Kembara Xtra - Medicine - Pseudofolliculitis Barbae ​

Kembara Xtra - Medicine - Pseudofolliculitis Barbae ​
An ingrown hair-related foreign body inflammatory reaction that causes papules and pustules to form. This is primarily prevalent in the barbae (beard area), but it can also appear in other hairy areas including the scalp, axilla, or pubic regions where shaving is done.
Extrafollicular and transfollicular hair penetration is a mechanical issue.
Skin/exocrine system is impacted. Synonyms include tinea barbae, pseudofolliculitis barbae (PFB), chronic sycosis barbae, pili incarnati, and folliculitis barbae traumatica.

Predominant age  is postpubertal middle age (14 to 25 years).
Male is the dominant sex, which may be seen in females of all ethnicities who wax or shave.
Adult male African Americans: unknown incidence, while adult male Whites: unknown incidence
Prevalence: 45-83% of African American troops who have Fitzpatrick skin types IV to VI (darker complexions) shave.


Pathophysiology and Etiology 

Low-cut hair shafts that attempt to escape from the skin through the follicle are frequently accompanied by inflammation and an intraepidermal abscess.
 A foreign body reaction starts at the tip of the invading hair, followed by abscess formation; more acute inflammation occurs when the hair enters the dermis; downgrowth of the epidermis in an effort to wrap the hair
Hair removal methods like plucking, tweezing, or waxing can damage follicles and lead to abnormal hair growth.
Genetics: Single-nucleotide polymorphism (disruption Ala12Thr substitution) alters the keratin of the hair follicle, and individuals with curly hair have an asymmetric accumulation of acidic keratin (hHa8) on the hair shaft.

Risk factors include having curly hair, shaving too closely or often, plucking or tweezing unwanted hair, and having ancestry from the South Mediterranean/Middle East, Asia, or Africa (skin types IV to VI).

Prevention 
Rinse face with warm water before shaving to moisturize and soften hairs.
 Use hair clippers with adjustable blades that leave very little hair above the skin.
 Use an electric triple "O-head" razor, a single-edge blade razor (such as the Bump Fighter), a foil-guarded razor (such as the PFB razor), or a manual adjustable razor at the coarsest setting to avoid tight shaves.
Regularly empty your razor of hair.
Shave with the growth of the hair in mind. When shaving, avoid overstretching the skin.
Use plenty of the recommended shaving cream or gel (such as Ef-Kay shaving gel, Edge shaving gel, Aveeno therapeutic shave gel, or Easy Shave medicated shaving cream).
Papules and pruritus are reduced by shaving every day.
 Using depilators on a regular basis

Keloidal folliculitis and pseudofolliculitis nuchae are associated conditions.

Diagnosis 

Shaving discomfort, itchiness in shaven areas, and irritating "razor bumps"

clinical assessment 

Alopecia Hyperpigmented "razor or shave bumps" Tender, exudative, erythematous follicular papules or pustules in the beard area (less frequently in the scalp, axilla, and pubic areas) 
 Brittle, lackluster hair

Differential Diagnosis: Impetigo, Acne vulgaris, Tinea barbae, Bacterial Folliculitis, and Sarcoidal Papules

Laboratory Results 

Initial examinations (lab, imaging)

A pustule's culture may reveal coagulasenegative Staphylococcus epidermidis (normal skin flora), which is normally sterile.
Females with hirsutism and/or polycystic ovarian syndrome may benefit from additional hormonal testing for dehydroepiandrosterone sulfate, luteinizing hormone (LH)/follicle-stimulating hormone (FSH), and free and total testosterone.
Interpretation of Tests
Papules and pustules on the follicles

Management 

Light cases
- For 30 days, refrain from shaving close or avoid shaving at all while maintaining a well-groomed beard.
- Applying 1% hydrocortisone cream before night and 5% benzoyl peroxide after shaving (or LactiCare-HC lotion) are two options.
- Tretinoin cream, 0.025%; use every day.
 Moderate situations
Consider eflornithine HCl cream (Vaniqa) to minimize hair growth and stiffness in combination with other therapies. Chemical depilatories (barium sulfide; Magic shaving powder); first test on forearm for 48 hours (for irritation).
 Serious cases
- Laser treatment: Dark skin is safer for longer wavelength lasers, such as neodymium [Nd]:YAG (5)[B].
- Grow a beard instead of shaving.


General Actions 
acute therapy
With a sterilized needle or pair of tweezers, remove embedded hair.
Continue massaging the beard region with a washcloth, a rough sponge, or a soft brush several times each day until the red papules have disappeared (minimum 3 to 4 weeks; longer if moderate or severe).
Selenium sulfide if seborrhea is present and to assist reduce pruritus; Hydrocortisone 1-2.5% cream to alleviate inflammation; Systemic antibiotics if secondary infection is present
pregnant women's issues
Use of benzoyl peroxide, doxycycline, or tretinoin (Retin-A) is not advised.

First Line of Medicine

Application of clindamycin (Cleocin T) solution BID or topical erythromycin - Low-dose erythromycin or tetracycline 250 to 500 mg PO BID for more severe inflammation - are topical or systemic antibiotics for secondary infections.
- BID: Administer Benzoyl peroxide 5%-Clandamycin 1% gel until papule/pustule dissolves.
Mild cases: use tretinoin 0.025% cream before bed; combine the aforementioned treatments
The cross-linking of the disulfide bonds in the hair is disrupted by moderate illness and chemical depilators, resulting in a blunt (less pointed) hair tip.
- Do not apply more than once every third day: 2% calcium thioglycolate (Surgex) or barium sulfide (Magic Shave); calcium hydroxide (Nair).
Clindamycin contraindications include a history of hypersensitivity, regional enteritis or ulcerative colitis, or antibiotic-associated colitis. Erythromycin, tetracycline, and tretinoin contraindications include a history of hypersensitivity.
Erythromycin: Use cautiously in patients with impaired hepatic function; GI side effects, notably abdominal cramps; pregnancy Category B (erythromycin base formulation) Precautions - Clindamycin: colitis, eye burning and irritation, skin dryness
- Use chemical depilatories with caution; prolonged use and frequent use might result in chemical burns and irritated contact dermatitis.
Avoid using tetracycline while pregnant.
- Tretinoin: avoid during pregnancy as it causes severe skin rashes.
- Benzoyl peroxide: allergic contact dermatitis, skin dryness and irritation
Significant potential interactions with hydrocortisone cream include localized skin irritation, skin shrinkage with continued use, and skin whitening.
Erythromycin raises theophylline and carbamazepine levels while lowering warfarin clearance.
Tetracycline: lowers the activity of plasma prothrombin

Salicylic acid or glycolic acid peels as  second Line treatment. 



Referral After 4 to 6 weeks, dermatological consultation should be sought if the condition gets worse or the treatments mentioned above don't work.
Occupational demands may also result in an early dermatological referral for more aggressive treatment.

Surgical Techniques 
For severe cases, long-pulsed Nd:YAG laser therapy is beneficial.

As required, perform follow-up patient monitoring and inform the patient of curative and preventative measures.

Prognosis: Good with preventive measures; bad with increasing scarring and the development of foreign body granulomas.

Complications 
Scarring (sometimes keloidal) Foreign body granuloma development Scarring (apply sunscreen; can be treated with hydroquinone 4% cream, Retin-A, clinical peels) Disfiguring post-inflammatory hyperpigmentation
 Laser-induced pigmentary alterations and epidermal (erythema, crusting, burns with scarring) changes, including impetiginization of inflamed skin

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