Pseudofolliculitis Barbae Prevention and Treatments

Pseudofolliculitis Barbae (PFB) is a condition categorized by vulnerability to ingrown hairs. Ingrown hairs on the face are the same thing as PFB. Patients with this skin concern are likely to experience painful discolored bumps on regularly shaved areas of their skin including the face, neck, chest, armpits, legs, or pubis.

This condition most commonly affects individuals with tightly curled hair, and is most common in global black communities. There are many people outside of the black community that can also experience PFB as well, especially if they have curly hair.

If you have pseudofolliculitis barbae, there are preventative measures and treatments available to you that vary based on your skin type. In general, a change in the way you shave is needed. If your concerns are already beyond prevention, there are multiple viable treatment options like steam, some specific products we will discuss further below, and even a few kinds of injections.

To find out what you need for your Pseudofolliculitis Barbae care, check out this blog for the facts.

Using the correct skin care products for your Baumann Skin Type can help prevent ingrown hairs.

What is an Ingrown hair?

There are two main types of ingrown hairs that lead to pseudofolliculitis barbae:

A hair that does not exit the hair follicle but penetrates the skin inside the follicle as it regrows, oftentimes curling onto itself beneath the surface of the skin. (Subcutaneous)

A hair that briefly exits the hair follicle and curls and re-enters the hair follicle penetrates the skin before curling and re-entering the skin. (Retorcutaneous)

For clarity, I distinguish these two types by naming them “subcutaneous ingrown hairs” and” retrocutaneous ingrown hairs” respectively to explain the process to my patients and for the purposes of this article. These are not official scientific names but for clarity there is a need to distinguish between these 2 causes of PFB so I am adopting these terms.

When a hair becomes ingrown, (literally growing within the skin), various symptoms can follow. Both subcutaneous and retrocutaneous ingrown hairs can sometimes trigger an immune response in your body, causing white blood cells to flood the area resulting in pustules, sebaceous cysts, or calcified pilar cysts. Bacteria can colonize the area and result in infection. Infections to these inflamed zones can lead to additional pustules. (5)

Even if this folliculitis is treated or eventually goes away, it is common for the inflammation of ingrown hairs to result in long term changes in pigmentation that need to be treated with skin care regimens to treat the hyperpigmentation.

Ingrown Hair vs PFB vs Folliculitis

An ingrown hair can occur from many causes including friction, improper skin care, and dysfunction of desquamation.

PFB by definition, are ingrown hairs that occur after shaving.

Folliculitis is an infection of the hair follicle that can be caused by ingrown hairs and PSB.

You can have all three: ingrown hairs due to shaving that results in a hair follicle infection could correctly be called any or all of these 3 terms.

Causes of PFB

Subcutaneous ingrown hairs:

These often occur when razors cut strands of hair both too short, and at too severe of an angle. This results in pointed sharpt hairs beneath the skin;s surface. Additionally, the popular multi-bladed razors often repeatedly cut hairs until they are fully invisible beneath the skin.

Retrocutaneous hairs:

The typical multi-bladed razor blades on the market leave a diagonal edge on hair strands, making them more likely to curl and penetrate beneath the skin becoming retrocutaneous ingrown hairs. They can also be caused by not getting a close enough shave. At certain lengths (varied based on your personal hair texture), hair shaved short but not “close” can become a retrocutaneous ingrown hair.

All of this considered together shows that different people have different needs in terms of treating their pseudofolliculitis barbae depending on their hair texture, angle of the curl, and shaving habits.

Where are ingrown hairs most common on the body?

Pseudofolliculitis can occur on any part of the body where shaving of hair is done. (3) This usually includes the jawline, under the chin, on parts of the neck, and on or near the pubis or genitals.

If you are a swimmer or otherwise shave your legs, chest, underarms, or arms, you might notice pseudofolliculitis in those areas.(8) Most research is directed to study its prevalence on the face, however “other shaved parts of the body” are generally mentioned in research. (6,7,8)

It is important to keep in mind that ingrown hairs are common on the pubis when the area is shaved and the red bumps and inflammation associated with ingrown hairs can sometimes resemble herpes. This kind of pseudofolliculitis is called pseudofolliculitis pubis.(7)

Who is vulnerable to PFB?

Who is vulnerable to pseudofolliculitis barbae?

Statistically, men of sub-equatorial African origin or descent are the most likely to experience pseudofolliculitis barbae due to their typically curly and textured hair. In fact, this condition was first medically categorized upon observing high rates of ingrown hairs for armed forces personnel of color who were required to shave daily. (9)

This condition is not exclusive to the black communities of the globe, however, as many other groups have expressed this condition in varying rates of prevalence. People of Asian, Latin, and European origin are all capable of experiencing pseudofolliculitis barbae, especially if they have thick or curly hair.

