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Patient Information Leaflet

Pseudofolliculitis

What are the aims of this leaflet?   

This leaflet has been written to help you understand more about pseudofolliculitis. It tells you what it is, what causes it, what can be done about it, and where you can find out more about it.

What is pseudofolliculitis?

Pseudofolliculitis is inflammation caused by cut hairs growing back into or under the skin surface. It looks rather like the spots caused by an inflammation of hair follicles (folliculitis); please see the separate Patient Information Leaflet dealing with ‘Folliculitis barbae’.) Pseudofolliculitis is usually seen on the face and neck of men who shave, when it may be called pseudofolliculitis barbae, (“barba” being the Latin word for a beard), but it can occur in other body regions that are shaved, in both men and women. It is also known as ‘shaving bumps’, or ‘razor bumps’.

What causes pseudofolliculitis?

The short answer is shaving:

• When a hair is shaved or cut, its end will be left with sharp edges that are unlike the round tapered end of an uncut hair. If the hair is cut just above the skin surface, and if its cut edge pushes against the skin, the hair can then re-enter the skin. This happens especially if the hair is curly or growing in a pit or groove, for example in a natural skin fold or in scarred skin. 
  
• If the beard is shaved very closely, the cut hair can retract below the skin surface, and then cut into the skin from below, without emerging at all. Occasionally a hair burrows under the skin for a few centimetres.
  
• Ingrowing hairs cause an inflammatory reaction seen as red spots. An infection may develop in the inflamed skin, but is not its original cause.

Is pseudofolliculitis hereditary?

Not as such, although having curly hair does run in families.

What are the features of pseudofolliculitis?

The in growing hairs cause irritation. Small red patches or spots may surround the entry points. In pale skin, the spots are red; in dark skin, increased pigmentation is more obvious. Small pimples may develop, with larger ones appearing if infection occurs.

In people with a tendency to form unsightly scars, these may appear as the spots heal.

How will pseudofolliculitis be diagnosed?

The hairs which penetrate the skin by re-entry can be seen with a magnifying glass. Those that grow into the skin from under the surface are not always obvious.

Can pseudofolliculitis be cured?

Yes, if shaving is stopped, though it may take several weeks to go away. Otherwise the problem is likely to persist, although some measures can be taken to help.

How can it be treated and what can I do?

The only certain cure is to stop shaving.

Adjusting your shaving technique may sometimes help, but a balance has to be struck between leaving stubble long enough to curl back, and shaving so closely that hairs retract into the skin. How to deal with this depends on your hair type and your skin contours, and there is no simple answer for everyone. You should experiment to find the best technique for yourself.

Wet shaving usually gives a closer shave than using an electric razor, but the choice is once again an individual one. Men who wet shave should avoid methods that give such a close shave that the hair retracts inside the follicle - such as shaving against the direction of hair growth, stretching the skin tight, and using double or triple blades. Shaving every second day rather than daily may help, and another suggestion is to aim for a stubble length of 1mm, though the beard area will not look clean shaven.

Other possibilities:

• In growing hairs can be flicked out using a sterile needle, although this is not practical for those with widespread involvement. 
  
• Long burrowing hairs occasionally need to be removed surgically.
  
• Some men find that removing facial hair with a depilatory cream avoids the sharp edges, but many find that these preparations irritate their skin.
  
• Lasers and intense pulsed light can be used to reduce hair growth for prolonged periods but, in dark skin, there is a high risk of developing increased or decreased pigmentation. 
  
• Inflammation can be reduced by creams containing a steroid preparation, and antiseptic lotions reduce the risk of infection. 
  
• A short course of an antibiotic may be used to treat infection. Some antibiotics with additional anti-inflammatory effects may be used long term in more severe cases.
  
• Retinoid creams or retinoid/antibiotic combinations may occasionally be helpful.

Where can I get more information about pseudofolliculitis?

Several sites on the internet confuse folliculitis barbae with pseudofolliculitis (see above). A description of both conditions can be found at:

www.emedicine.com/derm/topic159.htm

The British Skin Foundation fund vital research into all skin diseases. To find out how you can help, please visit the British Skin Foundation website here.

This leaflet aims to provide accurate information about the subject and is a consensus of the views held by representatives of the British Association of Dermatologists: its contents, however, may occasionally differ from the advice given to you by your doctor. 

This leaflet has been assessed for readability by the British Association of Dermatologists' Patient Information Lay Review Panel 

BRITISH ASSOCIATION OF DERMATOLOGISTS
PATIENT INFORMATION LEAFLET
PRODUCED DECEMBER 2006
UPDATED MAY 2010