Clinical and Dermoscopic Study of Pseudofolliculitis of the Beard Area

BACKGROUND: Pseudofolliculitis of the beard area is a very common dermatological problem in our geographical region. This could be partly because of the racial predilection as a large percentage of the population has curly hair and also may be due to local cultural customs, unlike the west do not encourage daily shaving of facial hair. OBJECTIVES: We aimed to mainly study the dermoscopic features of cases presenting with pseudofolliculitis. Secondary objectives included evaluating clinical patterns and possible etiological factors. METHODS: Twenty-four consecutive male patients presenting to a University Health Center with a clinical diagnosis of pseudofolliculitis involving beard area were included in the study. Patient history with regards to shaving habits, patient hair type, morphological patterns of the skin lesions, and dermoscopic findings were recorded. RESULTS: Majority of the patients had “curly” hair. Most of the patients had a usual shaving frequency of 2 or less per week. All the patients who were using razors mentioned that they tended to stretch the skin while shaving. The most common dermoscopic findings included - “Handle bar” sign showing curved hair attached to the skin on both ends, white areas indicate fibrosis and scaling, underlying linear bluish pigmentation (indicating the buried hair shaft), and linear vessels with occasional areas of hemorrhage. CONCLUSION: Dermoscopy can be a useful adjunct for diagnosis and patient counseling in pseudofolliculitis. Stretching the skin while using razors and growing the facial hair to a point where it has the length to curve might be important risk factors in the development of pseudofolliculitis. LIMITATIONS: The lack of histopathological correlation is the main limitation in our study.