156 Diagnosis and Treatment of Hair Disorders
In Caucasians a less severe, but more persistent variety
of pseudofolliculitis is observed in subjects with curly
and coarse beard hair who shave their beard very close
and stretch the skin before shaving (Figure 20.7). Cutting
of the hair shaft below the follicular ostium produces
embedding of the hair shaft before its emergency from
the skin (trans-follicular penetration) with foreign body
reaction and inflammation. This variety of folliculitis is
frequent in the bikini area and in the legs of women
who depilate with techniques that produce rupture of
the shaft within the follicle (waxing, tweezing, plucking).
Differential diagnosis of inflammatory lesions of the
beard are reported in Table 20.1.
Table 20.1 Differential diagnosis of
Figure 20.5 papulo-pustular lesions of the beard
Transfollicular penetration.
Acne vulgaris
Bacterial folliculitis
Candida folliculitis
Impetigo
Perioral dermatitis
Pseudofolliculitis
Rosacea
Sarcoidosis
Sicosis
Tinea barbae
Traumatic folliculitis
20.6 Management
The condition resolves 2–6 weeks after interruption of
shaving in most cases, but recurs when shaving is
restarted.
Beard region:
• Soften the hair with warm water before shaving
• Avoid double- or triple-bladed razors
• Avoid close shaving
• Shave in the direction of hair growth
• Utilize electric razors that cut the shaft at a minimum
distance of 1 mm from the skin
• Topical antiseptics/antibacterial soaps
• Topical retinoids and/or glycolic acid 5–10%
• Laser epilation.
20.7
Other regions:
Figures 20.6, 20.7 • Change depilatory methods (wax)
Pseudofolliculitis of the beard. • Laser epilation.