Hormones loom large in female pseudofolliculitis barbae

Pseudofolliculitis barbae, a disorder better known as razor bumps, is poorly studied in women, but may have a different etiology than in men and could be indicative of underlying hormonal comorbidities, based on data from 62 men and 62 women.

T.A. Nguyen, a medical student at Montefiore Medical Center – Albert Einstein College of Medicine, New York, and colleagues sought to characterize pseudofolliculitis barbae (PFB) in women by reviewing patient files from men and women presenting with unspecified acne or diseases of hair and hair follicles. They collected information on patients’ age, laboratory findings, treatments, and comorbidities. The findings were published in the British Journal of Dermatology (2015 [doi:10.1111/bjd.13644]) .

Overall, the researchers found that only differences in hormonal disorders, such as polycystic ovarian syndrome (PCOS), hirsutism, infertility, or hypo/hypertestosteronism, and acne were statistically different between men and women.

“These results point toward hyperandrogenism, a common cause of hirsutism, acne, and virilization, as a potential mitigating factor for PFB in women,” the researchers wrote, adding that the higher prevalence of hormonal disorders in the women’s cohort “demonstrates the importance of considering hormonal influences when working-up a female patient with PFB.”

Of the 62 women, 5 had known PCOS at diagnosis, and 4 were later diagnosed. Two women saw improvement of PFB severity after starting oral contraceptives or antiandrogen agents under the care of endocrinologists.

“It is possible that these agents may provide some benefit for a subset of patients,” the researchers wrote. A quarter of the female patients in the study were treated with eflornithine hydrochloride, which inhibits hair cell growth, while fewer than 2% of males received this treatment. The investigators noted that few women were treated with oral contraceptive pills, despite their use as a first-line strategy for acne in women.

“Our study demonstrates that female patients with PFB are empirically different from their male counterparts. In women with PFB, acne and hormonal disorders are significantly more common. Despite this fact, antiandrogen agents were not considered for treatment. Further studies are needed to evaluate the use of these agents in women with PFB and to identify optimal clinical work-up and treatment algorithms,” the researchers noted.

Dr. Adam Friedman, who was the lead author, disclosed financial relationships with Onset, GSK, Galderma, Amgen, L’Oreal, Johnson & Johnson, MicroCures, Liquidia, Salvona, and Valent.

Pseudofolliculitis barbae, a disorder better known as razor bumps, is poorly studied in women, but may have a different etiology than in men and could be indicative of underlying hormonal comorbidities, based on data from 62 men and 62 women.

T.A. Nguyen, a medical student at Montefiore Medical Center – Albert Einstein College of Medicine, New York, and colleagues sought to characterize pseudofolliculitis barbae (PFB) in women by reviewing patient files from men and women presenting with unspecified acne or diseases of hair and hair follicles. They collected information on patients’ age, laboratory findings, treatments, and comorbidities. The findings were published in the British Journal of Dermatology (2015 [doi:10.1111/bjd.13644]) .

Overall, the researchers found that only differences in hormonal disorders, such as polycystic ovarian syndrome (PCOS), hirsutism, infertility, or hypo/hypertestosteronism, and acne were statistically different between men and women.

“These results point toward hyperandrogenism, a common cause of hirsutism, acne, and virilization, as a potential mitigating factor for PFB in women,” the researchers wrote, adding that the higher prevalence of hormonal disorders in the women’s cohort “demonstrates the importance of considering hormonal influences when working-up a female patient with PFB.”

Of the 62 women, 5 had known PCOS at diagnosis, and 4 were later diagnosed. Two women saw improvement of PFB severity after starting oral contraceptives or antiandrogen agents under the care of endocrinologists.

“It is possible that these agents may provide some benefit for a subset of patients,” the researchers wrote. A quarter of the female patients in the study were treated with eflornithine hydrochloride, which inhibits hair cell growth, while fewer than 2% of males received this treatment. The investigators noted that few women were treated with oral contraceptive pills, despite their use as a first-line strategy for acne in women.

“Our study demonstrates that female patients with PFB are empirically different from their male counterparts. In women with PFB, acne and hormonal disorders are significantly more common. Despite this fact, antiandrogen agents were not considered for treatment. Further studies are needed to evaluate the use of these agents in women with PFB and to identify optimal clinical work-up and treatment algorithms,” the researchers noted.

Dr. Adam Friedman, who was the lead author, disclosed financial relationships with Onset, GSK, Galderma, Amgen, L’Oreal, Johnson & Johnson, MicroCures, Liquidia, Salvona, and Valent.

Pseudofolliculitis barbae, a disorder better known as razor bumps, is poorly studied in women, but may have a different etiology than in men and could be indicative of underlying hormonal comorbidities, based on data from 62 men and 62 women.

T.A. Nguyen, a medical student at Montefiore Medical Center – Albert Einstein College of Medicine, New York, and colleagues sought to characterize pseudofolliculitis barbae (PFB) in women by reviewing patient files from men and women presenting with unspecified acne or diseases of hair and hair follicles. They collected information on patients’ age, laboratory findings, treatments, and comorbidities. The findings were published in the British Journal of Dermatology (2015 [doi:10.1111/bjd.13644]) .

Overall, the researchers found that only differences in hormonal disorders, such as polycystic ovarian syndrome (PCOS), hirsutism, infertility, or hypo/hypertestosteronism, and acne were statistically different between men and women.

“These results point toward hyperandrogenism, a common cause of hirsutism, acne, and virilization, as a potential mitigating factor for PFB in women,” the researchers wrote, adding that the higher prevalence of hormonal disorders in the women’s cohort “demonstrates the importance of considering hormonal influences when working-up a female patient with PFB.”

Of the 62 women, 5 had known PCOS at diagnosis, and 4 were later diagnosed. Two women saw improvement of PFB severity after starting oral contraceptives or antiandrogen agents under the care of endocrinologists.

“It is possible that these agents may provide some benefit for a subset of patients,” the researchers wrote. A quarter of the female patients in the study were treated with eflornithine hydrochloride, which inhibits hair cell growth, while fewer than 2% of males received this treatment. The investigators noted that few women were treated with oral contraceptive pills, despite their use as a first-line strategy for acne in women.

“Our study demonstrates that female patients with PFB are empirically different from their male counterparts. In women with PFB, acne and hormonal disorders are significantly more common. Despite this fact, antiandrogen agents were not considered for treatment. Further studies are needed to evaluate the use of these agents in women with PFB and to identify optimal clinical work-up and treatment algorithms,” the researchers noted.

Dr. Adam Friedman, who was the lead author, disclosed financial relationships with Onset, GSK, Galderma, Amgen, L’Oreal, Johnson & Johnson, MicroCures, Liquidia, Salvona, and Valent.