Name
PSEUDOFOLLICULITIS BARBAE
DESCRIPTION
DETAIL
CAUSES β’ Reentry penetration of skin by external pointed tip of growing curved whisker, or sharp tipped whisker can grow into follicular wall if shaved too close β’ Plucking of hair can cause abnormal hair growth in injured follicles ------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS β’ Bacterial folliculitis β’ ImpetigoSPECIAL TESTS Culture of pustules - usually sterile. May show coagulase-negative micrococcus (normal skin flora). COMPLETE BLOOD COUNT - NORMAL
TYPENOTES
RISK FACTORS: Curly hair, Shaving too close with multiple razor strokes, Plucking hairs, Black raceGENERAL MEASURES . Acute treatment . Dislodge embedded hair with sterile needle . Discontinue shaving until red papules have resolved (minimum 3-4 weeks) . Massage beard area with washcloths, coarse sponge or brush several times daily . Systemic antibiotics if secondary infections present DRUG(S) OF CHOICE . Topical or systemic antibiotic for secondary infection . Application of clindamycin (Cleocin-T) solution bid . Low doses erythromycin or tetracycline 250 mg bid . Administer until papule/pustule resolution . Mild cases . 5% benzoyl peroxide - apply after shaving . 1% hydrocortisone cream - apply at bedtime . Moderate disease - chemical depilatories . Disrupt cross-linking of disulfi de bonds of hair causing blunt hair tip . Apply no more frequently than every 3rd day - 2% barium sulfi de (Magic Shave) or calcium thioglycolate (Surgex) . Moderate disease - adjunct treatment . Tretinoin (Retin-A) liquid/cream, applied daily or every other day ALTERNATIVE DRUGS Topical application of glycolic acid lotion (8% buffered glycolic acid in a suitable carrier, either oil-in-water lotion or a non-lipid soap) twice daily. This treatment may allow shaving comfortably every day. PATIENT MONITORING As needed. Educate patient on curative and preventive treatment. PREVENTION/AVOIDANCE . Mild cases . Use tiny plastic hook for removing ingrown hairs before shaving . Shave either with a manual adjustable razor at coarsest settings (avoids close shaves), a single edge blade razor (The Bump-Fighter), a foil guarded razor (PFB razor), electric triple O head razor, or electric hair clipper with polyester skin cleansing pad (Buf-Puf by Riker Labs) . Purchase Bump Fighter razor through ASR Consumer products (www.asrco.com) . Shave beard in direction of hair growth . Do not stretch skin when shaving . Use correct shaving cream/gel (Ef-Kay Shaving Gel, Edge Shaving Gel, Aveeno Therapeutic Shave Gel, Easy Shave Medicated Shaving Cream) . Consider 5% benzoyl peroxide after shaving and application of 1% hydrocortisone cream at bedtime (or Lacticare HC lotion after shaving) . Moderate cases . Chemical depilatories (barium sulfi de), (Magic Shave Powder) . Consider 0.05% tretinoin (Retin-A) liquid or cream . Consider eflornithine HCl (Vaniqa) cream . Severe cases . Laser therapy - experimental . Avoidance of shaving completely . Electrolysis to destroy remaining hair follicles - controversial . Use collar extender (JC Penney) POSSIBLE COMPLICATIONS . Scarring (occasionally keloidal) . Foreign body granuloma formation . Disfiguring postinflammatory hyperpigmentation . Impetiginization of inflamed skin EXPECTED COURSE/PROGNOSIS . Course is recurrent if preventative measures not followed . Prognosis is poor in presence of progressive scarring and foreign body granuloma formation
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
COMPLETE BLOOD COUNT