Pseudofolliculitis Barbae :Treatment, Procedure, Cost And Side Effects

Pseudofolliculitis barbae, more commonly known as Barber's Itch or Razor Bumps, is a chronic, inflammatory skin condition caused by the removal of hair by shaving, plucking, waxing or threading. The condition is caused by the inflammation of hair follicles and their surrounding skin caused when in-grown hair get trapped beneath the skin surface. It is most commonly observed on the face and neck of men with tightly curled hair except in the case of people of African descent where it presents itself in both men and women on any body part. Pseudofolliculitis barbae is difficult to treat and very few patients are ever cured. However, with a few well-practised grooming techniques, the condition can more or less be managed effectively. Patients are advised to shave infrequently and maintain a minimum hair length of 1 to 3 mm at all times. There is, currently, enough evidence to believe that individual hairs that have become ingrown due to transfollicular penetration, if given enough time, will come up to the surface, breaking the epidermal layer.

Chemical Depilatories, Adjunctive Agents and Laser Removal are the most effective treatments. Other than those, patients are advised to refrain from stretching the skin while shaving and are advised to shave in the direction of hair growth. This is so as to minimise the presence of cut hairs with sharp edges that are more likely to penetrate back into the skin. Shaving with electric razors and frequent and regular exfoliation of the skin using brushes or loofahs are also effective prevention techniques.

The diagnosis can be done through self-examination or through clinical diagnosis wherein Magnification, eg dermatoscopy, is used to check ingrown hairs. In some cases swabs may be taken for bacterial culture. Painful bumps can appear and lead to long-lasting or permanent dark spots, scars, and even keloids in the sites of inflammation. The available treats for the Pseudofolliculitis barbae are as follows:

1. Chemical Depilatories:

   Use of chemical depilatories, more commonly known as hair removal creams are also a viable option for patients who, for personal or professional reasons, prefer a closer shave. When used, these products not only remove hair from skin but also lyse the hair’s disulphide bonds. This softens the tip of the hair and decreases the risk of transfollicular penetration.

   Thioglycolate, mixed with sodium, potassium or calcium hydroxide is the most common active ingredient found in chemical depilatories. Generally available in the form of creams, depilatories should be applied to the affected area at room temperature. Depending on the coarseness of the hair, the cream must be left on for 3-15 minutes after which it must be wiped off along with the weakened hair and rinsed with water.

2. Adjunctive Agents

   Use of adjunctive agents is yet another viable option. Eflornithine hydrochloride is considered to be the most effective treatment against PFB as it has been shown to reduce hair growth, when combined with other depilatories, by irreversibly inhibiting ornithine decarboxylase. Application of the product slows down hair growth. It also ensures that the hair that does grow, comes out finer and softer thereby reducing the risk of transfollicular penetration.

   A thin layer of the product must be applied to the affected area and rubbed in daily, generally twice a day. The product should not be applied before 5 minutes after hair removal and once applied, should not be washed off for at least 4 hours.

3. Laser Hair Removal

   If surgical treatments are to be considered, Laser Therapy, that includes the permanent removal or destruction of hair follicles is considered to be the closest to a cure for Pseudofolliculitis Barbae. Laser Hair Removal is done by subjecting the skin to a laser light where it burns and damages hair follicles preventing hair growth.

   The number of sessions required depends upon the coarseness and density of hair. With hair follicles damaged and hair growth permanently reduced, the likelihood of in-grown hair also drops. However, it is important to note that the procedure is not completely permanent and occasional top-up procedures may be necessary.

Patients who notice painful bumps after shaving and which are causing long-lasting pain or permanent dark spots, scars, and even keloids in the sites of inflammation need to avail this treatment. Thus, such patients who find such symptoms are eligible for the treatment.

Those patients who are not having any issues after shaving or waxing need not avail such treatment. Apart from that chemical depilatories must not be used on patients with pre-diagnosed dermatological conditions or on patients with dry, broken or burnt skin. These products are location specific and should not be used on the face unless specified. They must also not be used on patients with sensitive skin or patients who have shown an allergic reaction against similar products in the past. Adjunctive agents should not be used on patients below 12 years of age. They should also not be used on patients who have shown to have allergic reactions to the product. The medication should not be applied to broken, dry or burnt skin. Laser Hair Removal treatments should not be performed on patients below 18 years of age. Pregnant or breastfeeding women should not undergo the procedure. Patients with a history of autoimmune diseases, melanoma or epilepsy or cold sores, sunburns, recent tanning and raised moles should not undergo the procedure.

Some of the common side effects are as follows:

1. In case of Chemical Depilatories, instant contact dermatitis is the most common side effect caused due to the high alkalinity of the medication.
2. For adjunctive agents, burning, tingling, stinging or redness of skin may occur. However, in case of persistent symptoms or severe allergic reactions medical advice must be taken.
3. In case of Laser Hair Removal, the treated area may feel sunburnt for a few days. Other side effects include temporary redness, swelling or scarring. Patients with darker complexion may if rarely, suffer from blisters. Any kind of permanent scarring or damage is very rare.

   In case any patient reports any other complexity after undergoing the treatment the patient is advised to consult the doctor immediately.

The expected recovery rates for veterinary activities vary greatly according to the kind of treatment which they have received. In case of minor treatments, recovery times are usually zero or up to 48 hours under observation. In the case of surgeries or treatments on a larger scale, recovery times may extend to a few weeks or even month. This is usually found in the case of major injuries, broken bones, serious diseases or internal injuries. Some veterinary treatments such as modification of diets or intake of supplements and medications may have no recovery time but simply persistent application and proper focus on the suggested procedures. In almost all cases, the veterinary doctors and physicians will give a prior intimation of the expected duration.

Over the counter, chemical depilatories can cost anywhere between INR 100 to INR 500. For specialised prescription medication, prices may go up to INR 700. Prices for Eflornithine Hydrochloride creams, the most popular adjunctive agents, ranging from INR 500 to INR 1100. These creams are not widely available but can be found online or in large medical stores or ones that specialise in dermatological products.

Laser Hair Removal treatments are the most expensive of the three. Prices vary according to size, complexity and other factors of the area being treated. Prices, therefore, may vary from as little as INR 1000 to INR 30,000. Prices may also vary according to the type of laser technology used, FDA approval status of the machines and licensing level of the clinic.

If viewed from a realistic perspective, no treatment for pseudofolliculitis barbae is permanent, however, laser hair removal is the most permanent solution to the problem. Depilatories are basically hair removal creams and need to be applied as and when the hair grows back. Adjunctive agents slow down hair growth and effects are visible for 4 to 8 weeks after which the medication should be reapplied.

Laser treatments are mostly permanent but can fail if proper post-treatment guidelines are not followed. Hair removed by laser has a 40% chance of re-growing. The re-growth, however, is slow and only occasional top-ups may be required.

If alternative treatments are being discussed, it is important to note that taking steps to prevent the condition by avoiding close shaves and regular moisturising is better than any possible treatment. Aloe Vera and Tea Tree Oil can be used to alleviate the condition.

Another important point to be considered is that none of the treatments mentioned above actually treat the condition, rather they are just preventive steps that can be undertaken to lessen the risk of the condition. In case someone is suffering from the condition, the best course would be to let the hair grow without disturbing it while keeping it clean and uninfected through regular application of antiseptic.