Q: My husband develops small pimples with scars on his cheeks and chin and because of this he finds it difficult to shave. If at all he tries, the pimples break out with bloodstains. What is the solution for this?

A:It appears that your husband has developed sycosis barbae. Sycosis barbae (SB) is a chronic, recalcitrant folliculitis in the beard area and there is inflammation of the surrounding skin area. The upper lip is particularly susceptible in patients who suffer from chronic nasal discharge from sinusitis or hay fever. In men, sycosis is often precipitated by shaving trauma. SB is characterised by burning and itching, with pain on manipulation of the hair. There are pustules in the hair follicles. Chronic, persistent infection results in spread to the surrounding skin, which becomes red and crusted, resembling eczema. Complications include abscess formation and cavernous sinus thrombosis if upper lip, nose or eyes are affected. SB has to be differentiated from acne, vulgaris, pustular miliaria, impetigo and fungal skin infections. Its management include the following: Local measures: cleaning - use chlorhexidine and apply saline or aluminium subacetate soaks / compresses for 15 minutes, twice daily. Larger pustules are opended and any necrotic tissue is trimmed away. Anhydrous ethyl alcohol containing 6.25% aluminium chloride may be helpful. General measures: systemic antibiotics e.g. cloxacillin or erythromycin - only if local treatment is ineffective; the infection is severe; or has become complicated or involves the upper lip, nose or eyes from which a cavernous sinus thrombosis may develop. Topical 2% mupirocin - 3 times daily and supported with dressings. It is particularly valuable in eliminating primary or secondary infection. Sometimes failure to respond to antibiotic therapy is due to development of gram-negative folliculitis. High dose trimethoprim - 300 mg twice daily in adults - is the antibiotic of choice in these situations. Isotretinoin has been successfully used to treat different forms of folliculitis including gram-negative folliculitis and HIV-associated eosinophilic folliculitis. Prevention inlcudes correction of precipitating factors - Systemic e.g. diabetes mellitus and local e.g. irritations, discharges, etc.