Lasers, shaving tips address pseudofolliculitis barbae


Minneapolis — Charles E. Crutchfield III, M.D., has had a lifelong battle with pseudofolliculitis barbae.

“When I became a dermatologist, it’s one of the things I focused on,” he says.

Razor bumps tend to haunt men — especially those who shave their beards daily — in the neck area.

Dr. Crutchfield, who practices in Eagan, Minn., and is clinical associate professor of dermatology, University of Minnesota Medical School, says athletes who shave or wax their chests also seek treatment for the unsightly bumps and pustules that result from hair removal. Pseudofolliculitis barbae can occur anywhere hair is temporarily removed, whether by shaving, plucking, waxing or chemical depilatory.

Culprits

There are two causes of pseudofolliculitis barbae, according to Dr. Crutchfield: transfollicular penetration and extrafollicular penetration.

“Either curly hair or hair that is oriented to an oblique angle has a higher propensity to form razor bumps,” he says. “If you have curly hair under the skin’s surface, it grows straight into the sidewall. That’s a process called transfollicular penetration.

“You can also have hair that’s really curly, grows out of the hair follicle and, then, curls and pokes back in (extrafollicular). The problem is that hair is made up of the protein keratin, which is one of the most inflammatory substances to the skin. You can get pustules and secondary infections, and it’s very painful.”

Treating the problem

A male patient suffering from pseudofolliculitis barbae on the chest (top), occurring after shaving, and a male patient suffering from the condition on the face and chin area. (PHOTOS: CHARLES E. CRUTCHFIELD III, M.D.)

One of the most important aspects of treatment, according to Dr. Crutchfield, is education.

“I think once you have the patient educated and onboard with the program, compliance is very high and results are much better,” he says.

Treatment should focus on getting rid of the offending agent, hair. And the best tool to that end is the laser, Dr. Crutchfield says.

“The laser works because you remove the offending and causative agent and everything clears. The real trick, though, is you have to differentiate between the melanin, or melanosomes, in skin and the melanosomes in hair,” he says. “If you don’t, it’s very easy to burn the skin while trying to get rid of the hair.”

Dermatologist can avoid burning the skin by spreading out the laser’s pulse duration. This is especially important when using laser hair removal on patients who have darker skin types.

“The laser is a good treatment for pseudofolliculitis barbae, but for dermatologists who are not familiar or skilled with lasers for treating skin of color, it’s a real danger zone. You could have terrible burns and scars,” Dr. Crutchfield says.

Even experienced dermatologists should always start with an inconspicuous test site, behind the ear, for example. Dr. Crutchfield’s treatment regimen for pseudofolliculitis barbae generally includes using the laser once a month for four to six months; then, two to three times annually, to maintain a hair-free state.

“A lot of guys worry that they’ll never be able to grow a beard. I point out that they don’t grow a beard on the neck (where razor bumps often occur) and, even if you use the laser on their faces, if we stop treatment, hair will grow back within a year,” he says.

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