Douglas Shander and Gurpreet S. Ahluwalia
The Gillette Company, a wholly owned subsidiary of The P&G Company,
Needham, MA, USA
17.2 Introduction 353
17.3 Etiology of PFB 355
17.4 Biochemical Factors Involved in Elaboration of Curly Hair 357
17.5 Shaving Regimens for Managing PFB 358
17.6 Treatment of PFB with Topical Eflornithine 359
17.7 Laser Treatments for PFB 363
17.8 Conclusions 365
Shaving bumps, or pseudofolliculitis barbae (PFB), is a condition of the beard area occurring in black men and other people with curly hair. Highly-curved hair can grow back into the skin, causing inflammation and a foreign-body reaction surrounding the site of the ingrown hair. Keloidal scars that look like hard bumps of the beard area and neck can develop over time with continued insults by ingrown hair in the same area. In addition to occurring in African American men, the condition also occurs in Caucasians with curly beard hair, and shaving bumps also develop in the back of shaved necks. Pseudofolliculitis barbae is a serious problem in women with excessive facial hair and the problem is especially challenging in African American men and women, as ingrown hair can cause disfiguring
Gurpreet S. Ahluwalia (ed.), Cosmetic Applications of Laser and Light-Based Systems, 353-367,
© 2009 William Andrew Inc.
hyperpigmentation. Shaving bumps also occur in axillae, thighs, and the bikini line, and are often accompanied by uncomfortable itching and irritation [1].
In the uniformed professions including military serviceman, firefighters, and police officers, clean-shaven faces are essential for situations requiring the use of gas masks with a tight seal, especially in combat areas such as Iraq and Afghanistan. Historical formal and informal norms in the military affecting group morale and advancement potential put strong pressures on men to be clean-shaven. Each military branch has their own regulations on shaving, and this has often been a source of tension and friction for African American men with PFB conditions which thwart their ability to maintain a hair – free appearance on their facial skin. Over time, the requirements for shaving have been partially relaxed to accommodate men who cannot tolerate shaving or the repeated use of caustic depilatories, if the presence of hair does not directly impact performance of their duties. Nonetheless, even today the US Marine Corps can summarily discharge servicemen for not complying with shaving requirements even if it does not impact their performance of duties, and male officers in highly visible positions such as recruiting or public affairs are expected to keep clean-shaven faces.
As a result of political and social pressures, much of the clinical research on PFB over the last 35 years has been supported and conducted by the military forces. Studies from the 1970s indicate that PFB incidence is estimated to be between 50% and 80% in African American men [2,3] and a method to assess the severity of PFB was developed by dermatologists practicing in the military [4]. The best method to prevent ingrown hair was use of depilatories, which eradicated ingrown hair above and below the skin but the caustic nature of these chemical depilatories that break disulfide bonds in hair and skin makes this strategy impractical. One outcome of the research of the 1970s led to the conclusion that in men who are able to tolerate it, a daily shaving regimen was the best treatment strategy to minimize PFB. Although counterintuitive, the rationale behind this conclusion was based on informal observations and shaving studies that less frequent shaving regimens increased the opportunity to develop an increased number of ingrown hair. Conversely increased shaving frequency maintained shorter hair lengths and prevented hair shafts from reaching the threshold lengths necessary to reenter skin. Most articles on PFB management recommend shaving frequency to be limited to two or three times a week, and daily shaving to be avoided. Our systematic review of the literature on PFB failed to reveal any informal or controlled clinical research studies supporting the benefits of less frequent shaving over daily shaving. Indeed, the limited number of published studies that have tested daily shaving demonstrate that daily shaving is beneficial over less frequent shaving in men with mild-to-moderate PFB.
Over the last ten years, the military has supported studies on the use of professional hair removal lasers as a treatment for PFB, including studies employing diode and Nd;YAG lasers which were conducted at the San Diego Naval Medical Center, as well as an extensive year-long treatment study using a Nd:YAG laser at the Tripler Army Medical Center in Honolulu Hawaii. Between 2004 and 2006, the US congress has approved 3.39 millions dollars earmarked for a US Army sponsored research program on a long wavelength diode laser being developed by Palomar Medical Technologies in Burlington, MA. Most recently, a million-dollar grant was earmarked for the assessment of a shaving kit at Brooke Army Medical Center at Fort Sam Houston Texas. The kit “Shaver’s Choice Skin Therapy Shaving System” is made by SC3 LLC in Madison, Miss and has a mild astringent towel wipe, a shaving gel, and an after-shave skin therapy lotion. In the course of this review, we summarize the results of a variety of treatment strategies and provide conclusions on individual and combination treatment regimens based on ideal shaving regimens, topical hair growth retardants, and a judicious use of lasers to maximize the efficacy and minimize risks of adverse events, and the costs and inconvenience of continuing medical supervision.
In addition to the military support for PFB research, The Gillette Company Corporate R&D Research Group supported substantial fundamental and clinical research studies. The first studies sponsored by Gillette were those conducted by Kligman and Strauss in the 1950s. The Gillette Research Institute (GRI) which was previously located in Maryland also did substantial amount of research on biophysical properties of hair and research on biological control hair follicle proliferation and differentiation processes of hair-shaft formation. In addition, studies on dermatological conditions related to hair – growth processes such as unwanted facial hair and PFB were conducted to exploit practical applications of the more fundamental research efforts.
The GRI researchers conducted fundamental and clinical research studies on PFB for over thirty years between 1968 through 2000, and the culmination of these efforts was identification of optimal shaving frequency regimens confirming and extending earlier findings at the US military facilities. In addition, research at GRI first demonstrated the efficacy and mechanism of action of the hair growth retardant Eflornthine HCl as an effective treatment modality in managing unwanted facial hair in women, as well as providing a viable treatment option for PFB in men.