Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentPrognosisCoping
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Prognosis
Coping
This article discusses the causes of pseudofolliculitis barbae, what it looks like, and how it can be prevented and treated.
Photo: LaylaBird / Getty Images
Pseudofolliculitis Barbae Symptoms
Pseudofolliculitis barbae affects thehair folliclesand surrounding skin in areas whereterminal hair—the thicker, coarser hair that begins to develop after puberty—grows.
The condition is most common in the beard area (the lower cheeks, jawline, chin, and neck). PFB can also appear on the back of the neck, in the pubic area, and occasionally on the underarms, arms, or legs.
Symptoms of pseudofolliculitis barbae include:
These symptoms may develop or worsen within a day or two after shaving.
More serious inflamed skin lesions, such as nodules andabscesses, may develop if the follicle becomes infected.Staphylococcus aureus, a type of bacteria, is the most common culprit.
Pseudofolliculitis also causes darkening of the skin in affected areas, a condition calledpost-inflammatory hyperpigmentation.
Hypertrophic (raised scars)orkeloid scarscan also develop in people who are prone to them.
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Causes of Pseudofolliculitis Barbae
Pseudofolliculitis develops when terminal hair doesn’t grow up and out of the hair follicle normally through the opening at the skin’s surface, orpore. Instead, the hair grows sideways underneath the skin’s surface, through the follicle wall, and into the surrounding skin tissue.
Sometimes the hair will exit the pore normally, but do a sharp “U-turn” and grow back into the skin from the surface.
There are three main factors that are particularly known to lead to the development of PFB:
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Curly Hair
Pseudofolliculitis barbae is incredibly common in Black men and men who have curly facial hair. It’s estimated that up to 83% of all Black men develop pseudofolliculitis barbae.
Genetic Predisposition
Interestingly, some people are more prone to developing pseudofolliculitis barbae regardless of their hair texture.
An important 2004 study published in theJournal of Investigative Dermatologyfound that people who had a single substitution in a specific keratin gene (K6hf) were six times more likely to develop pseudofolliculitis barbae than those without this mutation.
Shaving
Even with the other factors, it is shaving (and less often, waxing) that is the initial trigger for pseudofolliculitis.
Hair stretches, just a bit, when shaving, especially if the skin is pulled taut. As the razor cuts, the hair pulls back and retracts into the follicle. This is why the skin feels perfectly smooth without a hint of stubble: The hair shaft has been cut not at the skin’s surface, but just below it.
While this makes for a nice, close shave, it also sets up the perfect scenario for pseudofolliculitis to develop. The sharp, angled point that shaving creates at the tip of each hair can more easily pierce the skin as the hair grows.
Hair that is thick and coarse, being more robust than finevellus hair, can also penetrate the skin more easily.
Other Possible Causes
Pseudofolliculitis barbae is more common in women withpolycystic ovary syndrome (PCOS), and other hormonal disorders that causehirsutism, or excessive facial hair. It is also more common in perimenopausal and menopausal women.
Other risk factors for pseudofolliculitis include taking cyclosporine or and corticosteroids (in renal transplant patients).
PFB is diagnosed based on a review of symptoms and a visual inspection of the skin. There is no specific test for diagnosing pseudofolliculitis barbae.
Your healthcare provider may look at your skin using adermoscope, a handheld instrument is similar to a magnifying glass. This tool is used to magnify the skin up to 10 times and allows the healthcare provider to see ingrown hairs under the skin’s surface. They look like dark grey or black lines or spots under the skin.
In some cases, your healthcare provider may swab your skin to check for a bacterial infection.
Differential Diagnoses
In general, pseudofolliculitis is easy to diagnose, but there are otherskin conditions that cause inflamed bumps. Sometimes these conditions can occur at the same time as PFB.
Skin conditions that resemble pseudofolliculitis barbae include:
Pseudofolliculitis Barbae Treatment
The best treatment for PFB is prevention. Arguably, the most effective way to prevent these ingrown hairs is to completely stop all methods of hair removal and let hair grow out.
At first, this may cause an increase in symptoms because the hair that has already been shaved or removed can become trapped under the skin. Over time, though, the skin improves because the grown-out hair stays above the skin’s surface. Hence, it is much less likely for ingrown hairs to develop.
When you completely stop shaving, marked improvement is typically seen in about three months' time.
