Thread: Some information on razor bump (PFB) that I found useful

I sometimes get razor bumps after a bad shave, and for me the strongest predictor seems to be shaving with a razor that is not sharp enough. Other factors which I find seem to contribute are shaving ATG and using poor technique.

The information I have found here on SRP has been very helpful, and I thought it might be nice to add to this by sharing a couple of useful articles I found in medical journals. I've attempted to attach PDF copies of the articles to this post, and hopefully that works. I will also include the references and some captions from the articles below.


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Ribera, M., Fernández-Chico, N., & Casals, M. (2010). Pseudofolliculitis Barbae. Actas Dermo-Sifiliográficas (English Edition), 101(9), 749-757. doi: 10.1016/S1578-2190(10)70713-7

Correct Shaving TechniqueThe most important aspect after resolving an episode of
pseudofolliculitis is prevention. It is therefore necessary to
inform the patient of the cause of the lesions and of the
need for care when shaving. The patient must understand
the need to modify the shaving technique and always use
the recommended skincare products before and after
shaving. Prevention is based on good shaving, that is,
a good technique, a good razor, and the right products
(Table 3).

Table 3: Recommended Shaving Technique for Patients With Pseudofolliculitis

• Use a hydrating lotion or cream the night before shaving
• Choose the type of razor according to skin type. Compare tolerance to an electric razor and a blade razor
• The blades of a blade razor must be new, clean, and sharp in order to reduce the possibility of lesions
• When using an electric razor, use the medium (not the close) shave position
• When using a blade razor, use one with a single blade or, at most, 2 blades. Still better, use one with steel-wire guards
• Wet the face with warm water and cover the beard area generously with shaving foam, cream, soap, or gel
• Leave the chosen shaving product on for at least 2 to 3 minutes The harder the beard, the longer it takes to soften the hairs well
• Shave in the direction of hair growth, with short strokes and without using the other hand to tense the skin
• Do not try to achieve a very close shave if this means a more aggressive shave. When a closer shave is desired, it is better to shave more often but less intensely
• After shaving, rinse the beard area well and dry with a clean towel, slowly and gently massaging the beard area in a circular manner using a rough towel
• Ease out ingrown hairs using a sterile needle
• Apply a therapeutic aftershave lotion or use medication as aftershave lotion (topical antibiotics, benzoyl peroxide)
• If the skin is dry, use a moisturizing facial cream as well

Before Shaving
Moisturizing prior to shaving softens the hair. Soft hairs
are easily cut and are not left with a sharp tip, making
ingrowth less likely.
The skin can be prepared by application of a cream or
balm the night before, which will both soften the hair and
protect the skin.
It is advisable to wait at least 5 minutes after getting
up before shaving. First wash the face with warm water
to remove the physiologic skin desquamation and to
moisten the skin and hair. A towel moistened with water
and applied like a poultice is ideal for this. In this way,
the hair shaft is moistened, making it softer and easier
to shave.
Preferably use a brush to apply the shaving cream, rather
than applying it directly; this achieves greater lubrication
of the area and will facilitate the movement of the razor
blade. Apply a sufficient amount of shaving foam or gel that
provides good lubrication.

Shaving
Shaving can be performed with an electric or a blade razor.
If a blade razor is used, the blade must be sharp and
the same one should not be used for more than 5 days.
Razors with a single blade, or a maximum of 2 blades, or
ones with wire-protected blades that prevent shaving too
close should be preferred. In addition, shaving should be
done in the direction of hair growth, rather than against it
to avoid increasing erythema, causing a burning sensation
and promoting pseudofolliculitis. If shaving is performed
against the direction of growth, do not tense the skin or
put pressure on the razor. Shaving in the direction of hair
growth may sometimes be a problem, as it can be difficult
to see the direction of growth in whorls of hair. The
direction is easier to see if the patient allows the beard
to grow, shaving on alternate days. The patient can also
be encouraged to shave only when it is truly necessary,
if possible, to allow more time for the skin and beard to
recover between shaves.
During a shave, the blades should be rinsed with hot
water after each stroke, and the stroke should be slow, so
that each area is given due attention and the direction of
hair growth is taken into account.

