Treatment of pseudofolliculitis barbae with the diode laser

Pseudofolliculitis barbae is a common skin disorder of the beard area that is characterized by the presence of inflammatory follicular papules due to terminal hair shafts re-entering the epidermis. Postinflammatory hyperpigmentation and scarring often occur with pseudofolliculitis barbae. Such skin changes can lead to cosmetic disfigurement and be of great concern to the patient. We report a case of pseudofolliculitis barbae and hirsutism with associated postinflammatory hyperpigmentation in an African-American woman who was effectively treated with the diode laser.     

Treatment of pseudofolliculitis barbae with the diode laser

Pseudofolliculitis barbae is a common skin disorder of the beard area that is characterized by the presence of inflammatory follicular papules due to terminal hair shafts re-entering the epidermis. Postinflammatory hyperpigmentation and scarring often occur with pseudofolliculitis barbae. Such skin changes can lead to cosmetic disfigurement and be of great concern to the patient. We report a case of pseudofolliculitis barbae and hirsutism with associated postinflammatory hyperpigmentation in an African-American woman who was effectively treated with the diode laser.     

Treatment of pseudofolliculitis with a pulsed infrared laser

BACKGROUND: Pseudofolliculitis barbae is a common disorder in individuals with thick, curly hairs, and treatment options are limited. OBJECTIVE: To evaluate the effectiveness of a diode laser in the treatment of pseudofolliculitis barbae. DESIGN: Observational study. SETTING: Laser and Skin Surgery Center of New York, New York, NY. PATIENTS: Ten consecutive patients with long-standing pseudofolliculitis barbae and skin phototypes I to IV. INTERVENTIONS: Treatment was performed using an 810-nm diode laser (20- to 30-millisecond pulse duration) at fluences of 30 to 40 J/cm(2). Three treatments were performed at 6- to 8-week intervals, and subjects underwent evaluation for improvement in the pseudofolliculitis and the degree of hair reduction. MAIN OUTCOME MEASURES: Patients were assessed at 6- to 8-week intervals for the degree of hair-count reduction, improvements in papule and pustule formation, and adverse effects. RESULTS: Complete hair-growth delays of 3 to 8 weeks' duration were produced, and a decrease in hair density of greater than 50% was noted in all subjects 6 to 8 weeks after the last laser treatment. All patients exhibited greater than 50% improvement in the signs of pseudofolliculitis. Preexisting pigmentary changes improved with therapy. CONCLUSION: Diode laser treatment is a safe and effective method for improving pseudofolliculitis barbae in patients with skin phototypes I to IV.     

Treatment of pseudofolliculitis barbae in skin types IV,V, and VI with a long-pulsed neodymium:yttrium aluminum garnet laser

BACKGROUND: Pseudofolliculitis barbae affects a large number of individuals with coarse curly hair, and present treatment options are suboptimal. OBJECTIVE: We evaluated the safety and efficacy of a long-pulsed neodymium:yttrium aluminum garnet (Nd:YAG) laser in the treatment of pseudofolliculitis barbae. METHODS: This was a two-phase observational study conducted at a military tertiary medical facility. The study group included 37 patients (skin types IV, V, and VI) referred from primary care physicians with a diagnosis of pseudofolliculitis barbae refractory to conservative therapy. In phase I, one treatment with a Nd:YAG laser was performed on a tattooed area of the thigh with 3 light doses. Epidermal tolerance was evaluated, and hair counts were performed 3 months after treatment for each light dose. In phase II, the highest dose tolerated by the epidermis from phase I was applied to a small submental region of skin with an adjacent site as a control. Subsequently, papule counts were performed 90 days after treatment in the laser-irradiated and control areas. RESULTS: Phase I: When normalized for controls, there was 33%, 43%, and 40% hair reduction on the thigh for the 50, 80, and 100 J/cm(2) fluences, respectively, after 90 days. Overall, the highest doses tolerated by the epidermis were 50, 100, and 100 J/cm(2) for type VI, V, and IV skin, respectively. Phase II: Mean papule counts after 90 days were 6.95 and 1.0 for the control and treatment sites, respectively. CONCLUSION: Nd:YAG laser treatment may represent a safe and effective option for reducing hair and subsequent papule formation in patients with pseudofolliculitis barbae.     

Cosmetic problems in skin of color.

