Symptoms
In a mild course, there is a burning sensation (razor burn), redness, itching, and a rash after shaving that disappears within a few hours or a few days. A chronic and severe course, such as pseudofolliculitis barbae, manifests as an inflammatory reaction with papules and pustules, ingrown hairs, and even complications such as hyperpigmentation, scarring, abscess formation, and secondary infection.
Causes
Mild discomfort occurs due to skin irritation, minor injuries, cuts, and improper shaving technique (dull blade, too much pressure, shaving against the growth). Shaving and alcohol-based aftershaves also severely dry out the skin and compromise the skin barrier. Any hairy and shaved skin area can be affected, so in addition to the beard area, for example, the chest, armpits, extremities and intimate area. Pseudofolliculitis barbae mainly affects men of dark complexion of Hispanic or African origin with thick, frizzy hair. Women with hirsutism also belong to this risk group. It is a foreign body reaction to ingrown hairs. The tip of the hair, which has been sharply cut by shaving, grows back into the skin instead of growing out normally. This process is favored by a clean shave and cutting the hair under the skin. It is called pseudofolliculitis because no microorganisms are involved in its development.
Diagnosis
The diagnosis is made on the basis of physical examination and patient history. Possible differential diagnoses include acne, bacterial folliculitis, sarcoidosis, fungal infections in the beard area (tinea barbae), and other skin diseases.
Non-drug treatment
In cases of discomfort beyond mild irritation, shaving should be discontinued for a few days to a few weeks, depending on the cause, to allow the skin to calm down, the hair to grow out, and to prevent repeated irritation. In most cases, this causes the skin lesions to disappear. Longer hair is also easier to shave. Growing a beard eliminates the discomfort easily and permanently, but it is not an option for all men and not in every social setting. In the case of pseudofolliculitis barbae, smooth and wet shaving should be avoided and the hair should instead be trimmed to 1-3 mm with an electric razor. Various mechanical methods (washcloth, sponge, massage) can be used to detach the top layer of skin and facilitate normal hair growth. Hair follicles can also be permanently removed by laser treatment. If wet shaving is used, the skin and hair should first be softened and washed with water and a cleansing cream. Many guides recommend using warm water or taking a warm shower before shaving. While heat makes shaving easier on healthy skin and fine hair, it also increases circulation and can cause injury and irritation. Cold water, on the other hand, contracts the skin and vessels, soothing irritation and preventing irritation. The shaving gel additionally softens the skin and the hair and should be massaged in and left on for a sufficiently long time (1-5 minutes). When shaving, do not apply too much pressure and if possible always shave in the direction of hair growth. The blade must be sufficiently sharp and should therefore be regularly cleaned, changed and not damaged. At the end of shaving, rinse the skin with cold water, dry and apply a mild aftershave balm.
Drug treatment
After each shave, the skin should be rehydrated, cooled and conditioned with a mild, alcohol-free balm. Such aftershave balms are commercially available from various manufacturers. Alcohol-based aftershaves are not suitable in our view, as they irritate and additionally dry out the skin. Two possible positive effects are the disinfecting property of alcohol and the degreasing effect on oily skin. For the treatment of pseudofolliculitis barbae, keratolytics such as retinoids, acne medications and peels, topical glucocorticoids, antibiotics and depilatories are used, among others (see literature).