After Shaving
On completion of shaving, wash the face with water cold
and apply a balm or lotion to soothe and protect the skin.
For individuals with severe pseudofolliculitis the beard
area should have been rubbed with a sponge or brush
before the shave and the area should be massaged 4 or 5
times a day to free the ends of the hairs and help them to
reach the surface.
The razor must be washed with a brush and warm
water and then left in a place where it can drain and dry
well. The presence of hairs and humidity can promote
bacterial colonization of this debris and favor folliculitis
and pseudofolliculitis.


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Perry, P. K., Cook-Bolden, F. E., Rahman, Z., Jones, E., & Taylor, S. C. (2002). Defining pseudofolliculitis barbae in 2001: A review of the literature and current trends. Journal of the American Academy of Dermatology, 46(2, Supplement 2), S113-S119. doi: 10.1067/mjd.2002.120789

TREATMENT
Prevention
Given the pathogenesis of this disorder, it is understandable
that the mainstay of therapy has involved
preventive practices: primarily, the discontinuation of
shaving or other forms of hair removal (electrolysis,
tweezing, depilatory use, and waxing). Once thought
to be a complete cure, approximately 10% to 20% of
affected individuals continue to have inflammatory
lesions after cessation of shaving and cannot wait the
2 to 6 weeks needed for complete cure. In the past,
guidelines for obtaining a complete cure suggested
that patients with mild cases discontinue shaving for
1 month, moderate cases for 2 to 3 months, and
severe cases for 3 to 6 months. PFB tends to worsen
during the first week because of regrowth of previously
shaved hairs; however, Strauss and Kligman2
found that most papules resolve spontaneously after
1 month of hair growth. It is thought that the natural
tension placed on the hair after it has achieved a
length of 1 cm causes its release from the epidermis.
Various hair-releasing techniques have been recommended.
Washing the beard with warm water and
an antibacterial or acne soap for several minutes in a
circular motion provides gentle traction and may be
effective in releasing the hair. The use of an antibacterial
soap helps to reduce the risk of secondary
infection. The warmth from the water, enhanced by
using a warm compress, softens the hair and makes
it easier to manage, along with helping to prevent a
sharp edge after shaving. More effective but gentler
traction can be achieved with the use of a polyester
web sponge (Buf-Puf, Riker Laboratories, St. Paul,
MN) or mildly abrasive washcloth. Previous recommendations
have included the use of a toothbrush
or toothpick to dislodge ingrown hairs gently.
However, safer and less abrasive measures are available,
making these instruments less appealing and
generally not recommended.
Men who prefer a clean-shaven look may be
offered a variety of ways to reduce flaring of PFB. The
type of shaving instrument used and instruction for
appropriate shaving technique are key elements in
preventing flares. Regarding shaving technique, the
most important preventive measure is to reduce
the closeness of the shave. It is for this reason that the
now popular twin- and triple-blade razors are not recommended.
Patients should be instructed to shave
hair with electric clippers to a minimum length of 1
mm. Electric clippers are considered more advantageous
than a razor because clippers have a protective
gap between the blade and the comb, thereby preventing
a close shave. Conte and Lawrence17 reported
a 96% improvement rate in 96 male participants using
electric clippers formulated with a polyester skincleansing
pad (Buf-Puf, Riker Laboratories). Electric
clippers are produced by a variety of manufacturers
(ie, Norelco, Braun, Remington) and can be purchased
at beauty supply stores or through the
Internet (Electric Shavers, Sales, Service and Parts Since 1939).
Electric clippers are associated with what is felt to
be the overall best outcome, but the 1-mm hair stubble
left is often unacceptable for those who prefer a
clean-shaven appearance. Care should be taken to
avoid nicks and cuts. A variety of other shaving
instruments have been beneficial. The Bumpfighter
razor (American Safety Razor Co, Staunton, VA), formulated
with a single-edge blade, polymer coating,
and foil guard was manufactured specifically for PFB
patients. The guard, covering a third of the blade,
acts as a protector (like the comb in electric clippers)
and prevents a close shave. Alexander22 found that
72.7% of patients using this foil-guard razor had a
25% or greater reduction in the number of lesions
and its use led to improvement in 86.4% of patients.
Garcia and Henderson23 reported a 90% acceptance
rate among 300 patients using an adjustable electric
rotary razor. The Bumpfighter razor retails for $3.99
and can be purchased through Apprize consumer
products (Personna | Personna American Safety Razor Company). Several companies have
made electric rotary razors and have outlined shaving
techniques to achieve optimal results with their
instrument. Common recommendations made by
each of these manufacturers include moistening the
skin with warm water and a preshaving lotion before
shaving (similar to suggestions for using a blade to
soften the hair); avoiding taut skin by not pulling it
while shaving; shaving with the grain (ie, in the
direction) of hair growth; and applying cool compresses
after shaving. Another suggestion is to rinse
the blade with warm water after each shaving stroke
to prevent the traction that occurs with build-up of
hair between the blade and guard. The patient may
use the shaving cream of choice. Postshaving adjuvant
therapeutics are beneficial and will be discussed
in the management section of this article.21

