Pseudofolliculitis - AAD Feb 2006 eNewsletter

AAD February 2006 eNewsletter

For people of African-American and Hispanic descent, pseudofolliculitis is a common skin condition. Also known as ?razor bumps,? these lesions may develop when tightly coiled coarse hair is shaved ? or even plucked or waxed. These hair-removal methods can cause the tip of the remaining hair to grow back into the skin, which irritates the skin and leads to an inflammatory bump that resembles acne. Some people see numerous bumps after shaving, plucking, or waxing. When the bumps appear in the area where a beard would grow, the condition is called ?pseudofolliculitis barbae.? This condition most commonly affects African-American men. In the pubic region, the skin condition is known as ?pseudofolliculitis pubis.? The bumps also appear after removing hair from the underarm, neck, chest, and back. While the condition is most common in people of color, these bumps can develop in anyone with curly, coarse hair. Continuing to shave skin that has razor bumps can lead to postinflammatory hyperpigmentation (dark spots), scarring, and keloids (a type of scar that extends and spreads beyond the size of the original cut or wound). These conditions occur with much more frequency in skin of color. Infection also can develop. Treatment

The best way to treat the condition is to let the hair grow for about 30 days. Once the hair grows to a certain length, it naturally springs out of the skin.

Sometimes medication is needed to help clear the skin. A dermatologist can prescribe a mild topical corticosteroid that can reduce the inflammation. Antibiotics are prescribed to treat infection. One topical medication combines three active ingredients: a corticosteroid, tretinoin, and hydroquinone. This combination is proving effective for treating pseudofolliculitis barbae because it can decrease inflammation, release ingrown hairs, and lighten dark spots.

Advances in laser therapy have created ?color-blind? lasers, which are safe and effective for removing unwanted hair in people with skin of color. Studies show that laser hair removal can slow pseudofolliculitis barbae. Multiple treatments are usually necessary.

If laser therapy is an option, be sure to choose a dermatologist who is trained in using that type of laser and has extensive experience in performing laser procedures. The success of any laser treatment depends on the skill of the person performing it.

When You Must Shave

While allowing the hair to grow can effectively treat pseudofolliculitis, this is not an option for everyone. Some jobs, such as those in the military, require a clean-shaven look. If you must shave, adhering to the following shaving guidelines may help reduce irritation. These guidelines also can help keep skin clear if it has had time to heal.

Shaving Guidelines Moisten skin with warm water before shaving. Wetting the face or other area thoroughly with warm water helps to soften the hairs. One of the best ways to do this is to take a shower before you shave. Washing the area with a mild soap and washcloth while using circular motions can help prepare the skin and dislodge ingrown hairs.

Apply shaving cream, non-irritating shaving gel, or pre-shave oil to wet skin. After showering or wetting the skin, do not dry the area to be shaved. While your skin is still moist, apply the shaving cream, gel, or pre-shave oil and let it stand for 3 to 4 minutes before shaving. This softens the hair and allows the razor the cut the hair with less pressure.

When selecting a shaving cream, gel, or pre-shave oil, you may want to steer clear of products containing menthol. While the menthol can feel cooling, menthol also is more likely to irritate the skin.

Use a barber?s clippers, single-edge and foil-guarded safety razor, or electric razor set on the highest setting. You won?t get a close shave, but you will reduce trauma to the skin and decrease the risk of the remaining hair curving back into the skin.

Shave with the grain. This means shaving in the direction that the hair grows. When you shave against the grain, the skin is more likely to become irritated. This increase the risk of razor bumps.

Avoid pressing the razor into the skin, and avoid multiple strokes. Several strokes to the same area and pressing the razor into the skin can irritate the skin.

Rinse the blade after each stroke. Rinsing helps prevent the razor from becoming dull.

Do not pull the skin tight. The hair is less likely to curve back into the skin when the skin is not pulled tight.

Replace the blade often. A dull razor irritates the skin and causes more cuts. Dermatologists can recommend other products and guidelines that can help take the bump out of shaving. These include post-shave medicated lotions and tips for storing your razor blade after each shave.

References:

American Academy of Dermatology, More Than Skin Deep: Unique Care and Treatment for Skin of Color. News release dated November 2, 2005. Last accessed January 13, 2006.

Greidanus, TG et al. ?Pseudofolliculitis of the Beard.? eMedicine. Last Updated: September 2, 2005. Last accessed January 13, 2006.

Taylor, SC. ?Enhancing the Care and Treatment of Skin of Color, Part 1: The Broad Scope of Pigmentary Disorders.? Cutis. 2005 Oct;76(4):249-255.