pseudofolliculitis barbae

This patient has small, painful papules in the beard area consistent with pseudofolliculitis barbae (PB). PB is caused by penetration of the hair shaft into interfollicular skin, either through the lateral wall of the follicle (transfollicular penetration) or by curving back down into the skin after exiting the follicle (extrafollicular penetration). PB occurs in all ethnic groups but is most prevalent in black men who have tightly curled facial hair. Shaving with a multiblade razor, which cuts hair below the skin surface and leaves an angled tip to the hair shaft, further increases the risk.

The diagnosis of PB is usually apparent on clinical presentation. Complications include hyperpigmentation, secondary bacterial infection, and (occasionally) keloid formation. Discontinuation of shaving is first-line treatment and results in improvement in a few weeks. Subsequently, adjustment of shaving routine (eg, single blade, warm compresses prior to shaving) or use of alternative shaving methods (eg, hair clippers to leave hair longer) can be adopted. Chemical depilatories, laser hair removal, and topical eflornithine (which slows hair growth) can also be used.