Pseudofolliculitis Barbae in the U.S. Military, a Review

Pseudofolliculitis barbae (PFB), also known as ingrown hairs commonly results from adherence to military grooming standards in those who have curly facial hair. Many patients respond to specific grooming techniques or topical medications but severe cases often warrant restrictions on shaving or laser therapy. The treatment of PFB is challenged not only by grooming standards but also evolving readiness requirements. More recently, the Navy discontinued permanent restrictions on shaving because of concerns for poor gas mask fitting. The goal of this review is to outline the history of PFB in the military, describe current policies, and offer a more uniform approach to treating PFB in the military. We also discuss challenges that surround the management of PFB in the Armed Forces.

We conducted a systematic review of the literature utilizing PubMed to identify both current and past management and discussion of PFB in both civilian and military settings. We also performed an internet search to identify pertinent military regulations and history of PFB within the Armed Forces. A query of TRICARE, the health care program for the U.S. Department of Defense Military Heath System, was also performed to assess civilian-referred laser treatment for Active Duty service members.

PFB has a long history in the military dating back to World War I, when shaving was enforced not only to ensure good personal hygiene and to foster good order and discipline but also to ensure gas masks would seal in the event of a chemical attack. The management of PFB has presented a challenge in the military and even led to a social uproar in the 1970s. Policy changes in the military regarding shaving limitations, or profiles, have historically influenced how PFB is managed, but the basic tenets remain the same. Grooming techniques and topical medications can be effective in treating mild-to-moderate disease, but more severe cases of PFB respond best to laser therapy. Limitations on shaving remain an important part of management, especially during flares of the disease and while initiating therapy. Long-term shaving profiles may be needed for treatment-resistant cases. The impact of the Navy's recent policy on PFB is also discussed.

Pseudofolliculitis Barbae is a prevalent skin disease in the Armed Forces. A better understanding of the disease and patients' individual needs by the health care provider and commander is paramount.