Pseudofolliculitis Barbae And Keloidalis Nuchae

Pseudofolliculitis barbae and keloidalis nuchae are two chronic disorders that affect hair follicles. The conditions are particularly common to men with dark skin tones of African descent. The conditions are not well known, despite being quite common. Treatments can be challenging and require a multi-faceted approach and even so, the treatment efficacy varies from person to person. In the medical field, we’re working hard to find the best preventatives for these conditions alongside new treatments to get faster and more reliable results. Pseudofolliculitis barbae often resembles acne on the face, causing a breakout of what appears to be pimples, but only in the region where the beard grows. Alongside this, acne keloidalis nuchae despite also resembling the symptoms of acne, is not actually acne at all. Both conditions are a form of inflammation affecting the hair follicles.

Pseudofolliculitis Barbae Symptoms

Pseudofolliculitis barbae usually occurs as a result of shaving. The reason it is so common among African men is because of the tendency of that hair type to curl back towards the skin, often leading to ingrown hairs and causing inflammation. The visible symptoms, papules on the skin, usually occur around the neck, the cheeks, and the chin. Above the lip – the moustache area – alongside the nuchal, are not typically affected, or at least, they are affected to a lesser extent. In women, the papules occur as a result of tweezing and plucking hair on the chin and around the neck area, as well as the groin. Pseudofolliculitis on the “bikini” region on females, is incredibly common among ladies of all races. The papules vary from person to person. They may[MG1]  be skin-coloured, become hyper-pigmented (darkened), and if there is a secondary infection, they may get more severe leading to pustules and papulopustules. Hyper-pigmentation that remains after the pustules have healed, is possible as a long term side effect, as well as keloid scars. Pseudofolliculitis barbae is different from razor burn (traumatic folliculitis). Razor burn appears within a day or two after shaving and it happens as a result of shaving too close to the skin. The papules heal fairly quickly. Pseudofolliculitis barbae presents with similar symptoms but exists chronically.

Treatment Of Pseudofolliculitis Barbae

While the condition results in great emotional distress, there is no real danger. As with most chronic conditions, managing Pseudofolliculitis barbae is about controlling the symptoms for a better cosmetic outcome. We understand how devastating this condition can be. Managing it should reduce the visible symptoms, prevent secondary infections, prevent scarring (hypertrophic and keloid scars), and improving your self-esteem and confidence.

Because Pseudofolliculitis barbae is caused by shaving, one of the first treatment protocols is to remove the need for shaving. This means growing a beard or having the hair permanently removed. While the latter is not always an option, men often have to choose between disciplinary action at their work or exacerbating the condition by shaving. This is especially true for occupations that require a close shave – like policemen, flight attendants, and others. It is important that we work with you and involve your employer to understand the importance of dealing with your health, putting your well being first. During your first consultation, we will recommend that you stop shaving for at least one month – if this is not possible, we will work on your shaving routine;

  • Always use a clean and sharp razor
  • Never stretch the skin, the skin must be relaxed while you are shaving
  • We will develop a hygienic preshave and post shave protocol based on your unique skin and its needs
  • Shave in the same direction your hair grows to minimise friction
  • Shave with a single-blade razor to avoid  transfollicular penetration

We will also look at the following pharmacological treatment options alongside changing your shaving habits;

  • low-potency topical corticosteroids
  • topical antibiotics
  • topical retinoids

Folliculitis Keloidalis Nuchae

keloidalis nuchae is particularly common among South African men who have frequent haircuts. It also occurs among African women who shape their hair styles along the neck line. The reason it is more prevalent among those with African ancestry is because of the hair’s coiling nature. There are conflicting hypotheses on the precise mechanisms of the condition, some saying it is a form of folliculitis that is a result of shaving. Others say that it is a form of cicatricial alopecia.

The Symptoms Of Keloidalis Nuchae

We diagnose KN by the occurrence of fibrotic papules around the neck. The might also be Pustules which are inflamed and crusty and in cases where infection has set in, there may also be abscesses.  The skin often feels irritated, leading to scratching and rubbing. There might also be more than one hair shaft from a single opening, leading to tufted hairs. The visible symptoms can affect the back of the neck as well as the nape of the neck and can become quite disfiguring, which is naturally extremely distressing to the patient.

Treatment Of Keloidalis Nuchae

Keloidalis nuchae can progress and spread, however, it is not contagious to other people. It is imperative that we start treatment early in order to keep it well managed before it becomes severe. The first point of call is to remove any irritants. This means being wary of shirt collars that might cause rubbing, hats, and to avoid scratching and touching. We will also recommend curbing short hair cuts for a time, and we will recommend an antimicrobial cleanser designed to combat secondary infection.

It is important to seek help before the condition becomes severe. If the papules are less than 3mm in size, they respond well to topical creams providing there are no nodules. The topical cream usually consist of corticosteroids (potent and ultra-potent depending on the severity of the symptoms). In some cases, we also add oral antibiotics and anti-inflammatories to the treatment schedule.

In extreme cases, there are surgical treatments available. Electrosurgery and well as carbon dioxide surgery are options. We do this to remove the posterior hairline. There is also laser hair removal which has, in some cases, shown a decrease in symptom severity. 

The Results Of Treatment For Managing Pseudofolliculitis Barbae And FKN

Both conditions are manageable, but not curable. They require ongoing treatment and an adjustment to personal care routines. When we have patients who work with us, we generally see positive results. Some people see faster results with medications while others find their symptoms ease when they adjust their routines. As your dermatologist, Dr Khoza works alongside you to find the most effective way to manage your condition. It’s all about helping you to feel your best so that you can face the day with confidence.