as well as itching and stinging one to two days after shaving. Typical skin lesions include erythematous papules (i.e., inflamed skin bumps) that develop in the neck, chin, and cheeks. If these lesions become secondarily infected by bacteria, they can turn into pus-filled pustules. Over time, there may be darkening of the skin in the affected areas, as well as hypertrophic scarring (i.e., developing a thick, raised scar).
How is pseudofolliculitis barbae diagnosed?
Pseudofolliculitis barbae is usually diagnosed based on the findings of a physical exam. If the clinical presentation is unclear, a dermatoscope (i.e., a hand-held magnifying glass used to diagnose skin conditions) may be used to visualize ingrown hairs under the skin’s surface. Although PBF is often easily identified, other conditions that can present similarly (e.g., acne; razor burns; and fungal infections affecting the facial hair, like tinea barbae) should be excluded.
How is pseudofolliculitis barbae treated?
Treatment of pseudofolliculitis barbae involves avoiding shaving the affected area for a minimum of four weeks to allow for continuous hair growth. If letting the hair grow is not a feasible option, individuals may be advised to use barber-style clippers or electric razors, which prevent facial hair from being trimmed close to the skin. Other recommended grooming techniques include avoiding close shaving (i.e., maintaining a hair length of 0.5 cm), shaving in the direction of hair growth, and not pulling the skin taut while shaving.Individuals with moderate to severe inflammation may benefit from treatment with topical steroids after shaving as well as a topical antibiotic cream. Topical retinoid preparations or benzoyl peroxide creams may also be effective in mild or moderate cases; however, they can cause mild skin irritation. Additionally, chemical peels containing salicylic or glycolic acid may also help to prevent ingrown hairs. Ultimately, though, the most effective treatment for PFB involves destruction of the hair follicle via laser therapy. Although there are several laser hair removal treatments available, long-wavelength lasers (e.g., Nd:YAG and diode lasers) are safer and better suited for individuals with darker skin types, who are more prone to developing PFB.
How long does pseudofolliculitis barbae last?
Most PFB lesions resolve on their own after at least one month of continuous hair growth. However, PFB is a chronic condition that can reappear once the individual resumes shaving, so practicing an adequate grooming technique is recommended to avoid recurrences.
What are the most important facts to know about pseudofolliculitis barbae?
Pseudofolliculitis barbae (PFB) is a chronic inflammatory skin condition mainly caused by removal of facial hair that primarily affects individuals with tightly coiled hair. It is characterized by firm, hyperpigmented papules and pustules that are typically painful and itchy after shaving. PFB is classically located on cheeks, jawline, and neck, but it can also develop in other body areas where hair is frequently shaved or plucked. Diagnosis is clinical, and the single most effective treatment is to allow the beard to grow or to remove the hair follicle via laser therapy.
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Resources for research and reference
Kundu, R. V., & Patterson, S. (2013). Dermatologic conditions in skin of color: Part II. Disorders occurring predominantly in skin of color. American family physician, 87(12), 859–865.
Ogunbiyi, A. (2019). Pseudofolliculitis barbae; current treatment options. Clinical, cosmetic and investigational dermatology, 12, 241–247. DOI:10.2147/CCID.S149250Ross, E. V., Cooke, L. M., Timko, A. L., Overstreet, K. A., Graham, B. S., & Barnette, D. J. (2002). Treatment of pseudofolliculitis barbae in skin types IV, V, and VI with a long-pulsed neodymium:yttrium aluminum garnet laser. Journal of the American Academy of Dermatology, 47(2), 263–270. DOI:10.1067/mjd.2002.124081