From the Guidelines
Pseudofolliculitis barbae (PFB) and acne require distinct treatment approaches, with PFB primarily treated by changing shaving habits and topical treatments, while acne treatment focuses on reducing sebum production, preventing follicular plugging, and controlling inflammation.
Treatment Approaches
The treatment of PFB and acne differs significantly due to their distinct pathophysiology. For PFB, the primary treatment involves changing shaving habits, such as using electric razors instead of blade razors, avoiding close shaves, and shaving in the direction of hair growth. Topical treatments for PFB include benzoyl peroxide 2.5-5%, clindamycin 1%, or retinoids like tretinoin 0.025-0.05% 1. For severe cases of PFB, oral antibiotics such as doxycycline 100mg daily for 2-4 weeks may be prescribed.
In contrast, acne treatment focuses on reducing sebum production, preventing follicular plugging, and controlling inflammation through topical retinoids (adapalene 0.1%, tretinoin 0.025-0.1%), benzoyl peroxide 2.5-10%, and antibiotics like clindamycin 1. Severe acne may require oral antibiotics (doxycycline 100mg daily for 3 months) or isotretinoin (0.5-1mg/kg/day for 4-6 months) 1.
Diagnostic Differences
The key diagnostic difference between PFB and acne is the presentation of inflammatory papules and pustules. PFB presents with these lesions primarily in the beard area with visible ingrown hairs, while acne appears as comedones, papules, and pustules across facial areas with sebaceous glands and lacks ingrown hairs.
General Recommendations
For both conditions, gentle skin cleansing and avoiding picking or squeezing lesions is essential for healing. The use of topical therapies, such as benzoyl peroxide and retinoids, can help prevent follicular plugging and reduce inflammation. In cases of severe acne, oral antibiotics or isotretinoin may be necessary to control the condition.
Evidence-Based Guidelines
The most recent guidelines for the management of acne vulgaris, published in 2024, recommend benzoyl peroxide, topical retinoids, and topical antibiotics as first-line treatments for acne 1. Oral doxycycline is also recommended for moderate to severe acne. These guidelines emphasize the importance of combining topical therapies with multiple mechanisms of action and limiting the use of systemic antibiotics to reduce the development of antibiotic resistance.
The most effective treatment approach for PFB and acne should prioritize the reduction of morbidity, mortality, and improvement of quality of life, and should be based on the most recent and highest-quality evidence available, such as the 2024 guidelines for the management of acne vulgaris 1.
From the Research
Differentiation between Pseudofolliculitis Barbae (PFB) and Acne
- PFB is a chronic inflammatory condition characterized by follicular and perifollicular papules and pustules primarily affecting the beard and neck area, whereas acne is a skin condition that occurs when the oil-secreting glands in the skin are clogged and become inflamed.
- PFB is caused by hair follicles penetrating the skin and causing an inflammatory response, especially in individuals with curly hair, whereas acne is caused by a combination of factors including excess oil production, bacteria, and clogged pores.
Treatment of PFB versus Acne
- Treatment for PFB requires a multifaceted approach that targets various aspects of the pathogenesis, including preventive measures, antibiotics, corticosteroids, keratolytics, chemical depilatories, and/or laser treatments 2.
- Topical therapies are currently the mainstay treatment for PFB, however, laser hair removal has become a potential long-term treatment option 2.
- In contrast, acne treatment typically involves topical or oral antibiotics, retinoids, and benzoyl peroxide, depending on the severity of the condition.
- It is essential to differentiate between PFB and acne to provide effective treatment, as the treatment approaches for these two conditions differ significantly.
Key Considerations for Treatment
- Cessation of shaving or removal of the involved hair follicles usually terminates the development of PFB 3, 4.
- A daily shaving regimen, which includes pre-shave hydration and post-shave moisturization, may be beneficial for individuals with PFB 5.
- Individuals with a single nucleotide substitution in the hair follicle companion layer specific keratin gene (K6hf) have a six-fold increased chance of developing PFB 3.