Pseudofolliculitis barbae
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Pseudofolliculitis barbae (PFB) is a persistent irritation caused by
shaving Shaving is the removal of hair, by using a razor or any other kind of bladed implement, to slice it down—to the level of the skin or otherwise. Shaving is most commonly practiced by men to remove their facial hair and by women to remove the ...
. It was first described in 1956.


Signs and symptoms


Related conditions

Razor burn is a less serious condition caused by shaving, characterized by mild to moderate redness and irritation on the surface of the skin. Unlike PFB, it is usually transient and there is no infection involved. There is also a condition called ''
folliculitis Folliculitis is the infection and inflammation of one or more hair follicles. The condition may occur anywhere on hair-covered skin. The rash may appear as pimples that come to white tips on the face, chest, back, arms, legs, buttocks, or head. A ...
barbae''. The difference between the two is the cause of the inflammation in the hair follicles. Where folliculitis barbae is caused by viral or bacterial infections, pseudofolliculitis is created by irritation from shaving and ingrown hairs. ''Pseudofolliculitis nuchae'', a related condition, occurs on the back of the neck, often along the posterior hairline, when curved hairs are cut short and allowed to grow back into the skin. Left untreated, this can develop into acne keloidalis nuchae, a condition in which hard, dark
keloid Keloid, also known as keloid disorder and keloidal scar, is the formation of a type of scar which, depending on its maturity, is composed mainly of either type III (early) or type I (late) collagen. It is a result of an overgrowth of granulation t ...
-like bumps form on the neck. Both occur frequently in black men in the military. Here it is so common that services often have known protocols for management.


Cause

Pseudofolliculitis barbae (PFB) is most common on the face, but it can also happen on other parts of the body where hair is shaved or plucked, especially areas where hair is curly and the skin is sensitive, such as
genital A sex organ (or reproductive organ) is any part of an animal or plant that is involved in sexual reproduction. The reproductive organs together constitute the reproductive system. In animals, the testis in the male, and the ovary in the female, a ...
shaving (more properly termed ''pseudofolliculitis pubis'' or PFP). After a hair has been shaved, it begins to grow back. Curly hair tends to curl into the skin instead of straight out of the follicle, leading to an inflammation reaction. PFB can make the skin look itchy and red, and in some cases, it can even look like
pimples A pimple is a kind of comedo that results from excess sebum and dead skin cells getting trapped in the pores of the skin. In its aggravated state, it may evolve into a pustule or papules. Pimples can be treated by acne medications, antibiotics, ...
. These inflamed
papules A papule is a small, well-defined bump in the skin. It may have a rounded, pointed or flat top, and may have a dip. It can appear with a stalk, be thread-like or look warty. It can be soft or firm and its surface may be rough or smooth. Some h ...
or
pustules A skin condition, also known as cutaneous condition, is any medical condition that affects the integumentary system—the organ system that encloses the body and includes skin, nails, and related muscle and glands. The major function of this sy ...
can form especially if the area becomes infected. This is especially a problem for some men who have naturally coarse or tightly curling thick hair. Curly hair increases the likelihood of PFB by a factor of 50. If left untreated over time, this can cause
keloid Keloid, also known as keloid disorder and keloidal scar, is the formation of a type of scar which, depending on its maturity, is composed mainly of either type III (early) or type I (late) collagen. It is a result of an overgrowth of granulation t ...
scarring in the beard area. Pseudofolliculitis barbae can further be divided into two types of
ingrown hair Ingrown hair is a condition where a hair curls back or grows sideways into the skin. The condition is most prevalent among people who have coarse or curly hair. It may or may not be accompanied by an infection of the hair follicle (folliculitis) o ...
s: transfollicular and extrafollicular. The ''extrafollicular'' hair is a hair that has exited the follicle and reentered the skin. The ''transfollicular'' hair never exits the follicle, but because of its naturally curly nature curls back into the follicle causing fluid build-up and irritation. A common polymorphism in a
keratin Keratin () is one of a family of structural fibrous proteins also known as ''scleroproteins''. Alpha-keratin (α-keratin) is a type of keratin found in vertebrates. It is the key structural material making up scales, hair, nails, feathers, ho ...
gene (K6hf) has been linked to PFB, suggesting that it may be a genetic
risk factor In epidemiology, a risk factor or determinant is a variable associated with an increased risk of disease or infection. Due to a lack of harmonization across disciplines, determinant, in its more widely accepted scientific meaning, is often use ...
. This sequence change leads to an amino acid substitution in the highly conserved
helix A helix () is a shape like a corkscrew or spiral staircase. It is a type of smooth space curve with tangent lines at a constant angle to a fixed axis. Helices are important in biology, as the DNA molecule is formed as two intertwined helices, ...
initiation motif of the K6hf rod domain. Carriers of the A12T polymorphism are six times more likely to develop PFB compared with people
homozygous Zygosity (the noun, zygote, is from the Greek "yoked," from "yoke") () is the degree to which both copies of a chromosome or gene have the same genetic sequence. In other words, it is the degree of similarity of the alleles in an organism. Mo ...
for the
wild-type The wild type (WT) is the phenotype of the typical form of a species as it occurs in nature. Originally, the wild type was conceptualized as a product of the standard "normal" allele at a locus, in contrast to that produced by a non-standard, "m ...
K6hf sequence. This suggests K6hf mutation structurally weakens the companion layer separating the inner and outer root sheath and increases the chances that a beard hair will in-grow.


