Pseudofolliculitis: Razor Bumps

Pseudofolliculitis is the medical term for those pesky lesions more commonly known as “razor bumps,” “shaving bumps,” and “ingrown hairs.” It is a common, chronic condition that can be quite bothersome for those affected.

Pseudofolliculitis can occur in any area that is shaved. It is appropriately called pseudofolliculitis barbae when it affects the beard area, which is perhaps the most common area of involvement. It is more common in men and darkly pigmented individuals with tight, curly hair. However, it can also occur in women and in other shaved areas such as the neck, pubic, and axillary regions.

Whereas folliculitis represents an infection of the hair follicle, pseudofolliculitis is caused by inflammation secondary to trauma. Interestingly, this trauma is caused by the hairs themselves. When tight, curly hairs are shaved, they are cut at an oblique angle that allows the sharp tip to penetrate the skin as it curves. This re-entry of hair into the skin causes a significant degree of inflammation. Close shaves are particularly problematic because they leave a sharp tip beneath the surface of the skin that is primed for re-entry.

Pseudofolliculitis presents as red bumps in the beard (or other shaved) area that are often painful and/or itchy. Sometimes, pustules or deep boils develop. These red bumps eventually turn dark and firm as they heal, often appearing much darker than the surrounding skin. Some people develop abnormally large scars or keloids. Unfortunately, in chronic or untreated cases, the post-inflammatory hyperpigmentation may be difficult to treat and scarring/keloid development permanent.

To the chagrin of many, pseudofolliculitis is a chronic condition. The only way to stop the inflammatory cycle is to stop shaving, and most people do not like to hear this! Although total abstinence from shaving may (ultimately and with great care) be avoided, it is very important to at least temporarily stop shaving so that healing may occur. Resolution of active inflammation can take anywhere from a few months to one year (in the case of very severe disease), so patience is required. Continuing to shave over inflamed skin can cause the development of permanent scars or keloids, as well as permanent changes to the hair. An alternate to shaving during this time is to use electric clippers or scissors, leaving at least ½ cm of hair present at all times.

Medical evaluation should be sought during the period of acute inflammation. Depending on the degree of inflammation, oral antibiotics, topical corticosteroids, or even oral corticosteroids may become necessary.

A number of options are available to treat this condition. Tretinoins, alpha-hydroxy acids, and benzoyl peroxide work well in mild to moderate disease by exfoliating the areas involved and removing excess skin. A bleaching agent such as hydroxyquinone may be useful in improving the appearance of post-inflammatory hyperpigmentation. Some patients choose to undergo hair removal (via creams or lasers) to reduce hair density and thus decrease the risk of hair penetration.

Once the acute inflammation resolves and all of the ingrown hairs are gone, shaving can be attempted for those who cannot abstain from shaving forever. This will likely lead to the recurrence of lesions, but the following steps may help to minimize this risk:

  • Before shaving, wash the area to be shaved with a gentle acne soap and a rough washcloth.
  • Soak the face with a moist hot towel, and apply a shaving cream, gel, or foam prior to shaving.
  • Always use a sharp blade and avoid cutting too close to the skin.
  • Use a single blade razor.
  • Shave in the direction of the hair with short strokes.
  • Do not shave over one area more than once.
  • After shaving, apply soothing aftershave lotion.

Although pseudofolliculitis can be quite bothersome, there are a number of preventative methods that can be taken to improve its appearance. In addition, multiple treatment modalities are available and should be chosen with the help of a specialist who can discuss their associated risks and benefits.

Related Information: Skinsight Research: Razor Bumps

Published on 03/16/2012 | Last updated on 12/20/2016