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A 17-year-old young African American man comes to the office because, for the past 2 years, he has been bothered by the uncomfortable bumps on the back of his neck (Figure 114-1). He is an athletic young man, more than 6 feet tall, and likes to keep his hair short for his sports. He notices the bumps get irritated and larger when he shaves his hair. He also has bumps on his face that get worse when he shaves his face (Figure 114-2). He is diagnosed with pseudofolliculitis barbae and acne keloidalis nuchae. His treatment consisted of patient education and twice-daily tretinoin cream and 0.1% triamcinolone cream to the neck area and nightly tretinoin cream to the beard area. He was told he could use 1% hydrocortisone cream on his face as needed. It was suggested that he minimize shaving, if possible.

Figure 114-1

Acne keloidalis nuchae in a 17-year-old African American man. (Courtesy of Richard P. Usatine, MD.)

Figure 114-2

Pseudofolliculitis barbae along the jawline and neck in the patient in Figure 114-1. (Courtesy of Richard P. Usatine, MD.)

Pseudofolliculitis is a common skin condition affecting the hair-bearing areas of the body that are shaved (Figures 114-2, 114-3, 114-4). Potential complications include postinflammatory hyperpigmentation, bacterial superinfection, and keloid formation.

Figure 114-3

Pseudofolliculitis barbae in a Dominican man. Note the active pustules on the neck. (Courtesy of Richard P. Usatine, MD.)

Figure 114-4

Pseudofolliculitis barbae on the face of a 28-year-old African man who works providing aid to Darfur refugees. The painful nodules become worse every time he shaves. (Courtesy of Richard P. Usatine, MD.)

  • Pseudofolliculitis—Razor bumps, shave bumps.
  • Acne keloidalis nuchae—Folliculitis keloidalis.

  • Pseudofolliculitis is most common in black men, with at least 50% of black men who shave being prone to the condition.1 In the beard area it is called pseudofolliculitis barbae, and when it occurs after pubic hair is shaved, it is referred to as pseudofolliculitis pubis. It may also occur in the neck area.
  • Acne keloidalis nuchae occurs most often in black men but can be seen in all ethnicities (Figures 114-3 and 114-5). The lesions are often painful and cosmetically disfiguring.
  • Both conditions are seen in women but far less often than in men (Figure 114-6).

Figure 114-5

Acne keloidalis with multiple firm keloidal papules in a Hispanic man who prefers to keep his hair short. (Courtesy of Richard P. Usatine, MD.)


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