Pseudofolliculitis Barbae Prevention and Treatments

There are two main types of ingrown hairs that lead to pseudofolliculitis barbae:

1. A hair that does not exit the hair follicle but penetrates the skin inside the follicle as it regrows, oftentimes curling onto itself beneath the surface of the skin.  (Subcutaneous)
2. A hair that briefly exits the hair follicle and curls and re-enters the hair follicle penetrates the skin before curling and re-entering the skin. (Retorcutaneous)

 For clarity, I distinguish these two types by naming them “subcutaneous ingrown hairs” and" retrocutaneous ingrown hairs" respectively to explain the process to  my patients and for the purposes of this article.  These are not official scientific names but for clarity there is a need to distinguish between these 2 causes of PFB so I am adopting these terms.

When a hair becomes ingrown, (literally growing within the skin), various symptoms can follow. Both subcutaneous and retrocutaneous ingrown hairs can sometimes trigger an immune response in your body, causing white blood cells to flood the area resulting in pustules, sebaceous cysts, or calcified pilar cysts. Bacteria can colonize the area and result in infection.  Infections to these inflamed zones can lead to additional pustules. (5)

Even if this folliculitis is treated or eventually goes away, it is common for the inflammation of ingrown hairs to result in long term changes in pigmentation that need to be treated with skin care regimens to treat the hyperpigmentation.

Pseudofolliculitis can occur on any part of the body where shaving of hair is done. (3) This usually includes the jawline, under the chin, on parts of the neck, and on or near the pubis or genitals. 

If you are a swimmer or otherwise shave your legs, chest, underarms, or arms, you might notice pseudofolliculitis in those areas.(8) Most research is directed to study its prevalence on the face, however “other shaved parts of the body” are generally mentioned in research. (6,7,8)

It is important to keep in mind that ingrown hairs are common on the pubis when the area is shaved and the red bumps and inflammation associated with ingrown hairs can sometimes resemble herpes. This kind of pseudofolliculitis is called pseudofolliculitis pubis.(7)

Statistically, men of sub-equatorial African origin or descent are the most likely to experience pseudofolliculitis barbae due to their typically curly and textured hair. In fact, this condition was first medically categorized upon observing high rates of ingrown hairs for armed forces personnel of color who were required to shave daily. (9)

This condition is not exclusive to the black communities of the globe, however, as many other groups have expressed this condition in varying rates of prevalence. People of Asian, Latin, and European origin are all capable of experiencing pseudofolliculitis barbae, especially if they have thick or curly hair.

Because “barbae” refers to beards and facial hair, this particular type of pseudofolliculitis is more common in men, however pseudofolliculitis of other body regions are common in both men and women.

The person at highest risk of pseudofolliculitis barbae is somebody who has already experienced it in the past, has tightly curled hair, and shaves regularly.

The dangers of Pseudofolliculitis barbae are not life threatening, but do pose a risk to the sufferer's confidence and general comfort. This condition can result in painful inflammation, infections, and post-inflammatory hyperpigmentation.

Typically, that is where the physical symptoms end, however in the case of infected growths resulting from Pseudofolliculitis barbae, topical antibiotics or injection of pustules may be required. The biggest problem with PFB is developing keloid scars.  When these are caused by ingrown hairs, PFB, and acne and is on the neck it is called acne keloidalis nuchae.  In this condition there are multiple keloid scars on the back of the neck.

The largest danger of Pseudofolliculitis barbae is likely the impact it can have on self-confidence, which can be as critical as many medical concerns. In fact, stress is known to have multiple potential effects on skin health, which can create a vicious cycle of infection, irritation, and more. If you have pseudofolliculitis barbae, the stress caused by your skin can be even worse.

To make sure you steer clear of these issues, take steps to avoid PFB such as changing your shaving habits. In some cases, going to a well trained barber who uses a straight razor and understands how to cut beard hair at a less sharp angle to prevent ingrown hairs can help.

Post-inflammatory hyperpigmentation (PIH) is one of the most common kinds of skin pigmentation conditions. It usually follows prolonged periods of irritated, reddened, or otherwise inflamed skin. 

Since pseudofolliculitis barbae, or ingrown hairs in general, cause inflammation, PIH is a common side effect.

The most common treatments for PIH include skin lightening ingredients such as tyrosinase inhibitors, PAR-2 blockers, or exfoliators.

Some common ingredients used to treat this condition are hexylresorcinol, niacinamide, and salicylic acid among many others. Check out our blog on skin lightening ingredients for a more comprehensive dictionary of options.

Shop by your Baumann Skin Type to find the best skin lighteners to treat PIH.

When skin is inflamed and pores become clogged, there is a greater chance for acne causing bacteria to develop on the face. (2) For that reason, ingrown hairs from pseudofolliculitis barbae often result in acne on the face, neck, or chest.

Pus is an easy medium for acne causing bacteria to develop in, meaning that the treatment of pustules related to ingrown hair is important in acne prevention.

