Keywords
Key points
- •Pseudofolliculitis barbae (PFB) is an inflammatory follicular disorder associated with shaving, most commonly seen in men of African ancestry.
- •Follicular penetration from ingrown hairs is the primary inciting factor in PFB.
- •In the appropriate patient, an effective prevention strategy for PFB is to grow a beard, but optimization of shaving practices (including pre- and postcare) is a useful approach for men who wish to continue shaving.
- •Folliculitis keloidalis nuchae (FKN) is a follicular-based disorder mainly affecting the nape of the neck; histopathologically, FKN has characteristics of a primary cicatricial alopecia.
- •PFB and FKN are chronic conditions requiring continual maintenance strategies.
Introduction
Pseudofolliculitis barbae
Epidemiology
Pathogenesis
Clinical Features




Management
Pharmacologic | Procedural |
---|---|
PFB Treatment Options | |
|
|
FKN Treatment Options | |
Corticosteroids (topical, intralesional), Class I or II corticosteroid gel or foam BID 43 | Removal with trephine device and secondary-intention healing/primary closure 28 Excision of nodules with tissue-expansion mechanisms 8 , 18 Laser 48 , 49 |
Antibiotics (oral) tetracycline derivatives or topical clindamycin for secondary infection 1 , 2 , 3 | Excision with primary closure 46 Excision with healing by secondary intention 44 |
Corticosteroid gel combined with retinoic acid gel 28 | Electrosurgical excision and secondary-intention healing 45 Cryotherapy 28 |

