A 24-year-old African American man presents with a 3-month history of red bumps on the face and chin. They are itchy and painful; exam shows hyperpigmented papules on the cheeks, jawline, and neck. What is the most likely diagnosis?

A 24-year-old African American man presents with a 3-month history of red bumps on the face and chin. They are itchy and painful; exam shows hyperpigmented papules on the cheeks, jawline, and neck. What is the most likely diagnosis?

• A. Acne vulgaris
• B. Seborrheic dermatitis
• C. Rosacea
• D. Pseudofolliculitis barbae

Answer: (D)

Pseudofolliculitis barbae is the best fit. This condition occurs when curly beard hairs curl back into the skin after shaving, triggering a follicular inflammatory response that forms red, itchy, sometimes painful papules or pustules in the beard area. It’s especially common in young African American men, and postinflammatory hyperpigmentation can leave dark, pigmented spots on the cheeks, jawline, and neck. Acne vulgaris would more often show comedones (blackheads and whiteheads) and typically isn’t as localized to the beard area or tied to shaving. Seborrheic dermatitis presents with greasy scales and is usually not restricted to the bearded regions. Rosacea features facial flushing and telangiectasias rather than inflamed papules from ingrown hairs.

Pseudofolliculitis barbae is the best fit. This condition occurs when curly beard hairs curl back into the skin after shaving, triggering a follicular inflammatory response that forms red, itchy, sometimes painful papules or pustules in the beard area. It’s especially common in young African American men, and postinflammatory hyperpigmentation can leave dark, pigmented spots on the cheeks, jawline, and neck.

Acne vulgaris would more often show comedones (blackheads and whiteheads) and typically isn’t as localized to the beard area or tied to shaving. Seborrheic dermatitis presents with greasy scales and is usually not restricted to the bearded regions. Rosacea features facial flushing and telangiectasias rather than inflamed papules from ingrown hairs.