In many cases, stopping shaving will completely clear up pseudofolliculitis barbae. At this point, any treatment for post-inflammatory hyperpigmentation or scars can be started.
However, letting hair grow out isn’t an option for everyone. You may have a job that requires you to be clean-shaven, for example. If that’s true for you, there are other treatment options that can be used.
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Shaving Tips
If you’re prone to pseudofolliculitis barbae, proper shaving techniques will help to avoid irritation and reduce ingrown hair development. These tips can be used for all areas of the body, not just the face
Chemical Depilatories
If you’re not getting adaquate results, even with careful shaving techniques, you may wish to try chemical depilatories.
The downside is depilatories are messy and smelly. They can also be irritating for some people, causing burning and stinging during use. If you’re particularly sensitive, they may also causecontact dermatitis.
Always use depilatories with care and follow all directions on the package.
Topical Exfoliants and Keratolytics
Options include:
Lightly exfoliating with an OTC scrub daily can help lift hairs that are already above the skin’s surface, preventing them from growing back into the skin. OTC scrubs are most effective as a preventative measure in minor cases of pseudofolliculitis barbae, and only if the skin is not considerably inflamed.
Topical Steroids
Your healthcare provider may recommendtopical steroidsfor short-term treatment to alleviate moderate to severe inflammation.
Over-the-counter hydrocortisone creamcan reduce itching and inflammation. If OTC options aren’t enough, you may be prescribed a stronger medication.
All topical steroids, including OTC hydrocortisone, should only be used on an as-needed basis and not as a long-term daily treatment, and only under the recommendation of a healthcare provider. Side effects includethinning of the skinand hypopigmentation, which is much more common in dark skin.
Procedures
These aren’t used as a first-line defense against PFB. Instead, these procedures may be tried if pseudofolliculitis is severe and not responding well to other treatments.
There is also a time investment involved because, with both procedures, you will need a series of treatments done in order to see any type of result.
Both procedures can cause hyperpigmentation (skin darkening) or hypopigmentation (skin lightening), especially for those with medium to dark skin tones.
Your healthcare provider can tell you if these procedures are appropriate for you.
Antibiotics
Antibioticsare prescribed on an as-needed basis to help clear up any infection that has taken hold.Signs of infection include increased swelling, pain, warmth, and drainage of pus.
Antibiotics don’t treat the underlying cause of pseudofolliculitis, though, so these can’t be used as the sole treatment. Instead, they are used in conjunction with other treatments.
The prognosis for PFB is good, although you may end up with some residual hyperpigmentation or scarring.
There is no cure for pseudofolliculitis, so you will always be prone to developing ingrown hairs. It requires lifelong management to keep this skin condition at bay.
Having pseudofolliculitis barbae can be embarrassing as well as uncomfortable. Because it most often appears on the face, it feels so “front and center.” Many people with PFB say they often feel embarrassed or ashamed because of the condition. It can affect self-esteem and self-confidence.
The most important thing you can do if you have this condition is to start treatment. There are many different options and, in most cases, pseudofolliculitis barbae can be considerably improved within just a few months with careful management.
In the meantime, if you desire, a tinted moisturizer, concealer, or cosmetic foundation can help tone down redness and help camouflage discoloration while you’re waiting for treatments to work.
Summary
Pseudofolliculitis barbae, more commonly known as ingrown hairs, is a skin condition that occurs when facial hair (and sometimes pubic hair or underarm hair) grows sideways into the skin rather than directly up and out of the hair follicle.
PFB can cause stinging and burning, especially while shaving. Avoiding shaving altogether is the best way to prevent PFB. When this is not feasible, however, various drug treatments and procedures may be effective.