Bacterium such as staphylococcus aureus and E.coli can also develop in clogged pores. 

Note that not all acne is related to ingrown hairs. 

Irritated, inflamed skin is more likely to catch an infection when it is scratched. This can be challenging to avoid with pseudofolliculitis barbae because affected areas are often itchy and/or peeling. Do what you can to avoid scratching to avoid infections.

Keloids are irregular scar tissue that continues to grow past the stage of healing, and often result in profound swollen appearances that can hamper with the sufferers' quality of life and self confidence. Keloids are basically scar tissue that grows too much, and one's susceptibility to them largely depends on genetic factors (10).

Pseudofolliculitis barbae is characterized by significant inflammation at the site of the ingrown hair and the directly surrounding area, which means scarring of some kind is often possible. If you pick at your ingrown hairs, scarring is more likely to occur; in the same vein, the more scarring that happens, the more likely you are to experience keloids if you have the genetic markers for them.

When keloids are severe, the best treatment for them is often an injection of steroids to the afflicted area. This is not always a guaranteed solution, and in severe cases keloids need to be surgically removed. This too is not a guaranteed success in treatment, as additional scarring and keloiding is possible after surgery.

in general, the best way to stay free of keloids is to not pick at inflamed tissue so scarring never happens. If you are experiencing keloids as a symptom of Pseudofolliculitis barbae, seek advice from your local dermatologist.

While everybody has different face shapes, hair textures, and thickness of facial hair, there are some practices that are considered the best for preventing ingrown hairs. (11)

In general, a single-edged razor is considered less likely to cause PFB because hairs are not cut very deeply below the surface of the skin. Sometimes, this is not enough of a precaution and subcutaneous ingrown hairs can happen anyways. If this is true for you, then we recommend always shaving downwards on your face, from the direction of your cheeks towards the direction of your neck. 

Shaving this way follows the natural growth trajectory of your facial hair, leaving it closer to the surface than shaving “against the grain.”

If your ingrown hairs are more often retrocutaneous ( growing back into your skin after penetrating the surface) then we recommend keeping your facial hair above a certain length, at least a “1” with your electric razor.

Electric razors cut less closely to the skin than manual razors, so they often are better for individuals prone to PFB.

If you often experience ingrown hairs, you also want to make sure your skin is well moisturized before and after your shave. We recommend using a moisturizer suitable for your skin type instead of commercial shaving creams to soften the follicle and assist new hair growth.

After shaving, an exfoliator can be a great preventative measure for PFB as well. An exfoliator will help scrub the outermost layer of your skin, the stratum corneum, which makes clogged pores less likely.

If you've tried these practices and still experience ingrown hairs often, consult your dermatologist for more advice.

As we've touched on, the best way to prevent pseudofolliculitis barbae is by changing your shaving habits; however sometimes your job or athletic career do not allow for facial hair. In cases like these, additional measures may be required. As mentioned in the previous section, utilizing a moisturizer and exfoliator can be critical to the prevention of ingrown hairs. So too can an appropriate cleanser and sunscreen prevent ingrown hairs. A good cleanser keeps your pores free of bacteria that could infect and further inflame ingrown hairs. When your inflammation doesn't get infected, it will go away sooner. (3,4)

Sunscreens can prevent sun damage, which often results in dead skin peeling from the face. Until the dead skin is removed from your face, it poses an additional risk of clogged pores.

Taking hot showers regularly or using a steam room are also good strategies for prevention, as hot water relaxes and opens the pores on your skin.

At the end of the day, the best products for you will depend on your skin type and the severity of your PFB, so we recommend taking our skin typing quiz to find the best recommendations for your skin.

If you already have pseudofolliculitis barbae, the best treatments are similar to the best preventative measures. Cleansers, exfoliators, moisturizers, and hot water are the best methods for treatment. (2) There are products specifically designed to treat the various aspects of pseudofolliculitis barbae, namely the “PFB” brand of products featured below.

in cases of cystic infections or pilar cysts, steroid injections are often the most effective and immediate course of treatment, but these can be expensive to undertake.

Note that pseudofolliculitis barbae does not usually just happen once, if it is a problem you have had in the past, you will likely have it again, so treatment of this condition and prevention are inextricably linked. 

The best products for pseudofolliculitis barbae depend on your specific Baumann Skin Type because some moisturizers and exfoliators are better for certain skin types over others. It is important that when designing your prevention or treatment regimen for PFB you keep your skin's specificities in mind. For example, if you have oily skin and use a comedogenic moisturizer, your pores are likely to clog. If you have dry skin, certain exfoliators or cleansers can strip too much sebum from your face, resulting in irritation or dead skin that can also clog your pores.

For the specific treatment of pseudofolliculitis barbae that has already begun, we recommend products by the “PFB” brand, seen just below. Make sure you find your skin type before making your choice, because as discussed different products have different effects on different skin types.