Description: Foreign body inflammatory reaction from ingrown hairs causing papules/pustules, mainly in the bearded area but also scalp, axilla, or pubic areas if shaved. Mechanical process: extrafollicular/transfollicular hair penetration.
Other Names: Chronic sycosis barbae, pili incarnati, folliculitis barbae traumatica, razor bumps, shaving bumps, tinea barbae.
System affected: Skin/exocrine
EPIDEMIOLOGY
Age: Postpubertal/middle age (14–25 years typical)
Sex: Male > female, but can affect any gender with waxing/shaving
Prevalence: Common in Fitzpatrick IV–VI (darker skin); 45–83% of African American soldiers who shave
ETIOLOGY & PATHOPHYSIOLOGY
Pathogenesis: Shaving too close causes curly hair to re-enter the skin, creating foreign body reaction → papules/pustules.
Contributing Factors: Plucking, tweezing, waxing, abnormal hair growth in injured follicles, curly hair, genetic polymorphisms in hair keratin.
Transfollicular Escape: Hair escapes the follicle into dermis → severe inflammation, possible abscess, foreign body granuloma.
RISK FACTORS
Curly hair
Close/multiple razor strokes
Plucking/tweezing
Fitzpatrick IV–VI skin (African, Mediterranean, Middle Eastern, Asian descent)
GENERAL PREVENTION
Hydrate hairs with warm water before shaving
Use adjustable clippers/razors (avoid close shaves)
Prefer single-edge, foil-guarded, or "O-head" electric razors
Shave in the direction of hair growth
Do not overstretch skin
Use adequate shaving gel/cream
Clean razor frequently
Daily shaving can reduce papules/pruritus
Regular use of depilatories (test for sensitivity first)
COMMONLY ASSOCIATED CONDITIONS
Keloidal folliculitis
Pseudofolliculitis nuchae
DIAGNOSIS
History
Pain or pruritus after shaving
“Razor bumps”
Physical Exam
Tender, erythematous follicular papules/pustules (2–4 mm) in beard area (can affect scalp, axilla, pubic)