PSEUDOFOLLICULITIS BARBAE

Question 1

(1) Condition caused by ingrowing hairs, mostly in the beard area (neck area is
typically most severe)
(2) Affects people with curly hair or those with hair follicles oriented at an oblique
angle to the skin surface.
(3) A sharp, shaved, tapered hair re-enters the skin as it grows from below the skin
surface and induces a foreign body reaction, producing a micro-abscess.
(4) Significant problem in predisposed individuals who are required to shave
closely.

Answer 1

Pseudofolliculitis Barbae.

Question 2

(1) Red papules or pustules appear in the affected skin Lesions can be both painful
and/or pruritic.
(2) Occurs in any area where the hair is shaved (scalp, posterior neck, groin, legs).
(3) Scarring and hyperpigmentation may result from this condition.
(4) Keloid formation is often a problem in affected skin, especially in AfricanAmerican people.
(5) Condition if found in 50% - 75% of blacks and 3% - 5% of whites who shave.
(6) Condition is found in both men and women

Answer 2

Pseudofolliculitis Barbae

Question 3

. Treatment Approach 1 - Medical Treatment with Grooming Modifications (for Mild
to Moderate PFB)

Answer 3

(1) Consists of the combined use of: application of medicated creams to make hairs
more shaveable, shaving with gentle equipment and shaving techniques to
minimize the risk of irritation and hair re-entry into the skin.
(2) Either a topical retinoid or eflornithine 13.9% (if available) and a temporary
waiver of facial hair standards for up to 60 days. The medications should be used
for the full 60 days before shaving is attempted and should be used continuously
after successful shaving is resumed.
(3) After 60 days using these products, shaving can be attempted with a PFB razor
with foil guard, a multi-blade razor with lubricating strips or with an electric
razor.
(4) Before shaving, water soften the beard first with a hot wet washcloth applied for
5minutes. This makes hairs easier to cut and more blunt tipped after cutting.
Apply a lubricating shaving gel for an additional 5 minutes. Shave with the grain
of the beard. Do not stretch the skin or press firmly against the skin. Use only one
stroke over each area of the beard. Always use a sharp razor, replacing often.
(5) If using an electric razor, set hair length to avoid too close a shave. Soften the
beard with electric razor pre-shave products. Shave with the grain of the beard.
Do not stretch the skin or press firmly against the skin. Avoid multiple strokes in
the same area. Do not press razor head hard against the skin

Question 4

. Treatment Approach 2 – Laser Hair Reduction with grooming modifications
(moderate to severe PFB)

Answer 4

(1) Where available, laser hair reduction is the most reliable approach allowing a
return to grooming standards. This is an appropriate treatment for moderate to
severe cases of PFB or any case desiring permanent hair reduction.
(2) A series of at least three treatments is usually needed, with 30-45 days between
treatments. This procedure is usually available at military medical treatment
facilities with a dermatology department.

Question 5

Disposition

Answer 5

(1) Generally, outpatient therapy with occupational duty modification(s)
(a) Medical treatment = IDC
(b) Grooming standards = SM CoC/CO

Question 6

Complications

Answer 6

(a) Abscess formation & scarring

Question 7

Differential diagnosis:

Answer 7

(a) Acne Vulgaris

b) Folliculitis (bacterial or fungal

Question 8

Labs/studies/imaging:

Answer 8

(a) Clinical diagnosis. Cultures rarely indicated.