Background
Pseudofolliculitis barbae (PFB) or shaving bumps is a foreign body inflammatory reaction involving papules and pustules. It primarily affects curly haired males who shave. [1] Pseudofolliculitis barbae can also affect some white men and hirsute black women. Pseudofolliculitis pubis is a similar condition occurring after pubic hair is shaved.
Pathophysiology
Two mechanisms are involved in the pathogenesis of pseudofolliculitis barbae: (1) extrafollicular penetration occurs when a curly hair reenters the skin, and (2) transfollicular penetration occurs when the sharp tip of a growing hair pierces the follicle wall.
Black men who shave are predisposed to this condition because of their tightly curved hair. The sharp pointed hair from a recent shave briefly surfaces from the skin and reenters a short distance away. Several methods of close shaving result in a hair cut below the surface. These methods include pulling the skin taut while shaving, shaving against the grain, plucking hairs with tweezers, removing hairs with electrolysis, and using double- or triple-bladed razors. The close shave results in a sharp tip below the skin surface, which is then more likely to pierce the follicular wall, causing pseudofolliculitis barbae with transfollicular penetration. [2, 3]
Etiology
African Americans are genetically predisposed to pseudofolliculitis barbae because of the curvature of their hair follicles. Improper shaving techniques and the desire for a clean-shaven appearance can result in ingrown hairs via extrafollicular or transfollicular penetration.
Epidemiology
US frequency
About 10-80% of adult black men have pseudofolliculitis barbae, particularly those who shave closely on a regular basis. [4] It is a significant problem in black men in the military where regulations require a clean-shaven face. [5]
Race
Pseudofolliculitis barbae is found mostly in black men.
Sex
Men with facial hair comprise most patients, although hirsute women can also develop pseudofolliculitis barbae. Both sexes can develop pseudofolliculitis pubis. Common sites in black women and those of ethnic backgrounds characterized by darker skin include the pubic and axillary areas because these are more frequent sites of hair removal in this population.
Age
Pseudofolliculitis barbae affects men with facial hair (postpuberty).
Prognosis
Although usually not regarded as a serious medical problem, pseudofolliculitis barbae can cause cosmetic disfigurement. The papules can lead to scarring, postinflammatory hyperpigmentation, secondary infection, and keloid formation. No cure exists, but effective treatment is available. If the patient is able to grow a beard, the problem usually disappears (except for any residual scarring).
Patient Education
Instruct the patient to stop shaving for 3-4 weeks. This gives adequate time for the hair follicles to grow to a length where ingrown hairs will spring free.
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Pseudofolliculitis barbae on the neck of a black man.
