A 37-year-old black man was referred for dermatologic consultation pertaining to a pending legal proceeding. The patient had always developed razor bumps when shaving regularly. His job required that he be sufficiently clean-shaven to wear a safety ventilator with an airtight fit. As a consequence, his pseudofolliculitis barbae had flared.
The litigation, however, was prompted by the recent loss of pigmentation on his neck. Physical examination disclosed a readily apparent area of nearly bone-white, scaly dyschromia on the anterior neck. This loss of pigmentation was in the midst of many juicy, inflammatory follicular papules. The patient was most concerned that this hypopigmentation would never resolve. He blamed it solely on resumption of shaving to conform to safety regulations in his workplace.
Pseudofolliculitis barbae is a significant problem and may well be the result of enforced shaving required by workplace regulations. To this patient, however, the most cosmetically distressing problem is not related to his grooming regimen. In fact, it is the tinea versicolor, which is limited to a small region of his neck.
After treatment with oral ketoconazole, 400 mg as a single dose, followed by induction of profuse sweating to deliver the drug to the skin surface, and some deliberate exposure to the sun during the ensuing few months, the hypopigmentation is expected to resolve. The patient's tort claim was dismissed. His company was advised of their legal obligation to provide an alternative position that did not require this otherwise satisfactory employee to shave and experience the ongoing problems associated with facial pseudofolliculitis.