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Pseudofolliculitis Barbae (PFB)
What Is Pseudofolliculitis Barbae (PFB)?
Pseudofolliculitis Barbae - pronounced - SOO-doh-fuh-LIK-yoo-LY-tis BAR-bee.
Pseudofolliculitis barbae (PFB), commonly referred to as razor bumps, shaving bumps, or ingrown hairs, is a common, chronic (lasting a long time) skin condition of the hair follicle caused by ingrown hairs producing a "foreign body inflammatory reaction". This can become unsightly and painful, and very distressing for the affected individual.
Who Gets Pseudofolliculitis Barbae (PFB)?
45 to 85 percent of black men have some form of PFB. PFB primarily affects men and women of African American and Hispanic origin who have tightly curled hair and who shave closely on a regular basis or tweeze hairs frequently, although any individual with curly hair may be affected. It is rather rare and usually far less severe in Caucasian males. PFB may also be seen in women of all races who wax or shave the axillary (pertaining to the armpit) and pubic area (this is known as pseudofolliculitis pubis, a similar condition occurring after pubic hair is shaved, affecting both males and females).
Among black men who shave, PFB is of particular concern because of both social pressures and limited medical understanding concerning its treatment.
Causes of Pseudofolliculitis Barbae (PFB)
Shaving is the major cause of PFB. PFB results from penetration by sharp incurving beard hairs. Curly beard hairs that are cut too short makes the hairs curl back into the skin. This often produces painful, pruritic, and sometimes hyperpigmented papules and pustules, causing inflammation and possible infection, and occasionally keloid formation over the beard area as a result of ingrown hairs. The shape of the hair follicle, hair cuticle, and the direction of hair growth each play a role in the inflammatory response once the hair is shaven or plucked and left to grow.
Curly hair has a much higher risk of growing back into the skin than straight or wavy hair.
Several methods of improper shaving techniques to achieve a clean-shaven appearance can result in ingrown hairs. Methods include:
- Shaving everyday
- Pulling the skin taut while shaving
- Shaving against the grain
- Using multi-blade razors
- Plucking hairs with a tweezers
- Removing hairs with electrolysis
The Military and Pseudofolliculitis Barbae (PFB)
Commonly encountered in the military, PFB has caused significant problems in all commands, both medically and administratively. PFB possibly affects 45 percent of all black servicemen.
Because of a continued requirement by the United States Army of clean shaven faces, significant interracial turmoil and hostility has been aroused, and definitive medical care has been difficult to achieve. The condition can be "cured" only by complete cessation of shaving (to stop shaving) but it can be adequately controlled in most individuals by carefully shaving the hairs neither too close nor too long and by meticulous (extremely precise) lifting out of penetrating hairs.
Randomly approached lower-ranking enlistees and draftees are much more likely to complain about their condition, even if minor, and are more likely to refuse to shave and be unkempt even without permission to grow a beard (in contravention of Army regulations). Career black enlistees are likely to under-report the severity of their condition and not seek medical help, possibly because of fear of continuous harassment and inability to be promoted by their superiors.
In the armed forces, PFB represents a real challenge for both the physician and the patient. The combat environment, with the recent threat of biological and chemical weapons, requires the servicemen to be clean-shaven for appropriate gas mask fitting around the face. A successful shaving technique involves a 30-day period of beard regrowth to eliminate ingrown hairs, twice-daily use of a new polyester skin-cleansing pad, and use of solely electric hair clippers for facial hair removal. Ninety-six percent of those using this technique could thereafter conform to the Air Force grooming code. (References: www.ncbi.nlm.nih.gov/pubmed - Jul 2003)
Treatment of Pseudofolliculitis Barbae (PFB)
Many treatment options are available. Proper treatment is essential to avoid unnecessary scarring, pigmentation, and keloid formation. Treatment must be individualized, as not all regimens will work for each patient. Management includes:
- Cessation of shaving.
- The use of various combinations of topical antibiotics, corticosteroids, and retinoids. (Topical application of glycolic acid lotion is an effective therapy for PFB and allows the person to resume a daily shaving regimen with little irritation.)
- Modification of shaving techniques.
- The use of lotion depilatories or hair clippers, combined with routine lifting of ingrown hairs are the most effective treatments, although complete cessation of shaving is first required.
Laser Therapy
More recently, laser therapy has revolutionized the treatment of PFB and has enabled a cure for the first time for those plagued with this disorder and for whom a beardless face is acceptable. (References: www.ncbi.nlm.nih.gov/pubmed - Jul 2005)
References:
U.S. National Library of Medicine - National Institutes of Health - PubMed - Jul - Aug 1977 - 2004 - www.ncbi.nlm.nih.gov/pubmed
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