Practitioners are confronted with a myriad of cutaneous diseases affecting skin of color. Skin of color, which encompasses the pigmented skin of those of African American, Asian and Hispanic descent is susceptible to several unique and cosmetically disfiguring problems. Acne vulgaris, pseudofolliculitis barbae, postinflammatory hyperpigmentation and photoaging are diseases which commonly necessitate visits to the dermatologist and are of major cosmetic concern for those with skin of color. Effective treatments are needed to quickly resolve the inflammatory lesions of acne and pseudofolliculitis. The number of agents available for the treatment of postinflammatory hyperpigmentation is limited, and some agents are minimally effective. In addition to more effective therapeutic agents, development of enhanced camouflaging techniques are also necessary. Finally, sunscreens which provide more complete protection for skin of color are needed to address the issue of both photoaging and hyperpigmentation. We look to the cosmetic industry to develop new products and to improve currently existing products to address the cosmetic concerns of skin of color.     

须部假性毛囊炎

报告1例须部假性毛囊炎。患者男,25岁。右侧颏部出现一3cm长的线状限局性、复发性红色丘疹及脓疱4个月。经检查证实该线状损害是一根在真皮浅层潜行的毛发。根据病史及皮肤科检查确诊为须部假性毛囊炎。     

Enhancing the care and treatment of skin of color, part 1: The broad scope of pigmentary disorders

Scientific research and technologies related to skin pigmentation and dyschromias, which are often key skin concerns for patients of color, have led to recent developments in skin care and treatment. Differences and similarities between skin of color and white skin and current issues in the treatment of ethnic skin are reviewed. Recent research findings, such as the elucidation of the protease-activated receptor 2 (PAR-2) pathway and its role in pigmentation, and areas for further investigation, such as the pathogenesis of pseudofolliculitis barbae (PFB), also are discussed. Awareness of this information within the wider community of dermatologists, primary healthcare providers, and the media will help to accomplish the objective of stimulating new prospective research.     

Laser-assisted hair removal for darker skin types

Before the advent of longer wavelengths, longer pulse durations and more efficient cooling devices, laser-assisted hair removal was best suited for phototypes I-III with dark terminal hairs. Now, laser-assisted hair removal can be performed safely and efficaciously on darker skin types. The long-pulsed diode and Nd:YAG-wavelength-based laser systems are best suited to safely and effectively treat patients with darker skin types. By using conservative fluences, longer pulse durations and multiple treatments, safe and effective laser-assisted hair removal is possible for darker skin types. Patients with darker skin who suffer from hirsutism, hypertrichosis, and pseudofolliculitis barbae can finally be treated safely and effectively.     

Treatment of steatocystoma multiplex and pseudofolliculitis barbae with isotretinoin

A 20-year old man with steatocystoma multiplex and pseudofolliculitis barbae was treated unsuccessfully with oral isotretinoin. Consistent with findings from previous reports, treatment with isotretinoin should be reserved for patients with steatocystoma multiplex suppurativum.     

Red face revisited: Disorders of hair growth and the pilosebaceous unit

This paper reviews the recent literature on the diseases of the hair and pilosebaceous unit that may cause a red face. We discuss the epidemiology, clinicals, pathogenesis, and therapy of lichen planopilaris with its variants, discoid lupus erythematosus, folliculitis decalvans, dissecting folliculitis, acne keloidalis nuchae, pseudofolliculitis barbae, tinea capitis, tinea barbae, folliculitis of diverse causative factors and inflammatory follicular keratotic syndromes, ulerythema ophryogenes, atrophoderma vermiculatum, keratosis follicularis spinulosa decalvans, and folliculitis spinulosa decalvans.     

Prevalence of benign cutaneous disease among Oxford renal transplant recipients

Background The burden of malignant and benign cutaneous disease among renal transplant recipients (RTR) is substantial. Little attention is given to non‐malignant skin problems in the literature despite their potential impact on quality of life or on aesthetics – which may contribute to poor compliance with immunosuppressive medications post‐transplantation. Objectives The aim of this study was to examine prevalence of benign cutaneous disease in a group of RTRs and identify risk factors for individual cutaneous conditions. Methods All cutaneous findings were recorded in a single full body skin examination of 308 RTRs. Data on medical, transplant and medication history were obtained from questionnaire and medical records. Odds ratios were calculated to look at associations between benign cutaneous diseases and various potential risk factors after controlling for gender, age, time since transplantation and skin type. Results Cutaneous infections such as viral warts (38%), fungal infection (18%) and folliculitis (27%) were common and usually chronic. A range of pilosebaceous unit disorders were observed with hypertrichosis being strongly associated with ciclosporin (P < 0.0001). Other iatrogenic cutaneous effects included gingival hyperplasia (27%) and purpura (41%). We identified seborrhoeic warts and skin tags in 55% and 33% respectively. Inflammatory dermatoses were rare (< 2%) apart from seborrhoeic dermatitis (9.5%). Discussion In this first comprehensive study on prevalence of benign cutaneous diseases in a UK transplant population, a wide range of skin disorders was identified. It is therefore important that RTRs have access to dermatology services post‐transplantation for appropriate management of benign cutaneous conditions as well as early detection of cutaneous malignancy and education regarding risks of sun exposure.     

