Smoothing out a bumpy situation

Part 1: The nature and causes of razor bumps

Razor bumps are a real and common problem. Razor bumps look and feel like pimples, but they are really the result of ingrown hairs. The medical term for this condition is Pseuodofolliculitis Barbae (PFB). It can occur in both men and women.

Pseudofolliculitis barbae has been a vexing problem throughout history and can even interfere with occupations that require a clean-shaven face, such as military officers, peace officers and firefighters. Thankfully, this condition can be addressed by implementing appropriate treatments and techniques.

This is most often seen in persons with curly hair or hair that grows at an oblique angle to the skin. Sometimes, if curly hair is cut extremely close, it never even exits the skin. Instead it penetrates the sidewall of the follicle (known as transfollicular penetration), or it comes out of the follicle and pokes the skin (known as extrafollicular penetration). The results are the same: the keratin invades the skin, producing a brisk inflammatory reaction that causes itching and the formation of pustules.

What causes razor bumps?

Hair grows inside tubes in the skin called “follicles.” When shaved, the tip of the hair is left with a sharp point. As curly hair grows, this sharp tip may curve back and pierce the skin. The medical term for this cause of PFB is “extra follicular penetration”

Razor bumps can also form when shaving too close to the skin causes the whiskers to be clipped off below the skin surface. This allows the hair to penetrate the side of the follicle instead of following its normal path to the skin’s surface. This can occur more often with curly hair. The medial term for this cause of PFB is “transfollicular penetration.” This type of PFB is also seen in women who “pluck” unwanted chin hairs.

The body treats all ingrown hairs just as it would a splinter or any other foreign object by producing an inflammatory pimple-like bump. Often, if the condition occurs over an extended period, the skin will respond by producing unsightly dark spots at the sites of the PFB bumps. Unfortunately, these dark spots can take many months to fade.

Since most African American men have curly, coarse hair and curved follicles, they frequently suffer from razor bumps. This is also true for people of Mediterranean descent. It should be noted that razor bumps can affect anyone who has curly hair, or who has hair follicles oriented at oblique angles to the skin surface, which makes it easier for the sharp hair tips to re-enter the skin.

The key to controlling PFB is to minimize hair re-entry back into the skin (and subsequent inflammation) by reducing the sharpness of the hair tip and leaving the hair at the appropriate length after shaving.

What to do about razor bumps

The best therapy is to avoid shaving and let the beard grow. However, this is not always a practical solution. If you do shave, a step-by-step preventive program is recommended.

It should be noted that if your doctor feels that your condition is extreme, you should let your beard grow out for several weeks before proceeding. As the hair lengthens, the shafts will act like miniature “springs” and eventually “pop free.” Your doctor may even prescribe a short course of antibiotic pills. Your doctor will tell you when to begin the anti-PFB shaving program.

Next week: a step-by-step program for reducing or preventing razor bumps.

Charles E. Crutchfield III, MD is a board-certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.