Pseudofolliculitis Barbae · What Is It, Treatment, and More

Pseudofolliculitis barbae (PFB), most often known as razor bumps, is a chronic inflammatory skin condition caused by ingrown hairs, most often seen in 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. PFB resembles folliculitis, which is inflammation of hair follicles due to infection, but the inflammation in pseudofolliculitis is not due to infection but rather irritation of the skin from ingrown hairs.  

Although PFB is not life-threatening, it can cause several complications, such as secondary bacterial infections, hypertrophic scarring, and post-inflammatory skin color changes that can lead to significant cosmetic concerns.  

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.   

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, there are other conditions that can present similarly, including acne, razor burns, and fungal infections affecting the facial hair, like tinea barbae. 

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 too 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. To help prevent this, individuals may be advised to use retinoids at nighttime once or twice a week initially and increase frequency slowly to build up skin tolerance.   

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.  

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.