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Preventing Pseudofolliculitis Barbae in Male Clients

Holly Harmon July 2014 issue of Skin Inc. magazine
Preventing Pseudofolliculitis Barbae in Male Clients

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Pseudofolliculitis barbae (PFB) is a foreign body inflammatory reaction involving papules and pustules on the beard area—the lower face and neck—of men. Typically, there are groups of small red or pigmented bumps on the beard area that may flare with repeated shaving, and PFB tends to be worse with very curly or kinky hair.

Causes of PFB

There are two primary causes of PFB:

  1. Extrafollicular penetration occurs when the sharply pointed hair from a recent shave briefly surfaces from the skin and re-enters a short distance away (See Extrafollicular Exfoliation); and/or
  2. Transfollicular penetration occurs when methods of very close shaving result in a hair that is cut below the surface. These methods include pulling the skin taut while shaving, shaving against the grain, plucking hairs with tweezers, and using double- or triple-bladed razors. The close shave may result in a sharp tip below the skin surface, which is then more likely to pierce the follicular wall, causing PFB with transfollicular penetration.1, 2

Treatment for PFB

Treatment for this condition depends on its severity. Treatment specifications include shaving protocols, skin care ingredients and regimens, and prescriptive remedies. An effective starting point for treatment is to advise clients to let their beard grow for 30 days to eliminate ingrown hairs, if lifestyle and work environment allow for this. When they are ready to shave again, ask them to follow these specifications.

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Extrafollicular Exfoliation

The penetrating hair causes inflammation and abscesses. With penetration of the dermis, the epidermis grows down to try to ensheathe the hair, resulting in severe inflammation, abscess formation and a foreign-body reaction at the tip of the hair.

How to Prevent PFB

Share the following tips with your clients.

  • Follow the shaving protocols and hair-releasing methods in this article.
  • Grow a beard or wear trimmed facial hair if your lifestyle allows.
  • Follow the recommended skin care regimen, even after symptoms dissipate.
  • Avoid using needles, toothpicks or tweezers to dislodge stubborn hair tips. This causes greater irritation and can further damage the skin.
  • If your budget allows, incorporate laser hair removal as an alternative to shaving.
  • The use of a long-pulsed Nd:Yag laser in the treatment of PFB demonstrated a decrease in papule formation, miniaturization and reduction of hair counts in darker skin tones (Fitzpatrick IV, V and VI).8

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