FOLLICULITIS
Beard Pseudofolliculitis
This condition was first described by Dubreuilh in 1922.
It is most common in Mediterranean individuals with curly hair.
Wet shaving makes curved hairs, mainly in the submandibular area, become sharp. These hairs become incurved and penetrate the dermis piercing the follicle, causing an inflammatory reaction due to rejection of a foreign body.
Bacterial overinfection as well as post-inflammatory hyperpigmentation or even scarring is frequent in these lesions.
Treatment
The best treatment is to stop shaving; something that is not well accepted by the patient.Changing from wet to dry shaving might be useful. Double or triple razor blades should be avoided for less aggressive shaving.
Do not shave against the direction of hair growth.
The application of antiseptic creams or antibiotics might be necessary on occasions.
Retinoids and alpha-hydroxy-acids also appear to decrease the hair’s tendency to curve up and emerge.
Ideally, a definitive epilation should be performed to put an end to the problem. Electrical hair removal is virtually impossible to perform because it is both painful and slow. Laser and intense pulsed light hair have proven to be a lot more effective requiring only a number of monthly sessions that are more spaced out in time as treatment progresses.
Pseudofolliculitis In Other Areas
Frequent in women who have been shaving hair in legs, bikini line and other areas for many years
It is usually due to waxing or electrical devices that pull out hair or after shaving or tweezing
Many times the patient tries to pull out buried hairs, which increases the likelihood of overinfection
Treatment is similar to that of beard folliculitis
Usually pseudofolliculitis initially appears as sterile lesions, meaning they are not infected. Later, however, they can become overinfected by staphylococcus and even less frequent germs such as pseudomonas, candida albicans and mycobateria.
Hidradenitis Suppurativa
Hidradenitis suppurativa is a chronic, relapsing, suppurative cicatrizing disease occurring in the apocrine follicles where apocrine sweat glands (at inguinal, axilar, and gluteal level) drain. The disease tends to become chronic and indolent because of subcutaneous extension leading to induration, sinus, and fistula formation. Its cause is unknown and commonly affects obese patients and women with hyperandrogenism. It starts with the occlusion of hair follicles and subsequent alteration of the normal anatomy of the hair follicle into which apocrine sweat glands drain, leading to infection by staphylococcus aureus. Clinically, it starts as itchy, inflammatory papules that keep growing to become large-sized nodules that drain spontaneously with abundant purulent content. When these lesions heal, they leave scars showing multiple drainage points. Treatment may include the administration of antibiotics, intralesional and systemic corticoids, retinoids and anti-androgens. Permanent epilation has been shown to decreases the number of hydradenitis outbreaks as frequent manipulation of the area to remove hair is avoided. Permanent epilation is the method of choice recommended by surgeons and dermatologists.