|The following article is part of conference coverage from the 2018 Fall Clinical Dermatology Conference in Las Vegas, Nevada. Dermatology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in dermatology. Check back for the latest news from Fall Clinical Derm 2018.|
Andrew F. Alexis, MD, MPH, chair of the department of dermatology and director of the Skin of Color Center at Mount Sinai St Luke’s-Roosevelt Hospital, and associate professor at the Icahn School of Medicine at Mount Sinai, both in New York City, spoke about skin care related to shaving. He noted that while many patients inquire about best shaving practices, clinicians often receive little training in this area.
Common shaving-related complaints such as discomfort, post-shave irritation (“razor burn”), and pseudofolliculitis typically result from inflammation induced by poor shaving practices.1 Up to two-thirds of men experience some degree of irritation related to shaving, according to Dr Alexis.
Considering how well-innervated the hair follicles and surrounding skin are, any “tugging, pulling, or displacement of the hair is going to induce some micro-injury and release of neuropeptides, which will result in mast cell granulation and redness and symptoms of burning and other signs of irritation,” he said.
He explained the importance of preparing the hair and skin for shaving by cleansing with a mild synthetic detergent cleanser or scrub, as this removes sebum, desquamating corneocytes, and environmental dirt. In addition, exfoliating before shaving releases trapped hairs and reduces the amount of skin interaction with the razor, and hydrating the hair reduces the cutting force compared with dry hair, with the most significant reduction noted after 2 minutes of water contact. Shaving gels or creams provide further hydration.
Dr Alexis also reviewed razor features such as the elastomer fin guard and lubricating strips on commercially available cartridges, which provide skin stretch and friction reduction, respectively. The skin can stretch up to 20% during shaving, often causing irritation.1 Modern 5-blade technologies contain lubricating strips at both the front and rear of the cartridge, while traditional technologies only contain a strip at the rear.
Findings suggest that razor quality has a significant influence on the inflammatory response. A 2016 study demonstrated that the post-shave blood flux was higher after use of a lower-quality disposable razor compared with a premium 5-blade razor, indicting greater skin impact from shaving.2
While it was previously believed that single-bladed razors were best for individuals with pseudofolliculitis barbae (PFB), it has recently been shown that multi-blade razors may be used with proper pre- and post-shave care.3 Patients who experience irritation often choose to shave less frequently. However, daily shaving has been found to reduce the severity of PFB compared with less frequent shaving.4
Post-shave moisturization with ingredients such as glycerin, niacinamide, shea butter, and aloe vera can help to minimize transepidermal water loss; aftershaves containing alcohol should be avoided.
Neal D. Bhatia, MD, director of clinical dermatology at Therapeutics Clinical Research in San Diego, California discussed shampoo ingredients and types as well as potential side effects of shampoos, including irritation that can result from using a shampoo with a pH >5.5, delayed wound healing, and accumulation of detergents in the organs. Additionally, patients may experience reactions to the various allergens commonly found in shampoos, including fragrance, cocamidopropyl betaine, propylene glycol, and parabens.5
Joshua Zeichner, MD, assistant professor of dermatology at the Icahn School of Medicine at Mount Sinai, covered the effects of fabric care on the skin. He emphasized the causative role of laundry detergents in allergic (due to dyes and fragrances) or irritant (due to surfactants or pH) contact dermatitis, as well as exacerbations in patients with sensitive skin or eczema.
He also stated that pH levels vary considerably among detergents, and those with a high pH may cause irritation and increase the pH of the skin. The pH level is often listed on the product, or consumers may contact the manufacturer to obtain this information.
Patients should be advised to avoid overusing detergents by closely following washing machine instructions. If they wash clothes by hand, they should choose a neutral pH detergent. Finally, detergents labeled as dye- and fragrance-free may be the best option for certain patients. Patch testing may be used to determine ingredients to which the patient is allergic.
For more coverage of Fall Clinical Derm 2018, click here.
1. Alexis AF, Bhatia ND, Zeichner J. What you need to know about personal care products. Presented at: 2018 Fall Clinical Dermatology Conference. October 18-21, 2018; Las Vegas, NV.
2. Cowley K, Vanoosthuyze K. The biomechanics of blade shaving. Int J Cosmet Sci. 2016;38 Suppl 1:17-23.
3. Daniel A, Gustafson CJ, Zupkosky PJ, et al. Shave frequency and regimen variation effects on the management of pseudofolliculitis barbae. J Drugs Dermatol. 2013; 12(4):410-418.
4. Gray J, McMichael AJ. Pseudofolliculitis barbae: understanding the condition and the role of facial grooming. Int J Cosmet Sci. 2016;38 Suppl 1:24-27.
5. Zirwas M, Moennich J. Shampoos. Dermatitis. 2009;20(2):106-110.