Epiluminescence dermatoscopy enhanced patient compliance and achieved treatment success in pseudofolliculitis barbae

SUMMARY A patient presented with recalcitrant pseudofolliculitis barbae and hypertrophic scarring. The use of epiluminescence dermatoscopy rendered clear visualization of U-shaped ingrowing hairs corresponding to the sites of individual papules. Such real-time demonstration led to an attitude change and good compliance with medical advice against over shaving, resulting in a successful treatment outcome.     

Comparative evaluation of men's depilatory composition versus razor in black men

Shaving with razors often is problematic for men with sensitive skin, especially black individuals who are generally prone to developing pseudofolliculitis barbae (PFB). For patients with PFB, physicians often recommend shaving with depilatory creams that chemically remove hair from the skin surface by dissolving keratin. This 1-week, controlled, single-center, split-faced, randomized trial compared shaving with 3 different depilatory compositions to shaving with a manual razor in black men. One depilatory composition was withdrawn during the study because of the high incidence of adverse events. The depilatory compositions produced fewer papules and more irritation immediately after use and to a greater extent than the manual razor; the irritation was transient and more often subjective than objective. In this preliminary study, the result of using depilatory compositions was that the skin looked and felt smoother compared to shaving with a razor. Depilatory products are recommended for patients who develop PFB or are unsatisfied with the results of shaving with a manual razor.     

Chemical peeling in ethnic/dark skin

Chemical peeling for skin of color arose in ancient Egypt, Mesopotamia, and other ancient cultures in and around Africa. Our current fund of medical knowledge regarding chemical peeling is a result of centuries of experience and research. The list of agents for chemical peeling is extensive. In ethnic skin, our efforts are focused on superficial and medium-depth peeling agents and techniques. Indications for chemical peeling in darker skin include acne vulgaris, postinflammatory hyperpigmentation, melasma, scarring, photodamage, and pseudofolliculitis barbae. Careful selection of patients for chemical peeling should involve not only identification of Fitzpatrick skin type, but also determining ethnicity. Different ethnicities may respond unpredictably to chemical peeling regardless of skin phenotype. Familiarity with the properties each peeling agent used is critical. New techniques discussed for chemical peeling include spot peeling for postinflammatory hyperpigmentation and combination peels for acne and photodamage. Single- or combination-agent chemical peels are shown to be efficacious and safe. In conclusion, chemical peeling is a treatment of choice for numerous pigmentary and scarring disorders arising in dark skin tones. Familiarity with new peeling agents and techniques will lead to successful outcomes.     

Pseudofolliculitis barbae and related disorders

Pseudofolliculitis barbae, although not a serious medical problem, is certainly a distressing one for the affected patient. Its pathogenesis lies in an ingrown hair arising from the curved hair and follicle common in black men and women. Improper shaving techniques cause ingrown hairs through both transfollicular and extrafollicular mechanisms. Various treatment modalities exist, but there is no cure. Treatment must be individualized, as not all regimens will work for each patient. With diligence, pseudofolliculitis barbae can in many instances be controlled. Dermatitis papillaris capillitii is related to pseudofolliculitis barbae because its pathogenesis also lies in a curved hair and follicle. The treatment differs, however. Mild to moderately severe cases can be kept under good control with intralesional injections of steroid and a topical chloramphenicol and steroid cream mixture. Scarred or keloidal lesions may require surgery.     

