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This review article details the available literature on the treatment options for patients with pseudofolliculitis barbae (PFB). Shaving practices, oral and topical treatments, and energy-based devices are reviewed in detail. An algorithmic treatment chart is provided to help clinicians with recalcitrant PFB cases.
This article provides useful information to help clinicians diagnose and treat patients with PFB.
Pseudofolliculitis barbae (PFB) is a chronic inflammatory condition characterized by follicular and perifollicular papules and pustules primarily affecting the beard and neck area. PFB is a condition that predominantly affects patients with skin of color. The objective of this paper is to review the epidemiology, pathogenesis, and presentation of PFB, and assess the most recent evidence-based treatment options and recommendations for PFB. This is important to increase the quality of care given to target patient populations and to address the prominent disparity in health care management of skin of color patients. A literature review was conducted utilizing PubMed and Cochrane Library. The key term "pseudofolliculitis barbae" was used. Search parameters were set to search from 1987 to the present. Results were further narrowed by limiting the literature review to published observational studies, case studies, case series, randomized control trials, and case-control studies. Effective treatment for PFB requires a multifaceted approach which targets various aspects of the pathogenesis. Current treatments include preventative measures, antibiotics, corticosteroids, keratolytics, chemical depilatories, and/or laser treatments. Topical therapies are currently the mainstay treatment. However, laser hair removal has become a potential long-term treatment option, and additional studies are warranted to understand its long-term efficacy and permanency.
Psuedofolliculitis barbae (PFB) is a chronic, inflammatory dermatosis, which results from a foreign-body reaction to the distal portion of the hair shaft caused by extrafollicular or transfollicular penetration. Variability in hair shaft morphology and genetic predisposition (possible association to mutations in KRT75) may account for the higher prevalence of this condition among individuals of African ancestry, Hispanics, and those who originate from the Middle East. Clinically, patients develop skin-colored and/or hyperpigmented follicular papules in areas of repetitive shaving.
Dalia et al provide a comprehensive review of the literature and an algorithmic approach to guide clinicians on the management of this condition, which is often clinically challenging. They recommend that patients be advised on the importance of proper shaving techniques and/or shaving cessation when possible. Notably, 10% to 20% of patients will continue to experience symptoms despite the discontinuation of shaving due to transfollicular penetration. Other treatment options include keratolytics (topical retinoids, chemical peels), topical and tetracycline oral antibiotics, low-dose topical steroids, intralesional steroids, and energy-based devices.
In my practice, I care for a fair number of patients with PFB, and I follow a similar treatment paradigm as proposed by the authors. In my experience, post-inflammatory hyperpigmentation is a prominent clinical sequela and can be quite difficult to treat. Therefore, I also recommend the use of a broad-spectrum tinted sunscreen and a topical lightening agent to most of my PFB patients. Unfortunately, access to therapies such as eflornithine and laser-based devices are limited because they can be cost-prohibitive and are often not covered by health insurance carriers, leaving patients without access to the most effective treatments.