II. Pathophysiology
- As per the name, not a Folliculitis
- Tightly curled hair penetrates skin when closely shaved
- Results in local, foreign-body inflammatory response
III. Epidemiology
- Most common in black men (45-85% Prevalence) and hispanic men
- Women may also be affected in areas of shaving
IV. Signs
- Hyperpigmented Papules and Pustules in beard and other areas of shaving
- Dermoscopy can visualize follicular penetration by hairs
- Distribution
- Men: Beard area
- Women: Face, axilla and suprapubic region
V. Differential Diagnosis
VI. Management: General Measures
- Most effective treatment and prevetion of recurrence is to stop hair removal
- Avoid shaving for at least 8 weeks after diagnosis
- Consider permanent hair reduction (e.g. Chemical Peel, laser therapy)
- See Hair Removal Technique
- Laser Hair Removal with adjunctive eflornithine 13.9% (Vaniqa) may offer best results
- Optimize shaving technique
- Avoid a close shave (leave hairs at least 0.5 mm long)
- Consider electric razors set to leave 1 to 3 mm
- Otherwise use hair clippers or a single-blade razor
- Replace razors after 5 uses
- Depilatories (e.g. barium sulfide powder, Calcium thioglycolate cream) may be used if not irritating
- Shave in Hair Growth direction (with the grain)
- Avoid pulling skin taught while shaving
- Avoid plucking hair
- Use short, slow strokes with razor in a single pass over an area
- Loosen embedded hairs prior to shaving (e.g. brush, apply compresses, or rub with towel)
- Warm compress, circular massage for 5 minutes over shaved area to release embedded hairs
- After shaving, apply cool compresses for 5 minutes
- Avoid dry shaving (apply a preshave oil or shaving cream first)
- Shave at least every 1 to 3 days
- Prevents Hair Shafts from growing long enough to curl back and penetrate skin
- Avoid a close shave (leave hairs at least 0.5 mm long)
VII. Management: Medications
- Low to medium potency Topical Corticosteroids applied immediately after shaving
- Topical Benzoyl Peroxide 2.5% applied in morning
- Combination Clindamycin 1% and Benozyl Peroxide 5% gel applied twice daily for 6 weeks
- Topical Retin A 0.025% applied at night
- Antibiotics indicated if secondary infection
VIII. Complications
- Postinflammatory Hyperpigmentation
- Hypertrophic Scars or Keloids
- Secondary infection of injured Hair Follicles
- Folliculitis Barbae
- Sycosis Barbae