Because “barbae” refers to beards and facial hair, this particular type of pseudofolliculitis is more common in men, however pseudofolliculitis of other body regions are common in both men and women.

The person at highest risk of pseudofolliculitis barbae is somebody who has already experienced it in the past, has tightly curled hair, and shaves regularly.

What are the dangers of PFB?

The dangers of Pseudofolliculitis barbae are not life threatening, but do pose a risk to the sufferer’s confidence and general comfort. This condition can result in painful inflammation, infections, and post-inflammatory hyperpigmentation.

Typically, that is where the physical symptoms end, however in the case of infected growths resulting from Pseudofolliculitis barbae, topical antibiotics or injection of pustules may be required. The biggest problem with PFB is developing keloid scars. When these are caused by ingrown hairs, PFB, and acne and is on the neck it is called acne keloidalis nuchae. In this condition there are multiple keloid scars on the back of the neck.

The largest danger of Pseudofolliculitis barbae is likely the impact it can have on self-confidence, which can be as critical as many medical concerns. In fact, stress is known to have multiple potential effects on skin health, which can create a vicious cycle of infection, irritation, and more. If you have pseudofolliculitis barbae, the stress caused by your skin can be even worse.

To make sure you steer clear of these issues, take steps to avoid PFB such as changing your shaving habits. In some cases, going to a well trained barber who uses a straight razor and understands how to cut beard hair at a less sharp angle to prevent ingrown hairs can help.

Dangers of Pseudofolliculitis barbae

Post-inflammatory hyperpigmentation

Post-inflammatory hyperpigmentation (PIH) is one of the most common kinds of skin pigmentation conditions. It usually follows prolonged periods of irritated, reddened, or otherwise inflamed skin.

Since pseudofolliculitis barbae, or ingrown hairs in general, cause inflammation, PIH is a common side effect.

The most common treatments for PIH include skin lightening ingredients such as tyrosinase inhibitors, PAR-2 blockers, or exfoliators.

Some common ingredients used to treat this condition are hexylresorcinol, niacinamide, and salicylic acid among many others. Check out our blog on skin lightening ingredients for a more comprehensive dictionary of options.

Shop by your Baumann Skin Type to find the best skin lighteners to treat PIH.

Acne and other infections

When skin is inflamed and pores become clogged, there is a greater chance for acne causing bacteria to develop on the face. (2) For that reason, ingrown hairs from pseudofolliculitis barbae often result in acne on the face, neck, or chest.

Pus is an easy medium for acne causing bacteria to develop in, meaning that the treatment of pustules related to ingrown hair is important in acne prevention.

Bacterium such as staphylococcus aureus and E.coli can also develop in clogged pores.

Note that not all acne is related to ingrown hairs.

Irritated, inflamed skin is more likely to catch an infection when it is scratched. This can be challenging to avoid with pseudofolliculitis barbae because affected areas are often itchy and/or peeling. Do what you can to avoid scratching to avoid infections.

acne and cysts

Keloids

Keloids are irregular scar tissue that continues to grow past the stage of healing, and often result in profound swollen appearances that can hamper with the sufferers’ quality of life and self confidence. Keloids are basically scar tissue that grows too much, and one’s susceptibility to them largely depends on genetic factors (10).

Pseudofolliculitis barbae is characterized by significant inflammation at the site of the ingrown hair and the directly surrounding area, which means scarring of some kind is often possible. If you pick at your ingrown hairs, scarring is more likely to occur; in the same vein, the more scarring that happens, the more likely you are to experience keloids if you have the genetic markers for them.

When keloids are severe, the best treatment for them is often an injection of steroids to the afflicted area. This is not always a guaranteed solution, and in severe cases keloids need to be surgically removed. This too is not a guaranteed success in treatment, as additional scarring and keloiding is possible after surgery.

in general, the best way to stay free of keloids is to not pick at inflamed tissue so scarring never happens. If you are experiencing keloids as a symptom of Pseudofolliculitis barbae, seek advice from your local dermatologist.

The right way to shave

While everybody has different face shapes, hair textures, and thickness of facial hair, there are some practices that are considered the best for preventing ingrown hairs. (11)

In general, a single-edged razor is considered less likely to cause PFB because hairs are not cut very deeply below the surface of the skin. Sometimes, this is not enough of a precaution and subcutaneous ingrown hairs can happen anyways. If this is true for you, then we recommend always shaving downwards on your face, from the direction of your cheeks towards the direction of your neck.

Shaving this way follows the natural growth trajectory of your facial hair, leaving it closer to the surface than shaving “against the grain.”

