Pseudofolliculitis barbae is a common complaint among darker-skinned patients with coarse, curly hair. Patients present with follicular papules in the beard area from ingrown hairs that can eventually result in post-inflammatory pigmentary alteration and scarring. While PFB is more common in men, women may also present with symptoms.
For dermatologists who do not regularly treat skin of color patients, here are tips for treating (pseudofolliculitis barbae).
- If your male patients don’t mind having a beard, suggest they grow one! The chances of having ingrown hairs that stimulate this condition are less likely if the hairs are not plucked or shaved. It also helps if they are kept at least a few millimeters long.
- If shaving is a must, advise your skin of color patients to:
- Apply warm compresses to the beard area for a few minutes prior to shaving. A mild exfoliant, loofah, or toothbrush can be used (in a circular motion) to help ingrown hairs be more easily plucked or released at the skin surface.
- Use a shaving gel and a sharp razor each time they shave.
- Do not pull the skin taut.
- Do not shave against the grain or direction of hair growth.
- Take short strokes and do not shave back and forth over the same areas.
- Use a soothing aftershave or hydrocortisone 1% lotion after each shave.
- If hair removal is a must, treatment options include:
- Using a shave protector mist or lotion to help soften the skin and reduce irritation.
- Using a self-cleaning electric razor (replacing the blades at least every 2 years).
- Using a thick shaving gel with either a single or twin blade razor or a chemical depilatory.
- Undergoing laser hair removal. Longer pulsed lasers (1064 nm or 810 nm) may work best in darker skinned patients.
- Using an enzyme inhibitor (has been shown to work synergistically with laser hair removal).
- Undergoing electrolysis. This may also be helpful if there are hairs that do not respond to laser hair removal with longer pulsed lasers.
- Products like PFB Vanish or A+ Skin Care products, that contain salicylic, glycolic, or lactic acid, can help prevent ingrown hairs after hair removal.
- If there are inflammatory papules or pustules, a combination benzoyl peroxide and clindamycin gel (such as BenzaClin or Duac) can be prescribed, but patients with severe inflammation may require oral antibiotics.
- The use of a topical retinoid at night, or a combination retinoid product with hydroquinone (such as Tri-Luma), may reduce post-inflammatory hyperpigmentation. Caution should be taken when treating darker skin with topical retinoids, however, because irritation from the products can lead to post-inflammatory pigmentary alteration. Advise patients to avoid using drying products, such as toners, if topical retinoids are being used.
- For severe or refractory post-inflammatory hyperpigmentation or inflammatory papules, consider chemical peels with 20%-30% salicylic acid.
For dermatologists who have worked with this type of condition before, what are your PFB solutions? The more we share our clinical insights, the better we will be able to achieve improved treatment results for our patients. Please take a moment to respond to this blog.