Background: Pseudofolliculitis barbae (PFB) significantly impacts the military population, especially
deployed personnel.
Objective: This study was designed to determine whether the addition of topical eflornithine to hair laser
treatment would improve efficacy in treating PFB.
Methods: This was a randomized, double-blinded, placebo-controlled, paired (right and left neck)
comparison study examining a combination of eflornithine and hair laser versus placebo and hair laser for
the treatment of PFB. In all, 27 male patients with clinical PFB were treated with a long-pulsed
neodymium:yttrium-aluminum-garnet laser with an energy fluence of 25 to 30 J/cm2, a pulse duration of 20
to 30 milliseconds, and a 10-mm spot size to the entire bearded neck region. The laser treatment was
performed every 4 weeks for a total of 16 weeks. Between laser treatments, patients applied eflornithine
and placebo creams twice daily to opposite sides of the bearded neck region. The number of hairs and
inflammatory papules were counted bilaterally at each visit.
Results: The eflornithine side had a statistically significant decrease in the number of hairs and
inflammatory papules compared with the placebo side. At 16 weeks, the eflornithine side had a median
hair reduction of 99.5% from baseline (range 48.5%-100.0%), whereas the placebo side had an 85.0%
median hair reduction from baseline (range 50.5%-94.5%), P less than .001.
Conclusion: The addition of topical eflornithine to hair laser treatment decreased hairs and inflammatory
papules faster when compared with hair laser therapy alone in the treatment of PFB. ( J Am Acad Dermatol
2012;67:694-9.)
From the Dermatology Service, San Antonio Uniformed Services Accepted for publication October 25, 2011.
Health Education Consortiuma; Dermatology Clinic, Bavaria Reprints not available from the authors.
Medical Activity, Grafenwoehrb; and Department of Clinical Correspondence to: Yang Xia, MD, Dermatology Service, San
Investigationsc and Dermatology Service,d Walter Reed Army Antonio Uniformed Services Health Education Consortium,
Medical Center, Washington. 2200 Bergquist Dr, Ste 1, San Antonio, TX 78236. E-mail:
Funding sources: None. yang.xia@us.army.mil.
Conflicts of interest: None declared. Published online January 9, 2012.
The opinions herein are the private views of the authors and do 0190-9622/$36.00
not reflect the official policy of the Department of the Army, Ó 2011 by the American Academy of Dermatology, Inc.
Department of Defense, or US Government. doi:10.1016/j.jaad.2011.10.029
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Recently, there have been reports of using eflor- The laser treatment was performed with a long-
nithine hydrochloride 13.9% cream as an adjunct pulsed neodymium:yttrium-aluminum-garnet laser
therapy in treating unwanted facial hairs in women (Coolglide, Cutera Inc, Brisbane, CA). The laser
with minimal side effects.6 Eflornithine hydrochlo- incorporated a built-in copper cooling system at
ride acts by inhibiting ornithine decarboxylase, an the laser tip. Laser settings used in this study were:
enzyme involved in hair cell division.7 As a result, the energy fluence of 25 to 30 J/cm2, pulse duration of 20
medication can reduce the growth of the active hair to 30 milliseconds, and 10-mm spot size. A clear,
follicles. Based on these stud- colorless gel was applied to
ies, there have been several the treatment area before the
anecdotal reports on the ben- CAPSULE SUMMARY laser therapy. The same laser
efits of using eflornithine in settings were used on both
Eflornithine hydrochloride 13.9% cream
treating patients with PFB.2,3
d
Fig 5. Bearded neck region of 33-year-old man at baseline (A) and 16 weeks (B). In this patient,
eflornithine (E ) was applied to right side and placebo (P) was applied to left side. His hair
density was considerably less on E side (red circles) versus P side ( green circles) at week 16.
number of hairs at week 4 for both sides was The addition of eflornithine could result in sub-
predominantly the effects of the hair laser. From stantial cost savings to both patients and the health
weeks 8 to 16, the differences in the number of hairs care system. Our data indicated the patient would
between the two sides are likely because of the require two fewer laser hair therapies with the
effects of eflornithine. This correlates well with combination treatment. The average amount of
previous reports of clinically significant hair reduc- eflornithine cream used on the entire bearded neck
tion often seen starting at week 8 of eflornithine region was 30 g every 4 weeks. A 30-g tube of
use.6,8 The addition of eflornithine likely halts the eflornithine costs $90 to $130. The estimated cost for
regrowth of the remaining viable hair follicles after eflornithine use for the first 8 weeks would be $180
initial laser destruction of the follicles through selec- to $260. Individual hair laser treatment can range
tive photothermolysis.9 The slight increase in the from $200 to $300 per session. Therefore, the cost
number of hairs on the placebo-treated side at week savings of using eflornithine for the first 8 weeks and
12 may be attributed to the paradoxical hair growth foregoing the final two laser treatments would be
from repeated hair laser treatments. The number of $220 to $340 per patient.
inflammatory papules decreased steadily for both The limitation of the study was that patients
eflornithine and placebo from weeks 8 to 16. This is were not followed up beyond 16 weeks and we did
likely the result of fewer remaining hairs that re-enter not evaluate whether eflornithine could be used as
the skin to cause the inflammatory papules. a stand-alone adjunctive therapy after the laser
Our patients with PFB achieved a greater clear- treatment was complete. We believe that if eflorni-
ance of their ingrown hairs after two laser treat- thine was stopped at the end of the last laser
ments in combination with eflornithine as treatment, a patient’s PFB could worsen as viable
compared with 4 laser treatments alone. The results hair follicles become active again. Therefore, pa-
from our study may have significant positive impli- tients with PFB may need to continue to use
cations for patients with PFB, to include our active eflornithine therapy after the conclusion of hair
duty military soldiers and those patients who desire laser treatments. It would be beneficial to know if
reduced hair growth. Although the standard treat- eflornithine therapy alone will sustain the clinical
ment for PFB in the military is 4 to 6 laser treatments response after the initial laser hair treatments. A
spaced 4 to 6 weeks apart, our patients may not longer study will be undertaken in the future to
have the time to complete a full treatment cycle answer this question.
because of deployments, training, or relocations.
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