Folliculitis keloidalis nuchae
Epidemiology
Pathogenesis
Clinical Features


Management
Summary
References
- Pseudofolliculitis barbae and acne keloidalis nuchae.in: Alexis A.F. Barbosa V.H. Skin of color a practical guide to dermatologic diagnosis and treatment. 1st edition. Springer, New York2013: 123-138
- Dermatological disorders in men of African descent.in: Dadzie O.E. Petit A. Alexis A.F. Ethnic dermatology principles and practice. 1st edition. Wiley-Blackwell, Chichester, West Sussex2013: 241-256
- Dermatologic conditions in men of African ancestry.Expert Rev Dermatol. 2009; 4: 595-609
- Defining pseudofolliculitis barbae in 2001: a review of the literature and current trends.J Am Acad Dermatol. 2002; 46: S113-S119
- Pseudofolliculitis barbae in the military. A medical, administrative and social problem.J Natl Med Assoc. 1974; 66 (479): 459-464
- Pseudofolliculitis barbae with keloids.J Emerg Med. 1986; 4: 283-286
- The medical and surgical therapy of pseudofolliculitis barbae.Dermatol Ther. 2004; 17: 158-163
- Pseudofolliculitis barbae.in: Kelly A.P. Taylor S.C. Dermatology for skin of color. McGraw-Hill, New York2009: 211-216
- Pathogenesis and treatment of pseudofolliculitis barbae.Cutis. 1983; 32: 373-375
- Pseudofolliculitis barbae and related disorders.Dermatol Clin. 1988; 6: 407-412
- An unusual Ala12Thr polymorphism in the 1A alpha-helical segment of the companion layer-specific keratin K6hf: evidence for a risk factor in the etiology of the common hair disorder pseudofolliculitis barbae.J Invest Dermatol. 2004; 122: 652-657
Kelly AP. Pseudofolliculitis barbae. In: Arndt K, LeBoit P, Robinson J, et al, editors. Cutaneous medicine and surgery. vol. 1. 1996. Philadelphia: W.B. Saunders p. 499–503.
- Pseudofolliculitis barbae. Medical consequences of interracial friction in the US Army.Cutis. 1979; 23: 61-66
- Hair and scalp disorders in ethnic populations.Dermatol Clin. 2003; 21: 629-644
- Insights into shaving and its impact on skin.Br J Dermatol. 2012; 166: 6-12
- Shave frequency and regimen variation effects on the management of pseudofolliculitis barbae.J Drugs Dermatol. 2013; 12: 410-418
- Evaluation of a foil-guarded shaver in the management of pseudofolliculitis barbae.Cutis. 1981; 27 (540–32): 534-537
- Comparative evaluation of men's depilatory composition versus razor in black men.Cutis. 2011; 88: 98-103
- Twice-daily applications of benzoyl peroxide 5%/clindamycin 1% gel versus vehicle in the treatment of pseudofolliculitis barbae.Cutis. 2004; 73: 18-24
- Pseudofolliculitis of the beard and topically applied tretinoin.Arch Dermatol. 1973; 107: 551-552
- Managing common dermatoses in skin of color.Semin Cutan Med Surg. 2009; 28: 63-70
- Topical tretinoin (retinoic acid) therapy for hyperpigmented lesions caused by inflammation of the skin in black patients.N Engl J Med. 1993; 328: 1438-1443
- Treatment of pseudofolliculitis barbae using the long-pulse Nd:YAG laser on skin types V and VI.Dermatol Surg. 2003; 29: 1187-1191
- Modified superlong pulse 810 nm diode laser in the treatment of pseudofolliculitis barbae in skin types V and VI.Dermatol Surg. 2005; 31: 297-301
- Treatment of pseudofolliculitis barbae in skin types IV, V, and VI with a long-pulsed neodymium:yttrium aluminum garnet laser.J Am Acad Dermatol. 2002; 47: 263-270
- Lasers and light-based therapies in ethnic skin: treatment options and recommendations for Fitzpatrick skin types V and VI.Br J Dermatol. 2013; 169: 91-97
- Topical eflornithine hydrochloride improves the effectiveness of standard laser hair removal for treating pseudofolliculitis barbae: a randomized, double-blinded, placebo-controlled trial.J Am Acad Dermatol. 2012; 67: 694-699
- Pseudofolliculitis barbae and acne keloidalis nuchae.Dermatol Clin. 2003; 21: 645-653
- Acne keloidalis in women.Cutis. 1989; 44: 250-252
- Ethnic dermatology: principles and practice.Wiley-Blackwell, Chichester (West Sussex)2013
- Keloid acne of the neck: epidemiological studies over 10 years.Int J Dermatol. 2005; 44: 49-50
- Prevalence of acne keloidalis nuchae in Nigerians.Int J Dermatol. 2007; 46: 482-484
- Acne keloidalis in females: case report and review of literature.J Natl Med Assoc. 2005; 97: 736-738
- Folliculitis keloidalis nuchae is associated with the risk for bleeding from haircuts.Int J Dermatol. 2011; 50: 1212-1216
- Folliculitis keloidalis nuchae, bleeding from haircuts, and potential HIV transmission.Int J Dermatol. 2012; 51 (24–6): 21-23
- Hair and scalp disorders in ethnic populations.J Drugs Dermatol. 2013; 12: 420-427
- Hairdressing is associated with scalp disease in African schoolchildren.Br J Dermatol. 2007; 157: 106-110
- Acne keloidalis nuchae is scar and keloid formation secondary to mechanically induced folliculitis.J Cutan Med Surg. 2011; 15: 238-240
- Acne keloidalis is a form of primary scarring alopecia.Arch Dermatol. 2000; 136: 479-484
- Clinical, biochemical and morphologic features of acne keloidalis in a black population.Int J Dermatol. 1993; 32: 714-716
- Acne keloidalis nuchae on herpes zoster scar in an HIV patient: isotopic response or not?.G Ital Dermatol Venereol. 2012; 147: 223-226
- Acne keloidalis nuchae. A transepithelial elimination disorder.Int J Dermatol. 1987; 26: 442-444
- An open label study of clobetasol propionate 0.05% and betamethasone valerate 0.12% foams in the treatment of mild to moderate acne keloidalis.Cutis. 2005; 75: 317-321
- Acne keloidalis nuchae: treatment with excision and second-intention healing.J Am Acad Dermatol. 1995; 33: 243-246
- Electrosurgical excision of acne keloidalis nuchae with secondary intention healing.J Clin Aesthet Dermatol. 2011; 4: 36-39
- The surgical management of extensive cases of acne keloidalis nuchae.Arch Dermatol. 2000; 136: 1376-1379
- Treatment of acne keloidalis nuchae with carbon dioxide laser.J Am Acad Dermatol. 1986; 14: 263-267
- Efficacy of diode laser for treating acne keloidalis nuchae.Indian J Dermatol Venereol Leprol. 2005; 71: 31-34
- The efficacy of laser-assisted hair removal in the treatment of acne keloidalis nuchae; a pilot study.Eur J Dermatol. 2012; 22: 645-650
Article info
Footnotes
Disclosure: Actual or potential conflict of interest, including employment, consultancies, stock ownership, patent applications/registrations, grants, other funding. A. Alexis: Consulting (Allergan, Galderma, L’Oreal USA, Schick); C.R. Heath: none; R.M. Halder: Consulting (L’Oreal USA, Combe Corporation, KCI), Grants (L’Oreal USA).