Ingrown hairs or Pseudofolliculitis of beard or pseudofolliculitis barbae (PFB) or razor bumps - 

a condition where shaved curly hair tends to grow into the skin instead of out of the follicle. Pseudofolliculitis barbae is a foreign-body inflammatory reaction surrounding ingrown facial hairs, which results from shaving.   It is caused by mal-alignment of the hair follicle due to improper shaving technique (reverse shaving). It can also occur on any body site where hair is shaved or plucked, including axilla, pubic area, and legs. It is also known as shaving rash. The ingrown hair can get infected forming a true folliculitis.

Pseudofolliculitis barbae is due to shaving, particularly close shaving—because the cut hair may retract beneath the skin surface. It can also occur in skin folds and scars. It occurs mainly in people with curly hair because the curl of the hair means that the sharp pointed end of a recently shaved hair comes out from the skin and re-enters the skin close by causing a foreign body inflammatory reaction. The injured follicles are highly susceptible to become infected, causing folliculitis barbae.

The skin typically looks bumpy and inflamed and can look like the papules and pustules of pimples. Razor bumps can get infected, causing true folliculitis. The treatment of true folliculitis is antibiotics and hot water fomentation and anti-inflammatory drugs.

Folliculitis barbae and pseudofolliculitis barbae can co-exist. 

 The curved hair grows inward and that produces a tender red bump and/or pustule.

The conservative treatment of this condition is to let the hairs grow longer and they come out of their follicles on their own, or manually remove the covering skin over the hairs and remove the hairs individually.

In case the conservative management fails, then the treatment of choice is removal of the involved hairs. The removal is done by first extracting the hair tip from its coiled position and then doing the electrolysis and removing the hair permanently.

Electrolysis can eliminate ingrown hairs and the skin returns to a healthier look without all the irritation from the temporary methods.

Electrolysis treatment is effective for anyone regardless of skin and hair types and colors. Electrolysis destroys the ability of the hair follicle to grow another hair. The regenerative ability of the hair follicle is permanently eliminated- therefore you are permanently free of unwanted hairs and ingrown hairs.

What are the features of pseudofolliculitis and folliculitis barbae?

After shaving, patients may experience an acne-like eruption on the area that has been shaved, usually the face and neck of men.

• Involvement of the skin under the jawline is typical, a site where the hair follicles grow in various directions.
• Pseudofolliculitis barbae presents as ingrown hairs associated with flesh-coloured or red follicular papules, which may be itchy or tender.
• Folliculitis barbae presents as painful pustules and can discharge pus.
• Lesions may bleed when they are shaved.

Folliculitis barbae and pseudofolliculitis are aggravated by co-existent eczema/dermatitis. 

What are the complications of folliculitis and pseudofolliculitis barbae?

Complications of folliculitis and pseudofolliculitis barbae include:

• Postinflammatory hyperpigmentation
• Hypertrophic scarring and keloid formation
• Temporary and permanent hair loss 
• Sycosis barbae – sinuses, abscesses and spreading infection due to infection and autoinflammatory reaction

How are pseudofolliculitis barbae and folliculitis barbae diagnosed?

Pseudofolliculitis barbae is a clinical diagnosis. Magnification, eg dermatoscopy, may be necessary to see the ingrown hairs. Folliculitis barbae is diagnosed by the presence of painful pustules.

What is the treatment?

Medical treatment of pseudofolliculitis barbae

• Hydrocortisone cream can reduce mild inflammation and itching.
• Topical acne treatments such as benzoyl peroxide and tretinoin are used to suppress follicular hyperkeratosis.
• A combination of tretinoin, low-potency topical corticosteroid, and hydroquinone may be selected to decrease inflammation, hyperkeratosis and pigment production.
• Oral antibiotics

What is the treatment of folliculitis barbae?

As folliculitis barbae and sycosis barbae are due to bacterial infection, they are treated with topical or oral anti-staphylococcal antibiotics.

How is pseudofolliculitis barbae prevented?

The only way of preventing pseudofolliculitis barbae is to permanently remove the hairs causing the ingrowth. Permanent hair removal can only be done with electrolysis. We are doing the permanent hair removal by Galvanic technique of Electrolysis (Galvanolysis) which has a success rate of 90% to 100% and no risk of damage to sensitive skin.