Friday, April 27, 2007

Bumpy beard


A young African American man with no medical history comes to the clinic with non-pruritic bumps with dark discoloration along his beard-line. This has been progressive over the past several years. He acknowledges shaving regularly and uses the reverse shave technique for the “extra-smooth feel”. On exam, he has firm, hyperpigmented papules and scattered pustules along his neck with some ingrown hair follicles.
Which of the following is the best course of action?

1. Topical Lotrisone bid, until complete resolution.
2. Doxycycline 100mg bid, for 3-4 weeks. Discontinue shaving for 3-4 weeks followed by use of “easy shave” gel, “PFB bump fighter” razors and avoiding reverse shaving- ANSWER
3. Tretinoin cream 0.025% for 10 weeks
4. Reassure, await spontaneous resolution.

Image adopted from: http://www.mamc.amedd.army.mil/referral/guidelines/derm_pfb_1.jpg