Hair - Pseudofolliculitis Barbae (PFB)

Pseudofollicultis Barbae

Both women and men with brown skin who have curved hair follicles may be affected by ingrown hairs (pseudofolliculitis barbae or PFB) and the consequent formation of bumps and dark marks. The bumps may be small or large and commonly occur on the cheeks, chin, jawline, neck and submental (the area under the chin) areas. As is the case with many women and men with brown skin, irritated skin can easily become hyperpigmented or darkened unevenly. For women, it is bad enough for hair to grow on the face, but the bumps and dark marks are often the last straw.

The cause of pseudofolliculitis barbae is the hair emerging from the curved follicle, which grows almost parallel to the skin surface (instead of away from the skin), and then curves inward. The inward-curving hair punctures the skin, causing an inflammatory reaction, irritation, and unsightly bumps. Women of color who tweeze or pluck their facial hair will find that the hair breaks below the surface of the skin, pierces the hair follicle and then produces the same inflammatory response and bumps.

To avoid persistent bumps, some men of color simply choose to grow beards and never shave. But women do not have this option. Fortunately, there are several hair removal methods and treatments available for both men and women with PFB.

Depilatories Prescription creams
Although there is no cure for PFB, there are several safe and effective topical creams that your dermatologist can prescribe to treat the bumps and inflammation associated with PFB. These include:

Topical antibiotics:

  • Erythromycin and clindamycin
  • Clindamycin/benzoyl peroxide combination (Benzaclin) - A study of male subjects revealed, for black patients, a mean percentage reductions in papule and pustule counts ranging from 38.2% at week 2 to 63.9% at week 10.

Retinoids

  • Adapalene (Differin) - Adapalene gel 0.1% applied at bedtime decreased papules and hyperpigmented macules
  • Tretinoin (Retin-A) - In blacks, tretinoin 0.025% cream combined with hydrocortisone 2.5% cream twice daily for 8 weeks reduced papules and hyperpigmented macules
  • Tazarotene (Tazorac) - Fifty African American or Hispanic patients who applied tazarotene 0.05% or 0.1% gel once daily for 90 days had a significant decrease in overall PFB severity after 60 days.

Hydroquinones

  • Combination Fluocinolone acetonide 0.01%/ Hydroquinone 4%/Tretinoin 0.05 creams (TriLuma) – Ten African-American subjects who applied TriLuma nightly for 90 days had overall PFB improvement of 34.5% over baseline.

Eflornithine HCl Cream, 13.9% (Vaniqa)

Electrolysis

Laser hair removal

Bottom Line

Pseudofolliculitis barbae is a chronic disorder characterized by ingrown hairs, papules and dark marks in hair-bearing areas of the face. It has a predilection for men and women of African American and Hispanic descent who have genetically tightly curled hairs and curved hair follicles. Although not considered to be a serious medical condition, it often causes significant cosmetic disfigurement and discomfort. There are multiple, partially effective treatments.

For scientific information on Pseudofolliculitis barbae, refer to Dr. Taylor’s papers:
Pseudofolliculitis Barbae in Skin of Color. J Am Acad DermatoI46(S2): 113-119,2002 (Perry P, Cook-Bolden F, Taylor SC, Rahman Z, Jones E).

Twice-daily applications of benzoyl peroxide 5%/clindamycin 1% gel versus vehicle in the treatment of pseudofolliculitis barbae. Cutis 73(S6): 18-24, 2004 (Cook-Bolden FE, Barba A, Halder R, Taylor S).

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