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Case of the Month

Pseudofolliculitis Barbae

30 year old man with a 3+ year history of painful, draining papules and nodules on his neck and chin. It seems to get worse with shaving.

What's Your Diagnosis?

Diagnosis: Pseudofolliculitis Barbae (PFB) with concomitant Sycosis Barbae

He clearly has PFB from the coiled and visible ingrown hairs, but he also has a concomitant (and secondary to the PFB) chronic bacterial infection Sycosis vulgaris. Sycosis vulgaris (also known as "Barber's itch," and "Sycosis barbae") is a cutaneous condition characterized by a chronic infection of the chin or bearded region. The irritation is caused by a deep infection of hair follicles, often by species of Staphylococcus or Propionibacterium bacteria.

As a result, he has both a pseudofolliculitis and true folliculitis! I started him on topical anti-inflammatories (Elocon cream BID x 10 days), topical abx (Bactroban BID x 10 days), oral abx (Keflex 500mg TID x 2 weeks), explained to him my full anti-PFB program as detailed in the Razor Bump brochure, below. I initially instructed use adjustable electric razor at low setting and cultured one of the pus-draining nodules to focus my abx tx if my original abx is not working. The bacterial culture came back positive for moderate amount of staph, resistant only to sulfa abx, I saw him back 2 ½ weeks into the treatment program and he was extremely happy and thankful after using the program described above.

Pseudofolliculitis Barbae

Sycosis definition:

Charles Crutchfield III M.D. Eagan Dermatologist

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