A Case of Facial Papules: Clinical and Trichoscopic Findings

Sir, CASE PRESENTATION A 23-year-old male, person of color, presented with complaints of multiple, itchy, raised lesions over the face of 2 years duration Figure 1, which were recalcitrant to management by various physicians as a case of acne vulgaris and allergic dermatitis. Clinical examination revealed multiple, discrete, and erythematous papules limited only to the lower beard region, sparing the malar region and neck. Trichoscopy of the lesions revealed multiple hairs showing a "bucket handle appearance" with curved hair attached to the skin at both ends Figure 2. Based on trichoscopic findings, a diagnosis of pseudofolliculitis was made. The patient was managed with cessation of shaving, anti-inflammatory agents, keratolytics, and chemical peels.Figure 1: Photograph of the patient showing multiple papules over both sides of the faceFigure 2: Trichoscopy showing "bucket handle appearance" with curved hair attached to the skin at both endsTeaching point Pseudofolliculitis barbae is an inflammatory hair disorder, usually in people of color, characterized by itchy papules triggered by the shaving of terminal hair. The most common site is the lower margin of the beard area in the anterior neck region. Treatment includes management of inflammation, shaving cessation, a combination of keratolytics, and chemical peels.1 Other treatment options include topical antibiotics, steroids, eflornithine cream, chemical depilation, electrolysis, and advanced methods such as laser hair reduction. This case demonstrates the importance of trichoscopic findings in the management of pseudofolliculitis barbae. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. The patients understand that their names and initials will not be published and that due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Data availability statement All data generated or analyzed is included in this article. Further enquiries can be directed to the corresponding author. Author contribution All the authors contributed to conception and design of the work, defining the intellectual content, literature search, acquisition and analysis of data; manuscript preparation, editing, review and final approval of the version to be published. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.