Shave Frequency and Regimen Variation Effects on the Management of Pseudofolliculitis Barbae
April 2013 | Volume 12 | Issue 4 | Original Article | 410 | Copyright © April 2013
Alyssa Daniel MD,a Cheryl J. Gustafson MD PA-C,a Pamela J. Zupkosky BS,b Anne Candido BSME,b Helen R. Kemp PhD,b Greg Russell MS,c and Amy McMichael MDa
aDepartment of Dermatology, cDepartment of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC bGillette Male Grooming, Procter & Gamble, Cincinnati, OH
BACKGROUND: Pseudofolliculitis barbae (PFB) is an inflammatory condition of the face with a clinical presentation of papules in the beard area with occasional pustules or hypertrophic scarring, all of which develop in response to shaving. Prevalent in African American men, a limited amount of data have been published on the shave outcomes as they relate to clinically measurable responses and patient satisfaction scoring. The primary purpose of this study is to evaluate the impact of a daily shaving regimen and advanced shaving products on exacerbation of lesions and symptoms in patients with PFB.
METHODS: Ninety African American men were randomized to 1 of 3 treatment groups shaving 2 to 3 times per week with standard products (control group), shaving daily with standard products (daily standard group) or shaving daily with advanced products (daily advanced). The number of pustules, papules, ingrown hairs, and investigator's assessment of severity and subjective symptoms of itching and burning/stinging were assessed at baseline, week 6, and week 12. The response to treatment was also assessed by the investigator and the subject at weeks 6 and 12. Secondary measures including questionnaires regarding baseline shave practices were also correlated with outcomes variables.
RESULTS: There were no significant differences noted between the 3 groups for papule (P=.32) or pustule (P=.46) count for the 12-week study. However, there was a significant mean papule reduction from baseline detected for both the control and daily advanced groups. In addition, compared to baseline, there was a significant reduction in ingrown hairs for the control group, and a directional reduction in ingrown hairs for the daily advanced group. There were significant group differences between the control group and both daily shaving groups, with the control group seeing significantly fewer ingrown hairs (P=.005 for control vs daily standard group and P=.04 for control vs daily advanced group). There were no significant group differences among the 3 groups for investigator-graded severity (P=.43) and response to treatment (P=.51). There was a significant perceived improvement in the response to treatment (P=.007) and itching (P=.002) for the daily advanced group vs the control group. J Drugs Dermatol.
Pseudofolliculitis barbae (PFB) is an inflammatory condition
of the face, or other shaven areas of the body, with a clinical presentation of papules in the beard area with occasional pustules or hypertrophic scarring, all of which usually develop in response to shaving. The prevalence is estimated to be between 45% and 83% in black men and is much less common in other racial groups and women.1,2 PFB is of particular concern for men who have curved hair follicles and shafts. The etiology is a foreign body inflammatory reaction
surrounding an ingrown hair seen in persons with wavy, curly, and kinky hair.3 The pathogenesis of this disorder has been shown to involve both extrafollicular and transfollicular penetration by the hair shaft. When hairs are cut short, they can retract below the surface of the skin and then grow in a curved manner, piercing the follicular wall. Both the transfollicular
and the extrafollicular methods of penetration cause an inflammatory response that can then be further traumatized during subsequent shaving.4 Symptoms of PFB include pain with shaving, itching, stinging, and pain immediately after shaving that may occur at each papule of PFB or diffusely on the skin.
There has been a limited amount of published data on the shave outcomes as it relates to clinically measurable responses
and patient satisfaction scoring. Current recommendations include avoidance of shaving if possible and, when it is not possible, shaving with a single-bladed razor in the direction of hair growth at least every 3 days.5,6 The primary purpose of this study was to evaluate the impact of a daily shaving regimen and advanced shaving products on exacerbation of lesions and symptoms in patients with PFB.
The study was limited to men with at least a 2-year history of symptoms of PFB between the ages of 20 and 60 years, inclusive.