From the Guidelines
Chronic folliculitis associated with shaving is primarily caused by microtrauma from razors, which allows bacteria to enter the hair follicles. This condition is particularly common with the increased popularity of shaving pubic hair, as noted in the American Academy of Pediatrics clinical report 1. To address this condition, it is essential to implement a comprehensive approach including proper shaving techniques and antimicrobial treatments. Some key considerations include:
- Using a clean, sharp razor and replacing blades frequently to minimize trauma
- Washing with antibacterial soap containing benzoyl peroxide or chlorhexidine before shaving
- Applying warm compresses to soften hair and open follicles
- Shaving in the direction of hair growth using a lubricating shaving cream
- Applying topical clindamycin 1% solution or benzoyl peroxide 2.5-5% gel once or twice daily after shaving
- Considering oral antibiotics like doxycycline 100mg twice daily or minocycline 100mg daily for 2-4 weeks for moderate to severe cases
- Using an electric razor instead of blade shaving or considering laser hair removal to reduce follicle inflammation in persistent cases These interventions are crucial as they reduce bacterial load on the skin and minimize trauma to hair follicles, allowing them to heal and preventing recurrent infection, as implied by the clinical context provided by 1. It is also important to counsel teenagers on proper hygiene and shaving techniques to minimize the risk of folliculitis, especially when shaving pubic hair becomes more common 1. By prioritizing these evidence-based approaches, individuals can effectively manage and prevent chronic folliculitis associated with shaving.
From the Research
Causes of Chronic Folliculitis
- The root cause of chronic folliculitis associated with shaving is multifactorial, involving the penetration of the adjacent skin by the growing sharp tips of hair, leading to an inflammatory reaction 2, 3, 4.
- The curved shape of the hair follicle allows for the downward curvature and penetration of the growing hair tips into the skin, resulting in a foreign body reaction that leads to itching and the development of papules, pustules, and post-inflammatory hyperpigmentation 2.
- Shaving or plucking the hair precipitates the onset of an inflammatory reaction, and cessation of shaving or removal of the involved hair follicles usually terminates the development of pseudofolliculitis barbae (PFB) 2, 3, 4.
- Individuals with curly hair are more prone to developing PFB, and those with a single nucleotide substitution in the hair follicle companion layer specific keratin gene (K6hf) have a six-fold increased chance of developing PFB 2.
Associated Factors
- The etiology of PFB is multifactorial, and heretofore a cure has been considered impossible for those desiring a clean-shaven face 3.
- PFB can cause significant hyperpigmentation and scarring, more noticeable in darker skin types 4.
- The most effective treatments involve a multifaceted approach including behavioral changes in shaving habits as well as the use of topical therapies 4.