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What is the cause and treatment for Pseudofolliculitis barbae?

Jan 2014
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Practicing since : 2002
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Over the past three weeks I have had a recurring, very red, complete-coverage rash only on the front of my neck. This is the only place I shave with an electric razor (have done so for years) but this rash has started recently out of nowhere. It's not blotchy, bumpy, weepy, or appearing as pinpoints and it does not have scales or puss. It appears the rash follows the exact shave area exactly. I have stopped shaving for the past week and now my neck seems a bit better in terms of the widespread red rash, but is appears to still be reacting to what looks to my untrained eye to be folliculitis barbae. I have always had an issue with razor rash and ingrown hairs, right in those pockets on either side of my throat. In fact, I believe my recent attempts to eliminate these is why I'm having this recurring rash now: About a month ago I tried shaving with a normal razor and first noticed this red rash all over my throat, which I assumed at the time was caused by the shaving cream (which I never used before since I always dry shave only my neck with an electric razor). Since then I have used my normal electric razor with brand new foil and blade; tried fancy electric shaver pre-oils (which seems to be mostly just a ton of alcohol); and a myriad of other post-shave creams and solutions over the past few weeks (including a lot of hydrocortisone and even the Desonide). Also, I noticed last week that the shaver I was using this whole time was not cleaning itself correctly so it may have been riddled with bacteria every time I shaved when this all first started. My guess is that I did a lot of harm to my skin in this area (which is exactly where the rash is appearing) and, combined with the cold weather and dry indoors, has caused my skin to be overly sensitive. This rash really all started out of nowhere and has not always been a problem. There was a gradual build-up. It seems the pattern is that I get the rash, it clears up a bit while my hair grows over three days, I shave it and it looks perfect, then the rash starts again 12 hours later from a combination of either rubbing against a collar or rubbing against ITSELF in the folds of my neck. I've tested this latter idea out lately and it seems to hold true that the redness comes back exactly in these folds when my chin is down for several minutes (reading in bed, for instance). Could it be the new stubble growth is irritating already severly-weakened skin? If stubble is the problem I can shave every day but I would still need something to address the razor burn and ingrown hairs. If so is there a way to toughen this skin or protect it from itself with an ointment (or help it heal itself more quickly)? Would the folliculitis combined with overworked skin have anything to do with this rash in the first place? Could seb derm play a part? Again, the rash is only where I shave. My hope is that I've simply overtaxed my skin with all these products and the stubble/collar rubbing is causing the rash and it just needs time to heal. My derm prescribed Denoside but it seemed to worsen the condition when applied here (but works like a charm in a couple of very small, scaly spots on my scalp). I think the razor burn is a separate problem which I would also need to address. Please let me know your thoughts. Ideally I wold like to continue to be clean shaven on my neck (I just use clippers on my face) and am hoping this rash will eventually heal and be eliminated by not shaving for several days (I can deal with a little folliculitis barbae). My worry is that it's something more serious than just dry skin or folliculitis barbae. The rash was really red and very stubborn! Thanks, XXXXXXX
Posted Wed, 19 Feb 2014 in Skin Hair and Nails
Answered by Dr. Kakkar S. 6 hours later
Brief Answer: Pseudofolliculitis barbae Detailed Answer: Hi XXXXXXX Thanks for posting your concern at XXXXXXX I would keep a possibility of Pseudofolliculitis barbae. Pseudofolliculitis barbae is prone to develop at sites such as beard in males and pubic area in both males and females. Pseudofolliculitis barbae arises after shaving and when the hairs regrow they curl back onto itself and can re-enter skin thus causing razor bumps. Rajor bumps can sometimes also get infected with bacteria. Shaving creates a sharp edge at the tip of hair and when the hair regrows and curls back onto itself and re-enters skin it causes irritation at that site where the sharp edged hair re-enters, visible as a bump. If possible, let the beard grow for 30 days to eliminate ingrown hairs. When you are ready to shave again, take the following precautions: 1. Shave while showering. Warm water makes the hair soft or one can use a wet washcloth soaked in warm water in that area before shaving. 