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Folliculitis Barbae - Causes, Clinical Feature, Diagnosis, and Treatment

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Folliculitis barbae is a condition in which hair follicles in areas that are often shaved become inflamed, causing itchiness and sometimes tenderness.

Written by

Dr. Vineetha. V

Medically reviewed by

Dr. Dhepe Snehal Madhav

Published At May 7, 2024
Reviewed AtMay 7, 2024

Introduction

A long time ago, in 1908, a skin rash after shaving was first mentioned by someone named Fox. Then, in 1956, two other people named Strauss and Kligman came up with the term ‘pseudo-folliculitis barbae’ to describe this condition. Folliculitis barbae resembles pseudofolliculitis barbae (PFB), where ingrown hairs cause bumps. PFB is more common in people with curly and coarse hair, like African Americans.

Sometimes, both conditions can happen together. Folliculitis barbae often happens in men who shave, especially in areas like the beard line. It is more frequently found in individuals with fairer skin. Sometimes, it can occur even if a person does not shave, like after laser hair removal. Folliculitis barbae can also be caused by viruses, fungi, or other factors. It might affect athletes and people with weakened immune systems.

What Is Folliculitis Barbae?

Hairs grow from small structures called hair follicles inside the skin. When these follicles get inflamed, it is called folliculitis, which can occur anywhere on the body. Folliculitis barbae specifically refers to inflammation of hair follicles in the beard area, since 'barba' is a Latin word for the beard. In this skin condition, hair follicles in areas like the beard line in men or legs and bikini area in women get inflamed, causing itching and sometimes pain.

The infection typically happens near the skin surface, in the upper part of the hair follicles. Sometimes, it goes deeper and affects deeper parts of the follicles. When this happens, it can cause larger swellings involving nearby follicles. This is known as sycosis barbae and may sometimes result in scarring.

What Are the Causes of Folliculitis Barbae?

  • Folliculitis barbae primarily arises from colonizing Staphylococcus aureus (S. aureus) bacteria within the superficial parts of hair follicles and the skin's surface, particularly in regions like the infundibulum.

  • However, there have been documented instances of folliculitis barbae linked to infections caused by herpes simplex virus and Candida (folliculitis barbae candidomycetica).

Risk of Reinfection:

Cases of reinfection with S. aureus following successful treatment suggest the persistent colonization of this bacterium within the nasal cavity or on previously utilized shaving equipment, such as razors.

How Does Folliculitis Barbae Clinically Manifest?

Symptoms of folliculitis barbae include:

  • There are itchy and tender bumps around hair follicles in areas like the beard line, neck, armpits, and groin.

  • It often happens after shaving.

  • Bumps may release pus or clear fluid.

  • Suppose the Staphylococcus aureus bacteria go deeper into the skin. In that case, it can lead to sycosis barbae, which are long-lasting tunnels (sinus tracts), abscesses, and deep inflammation between hair follicles.

Variations in clinical features across skin types -

  • The curlier and thicker hairs found in people with darker skin have a higher chance of growing into the skin, leading to pseudofolliculitis barbae (PFB).

  • Both PFB and folliculitis barbae might occur in individuals with darker skin. However, individuals with lighter skin, who typically have finer and straighter hairs, are less prone to developing PFB.

How Can Folliculitis Barbae Be Diagnosed?

Careful skin inspection can determine if the bumps are caused by hairs growing back into the skin (pseudofolliculitis) rather than true folliculitis barbae. Both of these skin conditions can occur at the same time. Folliculitis barbae is frequently diagnosed based on clinical observations and may be assisted by dermoscopy. Suppose folliculitis barbae does not respond to treatment.

In that case, pus samples and swabs from the nasal cavity might be needed to identify bacterial culture, drug resistance, and other possible causes.

  • A pus sample can be tested to check for infection and determine which antibiotics work best.

  • If the folliculitis does not go away quickly, taking swabs to see if the infection is from bacteria in the nostrils or carried by family members, close friends, or contacts might be helpful.

How Is Folliculitis Barbae Managed?

1. Specific Treatment

Use topical antibiotics like Clindamycin, Mupirocin, or Fusidic acid for mild cases.

  • If the condition is severe or does not improve with topical treatment, oral antibiotics such as Flucloxacillin or Doxycycline may be needed.

  • To remove Staphylococcus aureus in the nose, apply Chlorhexidine, Neomycin cream, or Mupirocin, especially if the disease keeps returning.

  • If the cause is a virus or fungus, specific antiviral (like Valaciclovir) or antifungal (like Fluconazole) treatments may be needed.

  • To ease inflammation and itching, use Hydrocortisone cream topically.

  • Photodynamic therapy might help, but there needs to be more proof of its effectiveness.

2. Self-Care Measures

If someone has ongoing folliculitis barbae, they should try to reduce the chances of bacteria spreading from contaminated shaving tools. One can use disposable razors or clean electric shavers regularly with an alcohol-based antiseptic solution. This will stop S. aureus from growing on the grooming tools. If the shaver has metal parts, they can be sterilized by boiling them in water. For shavers with plastic parts that touch the skin, clean them well after each use and soak them with alcohol to kill bacteria. Instead of regular shaving soap or foam, one might be advised to use an antiseptic lotion. Also, shaving less often and not too close to the skin should be considered.

What Is the Prognosis of Folliculitis Barbae?

When treated quickly, foliculitis barbae usually goes away without any problems. On the other hand, chronic or untreated cases may develop into sycosis and might result in lifelong scarring. Despite early worries, scarring may become less noticeable with time. To avoid problems and reduce scarring, proper care is essential. This includes following cleanliness guidelines, applying topical antibiotics, and using oral drugs in extreme cases. For cases of folliculitis barbae to be successful, early intervention and ongoing treatment are necessary.

Conclusion

Folliculitis barbae is when hair follicles in the beard area get inflamed, which is a common skin problem. Though it can be uncomfortable and not very nice to look at, it is usually not a big medical issue. Most of the time, it can be managed well with the right diagnosis and treatment, which helps relieve the symptoms. By preventing it and being gentle when caring for the skin and shaving, one can lower the chances of it returning and keep the skin in the beard area healthy.

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Dr. Dhepe Snehal Madhav
Dr. Dhepe Snehal Madhav

Venereology

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