By Rhonda Sanders, Physician Assistant, Family MedicineJuly 2, 2019
Pseudofolliculitis barbae -- often called "razor bumps" -- is an inflammatory skin reaction caused by ingrown hairs penetrating the outermost layers of the face and beard areas.
Several factors can cause this condition such as traumatic removal of hair, harsh shaving practices and genetics. Most often, younger males develop these bumps when they have to shave daily as part of the Army standard, but older men can develop this condition as well. Some have been battling it for years.
Curly hair has a much higher tendency of growing back into the outer skin layer than straight or wavy hair does. Razor bumps primarily affect African-American males due to their genetic predisposition for curly hair, but other races can be affected. This condition is not gender dependent and can occur on any skin area subjected to regular shaving, plucking, waxing or other traumatic means of hair removal.
Females with endocrine disorders can have facial hair on lower cheeks, chin and upper lip. They should not shave since it can certainly worsen the condition.
The direction and location of hair growth also can be an issue. For example, hair growing on the jaw, or what is known as a whorl pattern, can push deeper into the skin. This tends to occur when skin cells grow around hair and cause a pseudofollicle that can become inflamed, cause bumps, and in worse cases, pustules -- a term for bulging patches of skin. When this happens, skin cultures usually show normal skin flora, not pathogenic bacteria such as Methicillin-resistant staphylococcus aureus. Rarely can ingrown hairs cause firm, raised scars called keloids.
Ingrown hairs also can occur when skin is pulled tight during shaving such as a "baby smooth" cut by a barber. It can happen when hair is cut at an angle or shaving "against the grain" on the neck and lower jaw.
Treating razor bumps is usually a matter of time and changing the way shaving is done. Generally, it is best to shave after softening the face with a warm, wet washcloth going over the skin in a circular motion. This will dislodge hair away from the skin so shaving cuts hair off parallel to the face.
Try to avoid stretching the skin while shaving, and be mindful of the right skin treatment products. Using a moisturizing shave cream is better than a gel followed by harsh after-shave products. Sometimes taking a break from shaving every day, on days off, can help decrease bumps.
It is best to use fewer blades to keep from cutting hair below skin level. Some patients notice the bumps are worse with fewer blades. Changing razor blades after 5 uses is advised. Dull blades are not good for the face. Clippers and depilatories also can be used -- the latter is designed for the face only. Many patients report they are irritating, not beneficial or they do not like the smell of them. The choice is obviously up to the consumer.
Shaving bumps can be treated with some medications used for acne such as a benzoyl peroxide wash and retinoid products -- tretinoin or differin. Also, a topical antibiotic such as clindamycin to decrease inflammation may be prescribed by medical personnel. These often keep skin cells from sticking together and allow the hair to not curl into the skin. There are similar alpha hydroxyl products that can be bought over the counter, but they can be drying and irritating just as prescription-strength retinoids can be. Both also can increase the risk of sunburn.
For persisting cases of skin bumps, laser hair removal can be offered and is done about 4-6 weeks apart. Not all MTF's have laser hair removal, but a referral can be made. Some military patients may need a temporary or permanent shave profile. Those in this category cannot have facial hair longer than a quarter of an inch. No designs can be in the beard and no handle-bar mustache or goatee is allowed. A profile does not override any situation in which a unit commander feels shaving is needed to wear PPE in event of emergency or mission.
Those with questions about this topic should speak with their primary care medical provider.