Prevention

The most efficient prevention is to grow a
beard A beard is the hair that grows on the jaw, chin, upper lip, lower lip, cheeks, and neck of humans and some non-human animals. In humans, usually pubescent or adult males are able to grow beards. Throughout the course of history, societal at ...
. For men who are required to, or simply prefer to shave, studies show the optimal length to be about 0.5 mm to 1 mm to prevent the hair growing back into the skin. Using a beard trimmer at the lowest setting (0.5mm or 1mm) instead of shaving is an efficient alternative. The resulting faint stubble can be shaped using a standard electric razor on non-problematic areas (cheeks, lower neck). For most cases, completely avoiding shaving for three to four weeks allows all lesions to subside, and most extrafollicular hairs will resolve themselves within at least ten days. Permanent removal of the hair follicle is the only definitive treatment for PFB.
Electrolysis In chemistry and manufacturing, electrolysis is a technique that uses direct electric current (DC) to drive an otherwise non-spontaneous chemical reaction. Electrolysis is commercially important as a stage in the separation of elements from n ...
is effective but limited by its slow pace, pain and expense. Laser-assisted hair removal is effective. There is a risk of skin discoloration and a very small risk of scarring. Some men use electric razors to control PFB. Those who use a
razor A razor is a bladed tool primarily used in the removal of body hair through the act of shaving. Kinds of razors include straight razors, safety razors, disposable razors, and electric razors. While the razor has been in existence since before t ...
should use a single blade or special wire-wrapped blade to avoid shaving too closely, with a new blade each shave. Shaving in the direction of hair growth every other day, rather than daily, may improve pseudofolliculitis barbae. If one must use a blade, softening the beard first with a hot, wet washcloth for five minutes or shave while showering in hot water can be helpful. Some use shaving powders (a kind of
chemical depilatory A chemical depilatory is a cosmetic preparation used to remove hair from the skin. Common active ingredients are salts of thioglycolic acid and thiolactic acids. These compounds break the disulfide bonds in keratin and also hydrolyze the hair so t ...
) to avoid the irritation of using a blade.
Barium sulfide Barium sulfide is the inorganic compound with the formula Ba S. BaS is the barium compound produced on the largest scale. It is an important precursor to other barium compounds including BaCO3 and the pigment lithopone, ZnS/BaSO4. Like other c ...
-based depilatories are most efficient, but produce an unpleasant smell.


