John R. Tkach, M.D.
300 North Willson, Suite 203B
Bozeman, MT 59715
(406) 587-5442

Pseudofolliculitis Barbae

Patient Information Sheet

Pseudofolliculitis barbae is a pimple-like inflammation of hair follicles of the bearded area due to shaving. Although it most commonly occurs in men in the area of the beard of the face and neck, it can anywhere that the hair is shaved such as under the arms, on the legs, and at preop surgery preparation sites such as the chest and abdomen. It is as problem there because it can cause wound infection.

The problem is shaving rather than infection. The shaved areas can become infected. Figures 1-5 show how this condition arises. Hair grows from hair follicles. The hair grows outward and emerges from the surface of the skin hair follicle opening.

When we shave, we try to get the closest possible shave. This is achieved by pulling on the skin and shaving against the grain. By pulling on the skin, the hair is made to stand farther out. After the razor passes over the hair and the skin is released, the hair stubble retracts under the skin. Since you cannot feel it, it feels smooth. When the razor cuts across the hair, it frequently cuts it at an angle producing a sharp point similar to a hypodermic needle.

As the hair grows out of the hair follicle again, the sharp point allows the hair to puncture the side of the hair follicle and move through the skin. In so doing, it carries bacteria and foreign material with it, which case an inflammation or infection in the hair follicle and surrounding skin (figure 4). Sometimes the grows into the skin (figure 5 curling around to produce an ingrown hair.

Normal Skin

Figures 1-5 Closely cut hair with a sharp tip retracts into hair follicle. It punctures the skin when it grows out.

Management:

The most effective way to control pseudofolliculitis barbae is to abandon shaving. Mother Nature does not really care if you have hair on your face or other areas. Unfortunately, our culture has become so highly civilized that people find this undesirable.

Here are some suggestions for management of this problem.

  1. Shave with a single blade razor rather than a multiple track razor. Some electric razors make pseudofolliculitis worse. The Norelco electric shaver that does not shave as closely may be preferable. Whether electric or plain, try to settle for a less close shave.
  2. Before shaving, wet the beard thoroughly and apply a heavy layer of shaving lather (not for electric razor). Allow the lather to sit in the beard about 3 minutes before shaving. This will soften the hair so that, when it is cut, it will produce more of a blunt end rather than a sharp needle like point.
  3. Shave with the grain rather than against it.
  4. Do not pull the skin tight.
  5. Pimples arising in the bearded area may be managed with medicines such as Cleocin T solution.
  6. Occasionally, it is possible to avoid shaving by using a depilatory cream like Nair. These chemicals dissolve the hair. You can get them in grocery stores and drug stores without a prescription. The problem is that these strong chemicals can be irritating. Use them with caution.

Pseudofolliculitis will continue as long as you continue to shave. The problem is more severe in people with short kinky hair such as black men. There was a famous case in which a black officer in the Air Force has such severe pseudofolliculitis that his doctor ordered him to stop shaving. This was against regulations. His commanding officer court marshalled him. This case went all the way to the Supreme Court where the patient lost. He left the Air Force. We dermatologists were upset about this decision.

By following these steps, it should be possible for you to greatly decrease the severity of your problem.

Tkach JR, Shannon AM, Beastrom R. Pseudofolliculitis due to preoperative shaving , ORN J. 1979-11. Vol. 30, Iss. 5; p. 881-4

The information provided in these patient information sheets is offered for general informational and educational purposes only; it is not offered as and does not constitute medical advice. In no way are any of the materials presented meant to be a substitute for professional medical care or attention by a qualified practitioner, nor should they be construed as such.

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