What is the management for pseudo folliculitis (false folliculitis)?

From the Guidelines

The management of pseudo folliculitis should prioritize preventive measures, such as stopping or modifying shaving practices, and topical treatments like benzoyl peroxide or topical retinoids to reduce inflammation and promote proper hair growth. The management of pseudo folliculitis (also known as razor bumps or ingrown hairs) involves both preventive measures and active treatments. First-line management includes stopping or modifying shaving practices, such as using an electric razor instead of a blade, shaving in the direction of hair growth, and avoiding close shaves. Allowing the beard to grow for 3-4 weeks can help existing ingrown hairs to release naturally. Some key points to consider in the management of pseudo folliculitis include:

• Avoiding greasy creams for basic care, as they might facilitate the development of folliculitis due to their occlusive properties 1
• Avoiding manipulation of the skin, as it may increase the risk of infection 1
• Topical treatments, such as benzoyl peroxide 2.5-10% applied once or twice daily to reduce inflammation and bacteria, or topical retinoids like tretinoin 0.025-0.1% cream applied nightly to prevent keratin plugging and promote proper hair growth
• For inflammation, topical corticosteroids such as hydrocortisone 1% or triamcinolone 0.1% can be applied twice daily for up to two weeks
• In more severe cases, oral antibiotics like doxycycline 100mg twice daily for 2-4 weeks may be prescribed to reduce inflammation and infection, although doxycycline exhibits more light sensitizing effects 1
• Chemical depilatories or permanent hair removal methods like laser therapy can be effective long-term solutions Proper skin care with gentle exfoliation and moisturizing can also help prevent recurrence, and emollients should be applied at least once daily to the whole body to return moisture and avoid dehydrating body care 1.

From the Research

Management of Pseudo Folliculitis

The management of pseudo folliculitis, also known as pseudofolliculitis barbae (PFB), involves a variety of treatment options. Some of the key management strategies include:

• Cessation of shaving or removal of the involved hair follicles, which can help terminate the development of PFB 2
• Improved hair removal methods, such as using a single-blade razor or avoiding close shaving 3
• Topical corticosteroids, topical and oral antibiotics, and retinoids to reduce inflammation and prevent infection 4, 5
• Photodynamic therapy, which has been shown to be effective in treating recalcitrant PFB 4
• Laser surgery, which can help reduce the curvature of the hair follicle and prevent ingrown hairs 4

Treatment Modalities

The treatment of PFB can be individualized, and not all regimens will work for each patient 6. Some treatment modalities that have been shown to be effective include:

• Intralesional injections of steroid and a topical chloramphenicol and steroid cream mixture for mild to moderately severe cases 6
• Topical therapies, such as hydrocortisone cream or antibiotic ointments, to reduce inflammation and prevent infection 5
• Light/laser therapies, such as photodynamic therapy or laser hair removal, to reduce the curvature of the hair follicle and prevent ingrown hairs 4, 5

Behavioral Changes

Behavioral changes in shaving habits can also play an important role in managing PFB. Some strategies that have been shown to be effective include:

• Pre-shave hydration and post-shave moisturization to reduce irritation and inflammation 3
• Shaving with a multiblade razor as part of a daily regimen, which has been shown to be beneficial in some cases 3
• Avoiding close shaving or using a single-blade razor, which can help reduce the risk of ingrown hairs 3