Decision Support in Medicine
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Pseudofolliculitis Barbae (pili incarnati, shaving bumps)
- Are you confident of the diagnosis?
- Who is at Risk for Developing this Disease?
- What is the Cause of the Disease?
- Systemic Implications and Complications
- Treatment Options
- Optimal Therapeutic Approach for this Disease
- Patient Management
- Unusual Clinical Scenarios to Consider in Patient Management
- What is the Evidence?
- What you should be alert for in the history
- Characteristic findings on physical examination
- Expected results of diagnostic studies
- Diagnosis confirmation
Recent studies have demonstrated a single nucleotide polymorphism in which a GA transition in the Ala12 codon of the K6hf gene takes place in patients with the PFB phenotype. There are multiple reasons that may account for this unusual spread of the K6hf gene defect. First, it is evident that compared with the known plethora of disfiguring and disabling keratinopathies, PFB represents a distinctly minor health problem. Based solely on its symptoms, there is certainly only a negligible social pressure against its spread. Only a few examples are known for distressing and discriminating situations related to PFB, ie, for Afro-American men enrolled in the US Military, where a rigid grooming code requires clean-shaven faces and the resulting "razor bumps" are a source of much misunderstanding and social unrest.
Otherwise, affected men have the options of either growing a beard ,hich completely circumvents the outbreak of the disorder, or substantially minimizing PFB symptoms by improvising less traumatic shaving "with the grain," using razors that avoid both the formation of sharp hair tips or retraction of the cut hair underneath the skin. More importantly, however, it has to be taken into consideration that in the female population with a generally low shaving rate, the Ala12Thr polymorphism remains essentially dormant and is thus propagated without knowledge. Collectively, all of these factors contribute to the relatively high incidence of the deleterious K6hf gene defect and its maintenance in the human population.
Washing with a gentle scrub and warm water before shaving is a simple way to cleanse the skin and significantly improve the quality of the shaving experience. When oil, dirt, perspiration and debris build up around the hair follicles, water penetration into the hair can be inhibited and prevent the razor from cutting optimally. Using a gentle scrub before shaving removes excess oils, dirt, dead skin cells and may free trapped or embedded hairs that have started to grow into the skin and initiate a PFB reaction.
I recommend a 90-day follow-up to check progress. If PFB continues despite treatment or if there is associated scarring, I would suggest a prompt referral for laser therapy.
Winter H, Schissel D, Parry D, Smith T, Liovic M, Lane E, et al. An unusual Ala12Thr polymorphism in the 1A Alpha-Helcal 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;122:652-7.
(A white patient with unilateral PFB in the inframandibular region, the first such case associated with a hair whorl, is described.)
(A review of the pathogenesis of PFB with a systematic approach to therapy.)
(A review of the history, incidence, clinical manifestations, dermatopathology, prevention and treatment of PFB.)
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