Skin diseases in Turkish renal transplant recipients

BACKGROUND: Organ transplant recipients are predisposed to a variety of cutaneous complications due to immunosuppressive therapy. We aimed to determine the prevalence and the clinical spectrum of skin diseases in renal transplant recipients (RTRs). METHODS: One hundred and eleven RTRs were examined at the Renal Transplantation Center in Ege University Hospital between October 1999 and October 2001. The effects of age, gender and duration time after transplantation on cutaneous manifestations were evaluated and the dermatologic manifestations in RTRs were compared with findings in a control group consisting of 100 patients. The t-test, chi2 test and Fisher's exact test were used for statistical analysis. RESULTS: Seventy-five patients (66.4%) had an infection of the skin, 66 patients (58.4%) had drug-related manifestations, and 11 patients (9.7%) had premalignant or malignant skin lesions. Human papilloma virus (HPV) infections were the most common skin lesions. There was no significant relation between age and gender and the incidence of skin diseases in RTRs. The incidence of HPV infections, tinea versicolor and premalignant and malignant lesions increased with the duration of immunosuppression. The incidence of infectious skin diseases, especially HPV infections and tinea versicolor, was higher in the study group than in the control group. CONCLUSIONS: In this study, we observed that cutaneous lesions, especially those caused by infectious diseases, had a higher frequency in RTRs. The findings emphasize the importance of regular dermatological screening in these patients, which can provide early diagnosis and a better quality of life for RTRs.     

Follicular and Scarring Disorders in Skin of Color: Presentation and Management

Skin of color, also known as ethnic skin, is described as skin of individuals of African, Asian, Hispanic, Native-American, Middle Eastern, and Pacific Island backgrounds. Differences in hair morphology, hair grooming, cultural practices, and susceptibility to keloid scarring exist within these populations and have been implicated in hair, scalp, and skin disorders. Acne keloidalis (AK), central centrifugal cicatricial alopecia (CCCA), dissecting cellulitis of the scalp (DCS), pseudofolliculitis barbae (PFB), traction alopecia (TA), and keloids are the most prevalent follicular and scarring disorders in skin of color. They have been associated with disfigurement, permanent hair loss, emotional distress, and decreased quality of life. Hair grooming practices, such as the use of chemical relaxers, heat straightening, and tight braiding and weaving can cause scalp irritation and follicular damage and are linked to the pathogenesis of some of these conditions. Consequently, patient education and behavior modifications are integral to the prevention and management of these disorders. Scarring disorders are also of concern in ethnic populations. Keloid scarring is more prevalent in individuals of African, Asian, and Hispanic descent. The scarring alopecia CCCA is almost exclusively seen in patients of African descent. Therapeutic regimens such as intralesional corticosteroids, surgical excision, and laser therapy can be effective for these follicular and scarring disorders, but carry a risk of dyspigmentation and keloid scarring. Ethnic skin and hair may present unique challenges to the clinician, and knowledge of these differences is essential to providing quality care.     

Pseudofolliculitis--revised concepts of diagnosis and treatment. Report of three cases in women.

Three cases of pseudofolliculitis are described in black American women, bringing the total number of cases described in the literature to five. Pseudofolliculitis pubis, pseudofolliculitis axillae, and pseudofolliculitis faciale (for women with facial involvement) are new diagnoses we propose to add to the nomenclature. Topical retinoic acid may be the treatment of choice. It appears that this is not a rare disease in black women.     

Pseudofolliculitis barbae

Pseudofolliculitis barbae is a chronic, irritating, and potentially disfiguring condition that develops as a result of attempts to eliminate hair from the beard area, usually by shaving. It is difficult to determine the incidence of the disorder, but some studies report that it affects up to 1 of every 5 caucasian individuals and that it is much more common in black persons. Clinically it is characterized by the appearance of inflammatory papules and pustules. Once pseudofolliculitis has become established, treatment consists of avoiding shaving and the use of medical treatment similar to that used in acne. However, the long-term result is much more dependent on prevention through a correct shaving technique. In severe cases or when a definitive solution is sought, the treatment of choice is photodepilation.     

Coexistence of Basal Cell Carcinomas and Multiple Sebaceous Gland Hyperplasias in a Cyclosporine (Ciclosporin)-Treated Renal Transplant Recipient

A 55-year-old man presented with multiple, asymptomatic, yellowish papules on his face with a 4-year history, and two non-healing tumoral lesions on his nose with a 7-month history. He was a renal transplant recipient and had been treated with cyclosporine (ciclosporin) for 9 years. A biopsy from the asymptomatic, yellowish papule on the face showed sebaceous gland hyperplasia, and biopsies from the lesions on the nose revealed basal cell carcinomas. The lesions on the nose were excised. Sebaceous gland hyperplasia and skin cancers are among the cutaneous neoplasms observed in renal transplant recipients receiving cyclosporine. To our knowledge, this is the third reported case of the coexistence of basal cell carcinomas and multiple sebaceous gland hyperplasias in a cyclosporine-treated renal transplant recipient.