2. Use a shaving cream/gel for moisturizing which makes the hair soft. 3. Avoid a close shave OR use a single blade razor. 4. Don't use clippers because clippers can make the hair go awry in all directions 5. Don't use dull razors 6. Shave in the direction of the follicle, not against the grain. Do not stretch the skin. 7. At night, apply a lotion containing glycolic acid to the affected areas. This exfoliates the surface skin cells and reduces the likelihood of new inflamed spots. Another treatment that may be considered is laser hair removal if you have no problem with having the beardless look. In some cases, this is much more effective than any other measure. hope this helps you take care regards
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Follow-up: What is the cause and treatment for Pseudofolliculitis barbae? 47 minutes later
Thanks Dr. Kakkar, I'm still very concerned with the red rash that I described, as this was the most concerning to me (I already assumed I had pseudofolliculitis barbae as well). Again, it's a recurring, very red, complete-coverage rash only on the front of my neck that started recently out of nowhere. It's not blotchy, bumpy, weepy, or appearing as pinpoints and it does not have scales or puss. The entire front of by neck turns bright red, almost like an allergic reaction. I believe I've always had pseudofolliculitis barbae but the rash that covered the front of my neck seemed very different. Could I have just overtaxed my skin with all these products and the stubble/collar rubbing is causing the rash and it just needs time to heal? My derm prescribed Denoside but it seemed to worsen the condition as I described above. Have you ever seen anything like that? Could it just be shaving extremely dry skin? Would seb derm appear out of nowhere like this and appear as I bright red rash? Thanks, XXXXXXX
Answered by Dr. Kakkar S. 11 hours later
Brief Answer: Apply a Moderately potent Steroid Detailed Answer: Hi. The red rash is definitely part of the problem you are facing. I would say that it is due to combination of dry skin, some amount of allergic/ irritant reaction to shaving creams/ aftershave lotions, rubbing against the collor... worsened by pseudofolliculitis barbae. Moreover pseudofolliculitis barbae can by itself make the skin look itchy and red and that may be the only presenting sign without any bumps Or pimples (As you said the rash gets better if you don't shave for a few days and appears again as soon as you shave.) I would rule out Seborrheic dermatitis since if it was due to seborrheic dermatitis it would not have improved on its own, as it does, when you are not shaving. If i was you treating doctor would have asked you to apply a moderately potent steroid cream like Fluticasone in combination with an antibiotic e.g Mupirocin (Fluticasone+mupirocin combination ointment is available). Desonide is a very low potency steroid and thus would act very slowly. I hope it answers your query. I am here to help you with any further clarifications regards
Above answer was peer-reviewed by
Follow-up: What is the cause and treatment for Pseudofolliculitis barbae? 1 hour later
Thank you very much for your thoughtful, detailed response. My only follow-up is that I'm a little nervous about being on steroids as I've heard horror stories about people becoming dependent on them and having much worse reactions after a certain period of time. Can I treat just the psuedofolliculitis with just an antibiotic ointment? Would OTC ointments like Neosporin help? Any long-term dangers with antibiotics? I've also ready these can be fungal. Do you see that as a possibility in the case I've described? Thanks again!
Answered by Dr. Kakkar S. 2 hours later
Brief Answer: Can use Neosporin for PFB Detailed Answer: Hi. Your concern about steroids is genuine and one should never use a steroid indiscriminately. Steroids should always be used as prescribed/on supervision of a dermatologist. A moderately potent steroid like fluticasone+antibiotc (Mupirocin or Neosporin) would be a very effective option in your case and it can be used safely for 2-4 weeks on face and neck. Antibiotics alone can be safely used for Pseudofolliculitis (PFB). They are usually sufficient by themselves for just 1 or 2 OR a few lesions. Topical antibiotic can be used safely for long term because PFB is a recurrent condition and people need to use them regularly (however it is possible to be free from PFB just by following the general measures that i mentioned). I usually prescribe Mupirocin. Neosporin should work the same way. Some people with pus filled bumps or nodules can also require a course of oral antibiotics. However only Laser hair removal/reduction promises to cure PFB permanently Fungus is not an etiology in PFB. Regards
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