Treatment

The simplest treatment for PFB is to let the beard grow. Complete removal of the hair from its follicle is not recommended. Severe or transfollicular hairs may require removal by a dermatologist. Medications are also prescribed to speed healing of the skin. Clinical trials have shown
glycolic acid Glycolic acid (or hydroxyacetic acid; chemical formula HOCH2CO2H) is a colorless, odorless and hygroscopic crystalline solid, highly soluble in water. It is used in various skin-care products. Glycolic acid is widespread in nature. A glycolate (so ...
-based peels to be an effective and well-tolerated therapy which resulted in significantly fewer PFB lesions on the face and neck. The mechanism of action of glycolic acid is unknown, but it is hypothesized that straighter hair growth is caused by the reduction of
sulfhydryl In organic chemistry, a thiol (; ), or thiol derivative, is any organosulfur compound of the form , where R represents an alkyl or other organic substituent. The functional group itself is referred to as either a thiol group or a sulfhydryl grou ...
bonds in the
hair shaft Hair is a protein filament that grows from follicles found in the dermis. Hair is one of the defining characteristics of mammals. The human body, apart from areas of glabrous skin, is covered in follicles which produce thick terminal and fine ...
by glycolic acid, which results in reduced re-entry of the hair shaft into the follicular wall or
epidermis The epidermis is the outermost of the three layers that comprise the skin, the inner layers being the dermis and hypodermis. The epidermis layer provides a barrier to infection from environmental pathogens and regulates the amount of water rele ...
.
Salicylic acid Salicylic acid is an organic compound with the formula HOC6H4CO2H. A colorless, bitter-tasting solid, it is a precursor to and a metabolite of aspirin (acetylsalicylic acid). It is a plant hormone, and has been listed by the EPA Toxic Substance ...
peels are also effective. Prescription antibiotic gels (Benzamycin, Cleocin-T) or oral antibiotics are also used.
Benzoyl peroxide Benzoyl peroxide is a chemical compound (specifically, an organic peroxide) with structural formula , often abbreviated as (BzO)2. In terms of its structure, the molecule can be described as two benzoyl (, Bz) groups connected by a peroxide () ...
may be used topically, combined or not with prescription antibiotics.
Retin-A Tretinoin, also known as all-''trans'' retinoic acid (ATRA), is a medication used for the treatment of acne and acute promyelocytic leukemia. For acne, it is applied to the skin as a cream, gel or ointment. For leukemia, it is taken by mouth ...
is a potent treatment that helps even out any scarring after a few months. It is added as a nightly application of Retin-A cream 0.05–0.1% to the beard skin while beard is growing out. Tea tree oil, witch hazel, and hydrocortisone are also noted as possible treatments and remedies for razor bumps.


Legal

In 1991, the
Eighth Circuit Court of Appeals The United States Court of Appeals for the Eighth Circuit (in case citations, 8th Cir.) is a United States federal court with appellate jurisdiction over the following United States district courts: * Eastern District of Arkansas * Western Distr ...
found that
Domino's Pizza Domino's Pizza, Inc., trading as Domino's, is an American multinational pizza restaurant chain founded in 1960 and led by CEO Russell Weiner. The corporation is Delaware domiciled and headquartered at the Domino's Farms Office Park in Ann Arbor ...
's policy of not allowing beards for employees created a disparate impact by excluding a quarter of black men from employment, but not an equivalent number of white men, thus violating
Title VII of the Civil Rights Act of 1964 The Civil Rights Act of 1964 () is a landmark civil rights and labor law in the United States that outlaws discrimination based on race, color, religion, sex, and national origin. It prohibits unequal application of voter registration requir ...
. In contrast, in 1993, the
Eleventh Circuit Court of Appeals The United States Court of Appeals for the Eleventh Circuit (in case citations, 11th Cir.) is a federal court with appellate jurisdiction over the following U.S. district courts: * Middle District of Alabama * Northern District of Alabama * ...
upheld the Atlanta fire department's "no-beard" policy because it was justified by a "business necessity", in that case the fact that even short beards interfered with firefighters' use of
self-contained breathing apparatus A self-contained breathing apparatus (SCBA), sometimes referred to as a compressed air breathing apparatus (CABA) or simply breathing apparatus (BA), is a device worn to provide breathable air in an atmosphere that is immediately dangerous to ...
.''Fitzpatrick v. City of Atlanta''
2 F.3d 1112
(11th Cir. 1993).


See also

*
Laser hair removal Laser hair removal is the process of hair removal by means of exposure to pulses of laser light that destroy the hair follicle. It had been performed experimentally for about twenty years before becoming commercially available in 1995 and 1996. O ...
*
List of cutaneous conditions Many skin conditions affect the human integumentary system—the organ system covering the entire surface of the body and composed of skin, hair, nails, and related muscle and glands. The major function of this system is as a barrier against t ...


References


External links

{{DEFAULTSORT:Pseudofolliculitis Barbae Conditions of the skin appendages