ADJUNCTIVE THERAPY TO BEARD HAIR REMOVAL
A variety of topical agents may help decrease irritation
after hair removal and are useful additions in
the management of PFB. Neutral pH or more acidic
emollients such as hydrocortisone cream (0.5% to
1%), 10% urea cream, and lactic acid may be helpful.
Kligman and Mills24 suggested that hyperkeratosis
plays a small role in the pathogenesis of PFB. Topical
retinoids (0.5% tretinoin, adapalene) in the cream,
gel, or solution forms are beneficial in reducing the
hyperkeratosis that often results from repeated nicking
of the follicular epithelium. Alpha-hydroxy acids,
including glycolic acids, are also helpful in reducing
hyperkeratotic cells in the follicular infundibulum and
reducing the thickened stratum corneum, as demonstrated
by Perricone.25 Daily application of glycolic
acid lotion reduces the lesions associated with PFB
through an additional mechanism as well. This agent
reduces the sulfhydryl bonds in the hair shaft, causing
the hair to grow straighter and decreasing the chance
of re-entry into the epidermis or follicular wall.25
Topical antibiotics (clindamycin, erythromycin,
benzoyl peroxide/erythromycin) are useful in reducing
the colonization of normal flora that can aggravate
the inflammation and lead to secondary infection.
Chemical peels, particularly with glycolic and salicylic
acid, have been beneficial in some patients.
These agents have mechanisms similar to topical
retinoids. Salicylic acid may also have some antiinflammatory
properties and can be efficacious for
inflammatory lesions. A decrease in the hyperpigmented
macules can also be achieved.
Liquid nitrogen, which has been used as a cooling
spray, demonstrates a light peel effect.22,26 Caution
must be taken to avoid the hypopigmentation resulting
from melanocyte destruction that is associated
with aggressive use of liquid nitrogen. Compounds
that contain hydroquinone (4%), azelaic acid, and
kojic acid, as well as other peeling agents, can be
used to treat the hyperpigmentation associated with
PFB. Low-dose systemic antibiotics (eg, tetracyclines,
macrolides, penicillins) and corticosteroids (prednisone
at 40 to 60 mg/day for 5 to 10 days) may be
used in moderate to severe cases to reduce inflammation
around the hair follicles until the hair grows
and is no longer an aggravating factor. The choice of
antibiotics should be directed by culture results in
instances of clinical predominance of pustules and
when a pathogenic organism is suspected. There has
been at least 1 case report of successful use of
isotretinoin in the treatment of PFB.27 Often, a combination
of the above therapies is used.









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Wow! Some very thorough research here. It like I'm in college all over again! O wait I'm still in college... Anywho, even though I don't have a super sensitive beard but this is some really good information for everyone. Thank you for taking the time to do this research it truly was very useful!

I dunno... Even though they advise not going ATG, for me, on my neck, if I don't got ATG, the irritation is worse, especially the next day (I shave every other day).

A very thorough report, for sure. All I know is that using proper prep, a brush and soaps/creams, beard mapping, shaving technique and a straight razor eliminated razors bumps for me, as long as I do my part. The first four work well when using a DE as well.

With all of us that used to have 'big issues' with shaving, it's surprising that that kind of information
Isn't taught in a basic hygiene class right behind how to brush your teeth. Or am I showing my age.