A 30-year-old-man presents with a three-plus year history of painful, draining papules and nodules on his neck and chin that seem to get worse with shaving.
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 is a chronic skin infection on the chin or in the bearded area. Hair follicles deeply infected with a species of staphylococcus or propionibacterium bacteria typically cause the irritation. As a result, he has both pseudofolliculitis and true folliculitis.
I started him on topical anti-inflammatories (Elocon cream BID x 10 days), topical antibiotic (Bactroban BID x 10 days), oral antibiotics (Keflex 500 mg TID x 2 weeks), and explained my full anti-PFB program. I initially instructed he use an adjustable electric razor at a low setting and cultured one of the pus-draining nodules to focus my antibiotics treatment if the original antibiotics were not working. The bacterial culture came back positive for a moderate amount of staph, resistant only to sulfa antibiotics. I saw him back two and a half weeks into the treatment program and he was extremely happy and thankful after using the program described above.
Contact Charles E. Crutchfield III, MD, at Crutchfield Dermatology or visit crutchfielddermatology.com for more information.