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Gray J, McMichael AJ.Pseudofolliculitis barbae: understanding the condition and the role of facial grooming.Int J Cosmet Sci. 2016 Jun;38 Suppl 1:24-7. doi:10.1111/ics.12331Ogunbiyi A.Pseudofolliculitis barbae; current treatment options.Clin Cosmet Investig Dermatol. 2019;12:241-247. doi:10.2147/CCID.S149250Adotama P, Tinker D, Mitchell K, Glass DA 2nd, Allen P.Barber knowledge and recommendations regarding pseudofolliculitis barbae and acne keloidalis nuchae in an urban setting.JAMA Dermatol.2017;153(12):1325-1326. doi:10.1001/jamadermatol.2017.3668Winter H, Schissel D, Parry DA, et al.An unusual Ala12Thr polymorphism in the 1A alpha-helical segment of the companion layer-specific keratin K6hf: evidence for a risk factor in the etiology of the common hair disorder pseudofolliculitis barbae.J Invest Dermatol.2004 Mar;122(3):652-7. doi:10.1111/j.0022-202X.2004.22309.xNguyen TA, Patel PS, Viola KV, Friedman AJ.Pseudofolliculitis barbae in women: a clinical perspective.Br J Dermatol.2015;173(1):279-81. doi:10.1111/bjd.13644Ilyas M, Colegio OR, Kaplan B, Sharma A.Cutaneous toxicities from transplantation-related medications.Am J Transplant. 2017;17(11):2782-2789. doi:10.1111/ajt.14337Diernaes JE, Bygum A.Successful treatment of recalcitrant folliculitis barbae and pseudofolliculitis barbae with photodynamic therapy.Photodiagnosis Photodyn Ther. 2013 Dec;10(4):651-3. doi:10.1016/j.pdpdt.2013.08.003Additional ReadingAwosika O, Burgess CM, Grimes PE.Considerations when treating cosmetic concerns in men of color.Dermatol Surg.2017;43 Suppl 2:S140-S150. doi:10.1097/DSS.0000000000001376Ladizinski B, Ramirez-Fort MK, Cohen YK, Rosendahl C, Elpern DJ.Pseudofolliculitis barbae: a dermatoscopic correlate.Dermatol Pract Concept. 2013;3(2):53-4. doi:10.5826/dpc.0302a07
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Gray J, McMichael AJ.Pseudofolliculitis barbae: understanding the condition and the role of facial grooming.Int J Cosmet Sci. 2016 Jun;38 Suppl 1:24-7. doi:10.1111/ics.12331Ogunbiyi A.Pseudofolliculitis barbae; current treatment options.Clin Cosmet Investig Dermatol. 2019;12:241-247. doi:10.2147/CCID.S149250Adotama P, Tinker D, Mitchell K, Glass DA 2nd, Allen P.Barber knowledge and recommendations regarding pseudofolliculitis barbae and acne keloidalis nuchae in an urban setting.JAMA Dermatol.2017;153(12):1325-1326. doi:10.1001/jamadermatol.2017.3668Winter H, Schissel D, Parry DA, et al.An unusual Ala12Thr polymorphism in the 1A alpha-helical segment of the companion layer-specific keratin K6hf: evidence for a risk factor in the etiology of the common hair disorder pseudofolliculitis barbae.J Invest Dermatol.2004 Mar;122(3):652-7. doi:10.1111/j.0022-202X.2004.22309.xNguyen TA, Patel PS, Viola KV, Friedman AJ.Pseudofolliculitis barbae in women: a clinical perspective.Br J Dermatol.2015;173(1):279-81. doi:10.1111/bjd.13644Ilyas M, Colegio OR, Kaplan B, Sharma A.Cutaneous toxicities from transplantation-related medications.Am J Transplant. 2017;17(11):2782-2789. doi:10.1111/ajt.14337Diernaes JE, Bygum A.Successful treatment of recalcitrant folliculitis barbae and pseudofolliculitis barbae with photodynamic therapy.Photodiagnosis Photodyn Ther. 2013 Dec;10(4):651-3. doi:10.1016/j.pdpdt.2013.08.003Additional ReadingAwosika O, Burgess CM, Grimes PE.Considerations when treating cosmetic concerns in men of color.Dermatol Surg.2017;43 Suppl 2:S140-S150. doi:10.1097/DSS.0000000000001376Ladizinski B, Ramirez-Fort MK, Cohen YK, Rosendahl C, Elpern DJ.Pseudofolliculitis barbae: a dermatoscopic correlate.Dermatol Pract Concept. 2013;3(2):53-4. doi:10.5826/dpc.0302a07