If your ingrown hairs are more often retrocutaneous ( growing back into your skin after penetrating the surface) then we recommend keeping your facial hair above a certain length, at least a “1” with your electric razor.

Electric razors cut less closely to the skin than manual razors, so they often are better for individuals prone to PFB.

If you often experience ingrown hairs, you also want to make sure your skin is well moisturized before and after your shave. We recommend using a moisturizer suitable for your skin type instead of commercial shaving creams to soften the follicle and assist new hair growth.

After shaving, an exfoliator can be a great preventative measure for PFB as well. An exfoliator will help scrub the outermost layer of your skin, the stratum corneum, which makes clogged pores less likely.

If you’ve tried these practices and still experience ingrown hairs often, consult your dermatologist for more advice.

How to prevent PFB

How to Prevent PFB

As we’ve touched on, the best way to prevent pseudofolliculitis barbae is by changing your shaving habits; however sometimes your job or athletic career do not allow for facial hair. In cases like these, additional measures may be required. As mentioned in the previous section, utilizing a moisturizer and exfoliator can be critical to the prevention of ingrown hairs. So too can an appropriate cleanser and sunscreen prevent ingrown hairs. A good cleanser keeps your pores free of bacteria that could infect and further inflame ingrown hairs. When your inflammation doesn’t get infected, it will go away sooner. (3,4)

Sunscreens can prevent sun damage, which often results in dead skin peeling from the face. Until the dead skin is removed from your face, it poses an additional risk of clogged pores.

Taking hot showers regularly or using a steam room are also good strategies for prevention, as hot water relaxes and opens the pores on your skin.

At the end of the day, the best products for you will depend on your skin type and the severity of your PFB, so we recommend taking our skin typing quiz to find the best recommendations for your skin.

How to treat PFB

If you already have pseudofolliculitis barbae, the best treatments are similar to the best preventative measures. Cleansers, exfoliators, moisturizers, and hot water are the best methods for treatment. (2) There are products specifically designed to treat the various aspects of pseudofolliculitis barbae, namely the “PFB” brand of products featured below.

in cases of cystic infections or pilar cysts, steroid injections are often the most effective and immediate course of treatment, but these can be expensive to undertake.

Note that pseudofolliculitis barbae does not usually just happen once, if it is a problem you have had in the past, you will likely have it again, so treatment of this condition and prevention are inextricably linked.

How to treat PFB

Products for Pseudofolliculitis Barbae

The best products for pseudofolliculitis barbae depend on your specific Baumann Skin Type because some moisturizers and exfoliators are better for certain skin types over others. It is important that when designing your prevention or treatment regimen for PFB you keep your skin’s specificities in mind. For example, if you have oily skin and use a comedogenic moisturizer, your pores are likely to clog. If you have dry skin, certain exfoliators or cleansers can strip too much sebum from your face, resulting in irritation or dead skin that can also clog your pores.

For the specific treatment of pseudofolliculitis barbae that has already begun, we recommend products by the “PFB” brand, seen just below. Make sure you find your skin type before making your choice, because as discussed different products have different effects on different skin types.