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Gray J, McMichael AJ.Pseudofolliculitis barbae: understanding the condition and the role of facial grooming.Int J Cosmet Sci. 2016 Jun;38 Suppl 1:24-7. doi:10.1111/ics.12331Ogunbiyi A.Pseudofolliculitis barbae; current treatment options.Clin Cosmet Investig Dermatol. 2019;12:241-247. doi:10.2147/CCID.S149250Adotama P, Tinker D, Mitchell K, Glass DA 2nd, Allen P.Barber knowledge and recommendations regarding pseudofolliculitis barbae and acne keloidalis nuchae in an urban setting.JAMA Dermatol.2017;153(12):1325-1326. doi:10.1001/jamadermatol.2017.3668Winter H, Schissel D, Parry DA, et al.An unusual Ala12Thr polymorphism in the 1A alpha-helical segment of the companion layer-specific keratin K6hf: evidence for a risk factor in the etiology of the common hair disorder pseudofolliculitis barbae.J Invest Dermatol.2004 Mar;122(3):652-7. doi:10.1111/j.0022-202X.2004.22309.xNguyen TA, Patel PS, Viola KV, Friedman AJ.Pseudofolliculitis barbae in women: a clinical perspective.Br J Dermatol.2015;173(1):279-81. doi:10.1111/bjd.13644Ilyas M, Colegio OR, Kaplan B, Sharma A.Cutaneous toxicities from transplantation-related medications.Am J Transplant. 2017;17(11):2782-2789. doi:10.1111/ajt.14337Diernaes JE, Bygum A.Successful treatment of recalcitrant folliculitis barbae and pseudofolliculitis barbae with photodynamic therapy.Photodiagnosis Photodyn Ther. 2013 Dec;10(4):651-3. doi:10.1016/j.pdpdt.2013.08.003
Gray J, McMichael AJ.Pseudofolliculitis barbae: understanding the condition and the role of facial grooming.Int J Cosmet Sci. 2016 Jun;38 Suppl 1:24-7. doi:10.1111/ics.12331
Ogunbiyi A.Pseudofolliculitis barbae; current treatment options.Clin Cosmet Investig Dermatol. 2019;12:241-247. doi:10.2147/CCID.S149250
Adotama P, Tinker D, Mitchell K, Glass DA 2nd, Allen P.Barber knowledge and recommendations regarding pseudofolliculitis barbae and acne keloidalis nuchae in an urban setting.JAMA Dermatol.2017;153(12):1325-1326. doi:10.1001/jamadermatol.2017.3668
Winter H, Schissel D, Parry DA, et al.An unusual Ala12Thr polymorphism in the 1A alpha-helical segment of the companion layer-specific keratin K6hf: evidence for a risk factor in the etiology of the common hair disorder pseudofolliculitis barbae.J Invest Dermatol.2004 Mar;122(3):652-7. doi:10.1111/j.0022-202X.2004.22309.x
Nguyen TA, Patel PS, Viola KV, Friedman AJ.Pseudofolliculitis barbae in women: a clinical perspective.Br J Dermatol.2015;173(1):279-81. doi:10.1111/bjd.13644
Ilyas M, Colegio OR, Kaplan B, Sharma A.Cutaneous toxicities from transplantation-related medications.Am J Transplant. 2017;17(11):2782-2789. doi:10.1111/ajt.14337
Diernaes JE, Bygum A.Successful treatment of recalcitrant folliculitis barbae and pseudofolliculitis barbae with photodynamic therapy.Photodiagnosis Photodyn Ther. 2013 Dec;10(4):651-3. doi:10.1016/j.pdpdt.2013.08.003
Awosika O, Burgess CM, Grimes PE.Considerations when treating cosmetic concerns in men of color.Dermatol Surg.2017;43 Suppl 2:S140-S150. doi:10.1097/DSS.0000000000001376Ladizinski B, Ramirez-Fort MK, Cohen YK, Rosendahl C, Elpern DJ.Pseudofolliculitis barbae: a dermatoscopic correlate.Dermatol Pract Concept. 2013;3(2):53-4. doi:10.5826/dpc.0302a07
Awosika O, Burgess CM, Grimes PE.Considerations when treating cosmetic concerns in men of color.Dermatol Surg.2017;43 Suppl 2:S140-S150. doi:10.1097/DSS.0000000000001376
Ladizinski B, Ramirez-Fort MK, Cohen YK, Rosendahl C, Elpern DJ.Pseudofolliculitis barbae: a dermatoscopic correlate.Dermatol Pract Concept. 2013;3(2):53-4. doi:10.5826/dpc.0302a07
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