DQH Knowledge drop: In your 20s, your skin cell turnover decreases. (Cell turnover is a key component in keeping your skin youthful.) You know what else slows down? Your collagen production. Starting in your 20s, collagen decreases by about 1 percent per year. Should you want to prevent fine lines and wrinkles, start by eliminating behaviors that contribute to premature aging. “If it’s bad for you, it’s bad for your skin,” says dermatologist Michel Somenek. “Cigarette smoking reduces blood flow to the skin and causes premature wrinkling and a dull skin texture. Making the repeated pursed motion to inhale can also cause smoker’s lines. Alcohol and recreational drugs are toxins for the skin that damage its cellular structure and DNA,” Somenek tells us. “The faster you eliminate vices while you are young, the better chance your skin and body have to recuperate.” Also, adopting an anti-aging routine in your 20s is key. After all, the best offense is a good defense. We spoke to Somenek and experts Joshua Ross and Audrey Kunin to find out more. Keep reading for the best anti-aging products for your 20s, according to skincare professionals. Sunscreen “We all know that the sun is the number one cause of skin aging and starting the prevention in your 20s is very important,” Ross says. “The majority of your sun damage won’t start to appear until you’re in your 30s, so don’t wait until you see it surface or you’ll be behind the curve. Stay ahead of it with a good-quality zinc-based sunscreen worn daily.” Farmacy Green Defense Daily Mineral Sunscreen An invisible sunscreen with SPF 30, plus botanical extracts meant to protect skin with tons of antioxidants. Bonus: It’s clean and fine to use under makeup. Bareminerals Complexion Rescue™ Tinted Moisturizer Broad Spectrum SPF 30 Although we recommend you use your SPF and moisturizer separately, we also understand moments when you don’t have time or energy for that extra step. For those times, this bareMinerals moisturizer is a great thing to have on hand. Vitamin C Serum “A great introduction to anti-aging is to start with a vitamin C serum in your morning skincare routine,” Ross says. “It’s a powerful antioxidant that will neutralize free radicals and brighten the skin.” He adds that it’s a great way to counteract the effects of the sun’s harmful rays, which, as previously mentioned, are among the biggest causes of premature aging. Drunk Elephant C-Firma™ Vitamin C Day Serum The Drunk Elephant C-Firma is a lightweight serum that promises to give skin a glow by combining the brightening powers of vitamin C with ferulic acid, l-ascorbic acid, and vitamin E. The included sodium hyaluronate is meant to replace hydration loss, so you shouldn’t have to deal with any irritation. Sunday Riley C.E.O. Rapid Flash Brightening Serum This potent serum is jam-packed with vitamin C (15 percent, to be exact), which means it’s a potential superstar at both brightening skin and dousing it in antioxidants. Peptides Using peptides on your skin has many benefits, says Somenek. “The skin barrier is what defends the body against pollution, UV rays, bacteria, and toxins. It can be damaged by several everyday factors. Using topical peptides aids in building a stronger barrier,” he says. “Peptides comprise elastic fibers, which are a type of protein. These fibers help to make skin appear taut and firm. Peptides can also help repair damaged skin, relieve inflammation, and even out skin tone. Some peptides can kill acne-causing bacteria that is common in 20-somethings.” Kunin agrees, saying, “Peptides are an excellent entry point for supporting collagen.” She recommends looking for face and eye treatments that contain these collagen-boosting powerhouses. Charlotte Tilbury Magic Eye Rescue Cream This Charlotte Tilbury super-emollient eye cream has a base of coconut oil and shea butter (read: it’s incredibly hydrating). Botanicals plus peptides are meant to help reduce dark circles and boost collagen, respectively. This creamy moisturizer serves up potent collagen-boosting peptides and pycnogenol, and antioxidant-rich vitamin C. “Instead of sitting on top of the skin, peptides penetrate the outer layer so they go deep. The ‘signals’ they send tell the cells to produce elastin and collagen, which are needed for youthful-looking skin,” explains Somenek. At-Home Peel Pads Remember that skin cell turnover fiasco we talked about earlier? One way to help support it is by exfoliating. “Exfoliation is important to help keep skin fresh and luminous,” Kunin says. She recommends using at-home peel pads as an easy and effective way to exfoliate. “The goal in your 20s is to fight the slowing pace of cell turnover. It is wise to use products that gently exfoliate, yet still remove oil and other impurities. Products that have Alpha Hydroxy Acids (AHA) or Beta Hydroxy Acids (BHA) are a good choice.” According to Somenek, you should only exfoliate two to three times a week. “People of all ages are guilty of over-exfoliating and that can be too much of a good thing,” he says. Dermadoctor Kakadu C Intensive Vitamin C Peel Pad A few swipes of this Derma Doctor powerful peel pad promise to leave your skin glowing and smooth, thanks to the seven (yes, seven) types of chemical exfoliants, including AHA and BHA. It also contains vitamin C via Kakadu plum extract for added brightening and antioxidant protection. KEY INGREDIENTS Kakadu plum extract is sourced from the Kakadu plum, a fruit grown in northern Australia. It contains vitamin C, which restores the skin’s natural barrier, increases collagen production, and soothes irritation. Dr. Dennis Gross Skincare Alpha Beta® Universal Daily Peel Pads These are the gold standard of peel pads, with a cult following and over 900 five-star reviews on Sephora. They’re easy to use and contain a blend of anti-aging exfoliating acids. Emollient Night Cream “In your 20s, you need to start upping the hydration in your skincare routine. You may have been cautious of over-moisturizing because of acne in your teens, but as you enter your 20s, your skin transitions and becomes drier,” Ross says. “I recommend an emollient night cream added into your evening skincare regimen.” “Twenty-somethings need to make sure that they are not using creams that will clog their pores and cause excess oil production,” says Somenek. Opt for non-comedogenic products. Cerave Skin Renewing Night Cream One great choice is the CeraVe Skin Renewing Night Cream, which is a non-comedogenic night cream that leaves skin soft and glowy. It combines the moisturizing powers of ceramides and hyaluronic acid. RoC Retinol Correxion Max Hydration Creme “The best night cream ingredients contain retinol, benzoyl peroxide, and/or salicylic acid or hyaluronic acid. The goal is to moisturize, yet remove excess oil,” says Somenek. This Roc Retinol Correxion cream fits the bill as it contains both hyaluronic acid and retinol so it promises to moisturize while also being non-comedogenic.

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