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Best Practices for Managing Pseudofolliculitis Barbae: An Expert Consensus Delphi Study
Simona A Alomary1,2, Nicole J Baker2,3, Grace Ugwueke4,5
1Rutgers New Jersey Medical School, Newark, New Jersey.
Importance:
Pseudofolliculitis barbae (PFB) is a chronic inflammatory disease caused by penetration of a shaved, curved hair shaft into the skin. Standardized recommendations for diagnosing and managing PFB are needed.
Objective:
To establish expert consensus recommendations outlining best practices for diagnosing and managing PFB.
Evidence Review:
A 3-round Delphi consensus study was conducted using a panel of board-certified US dermatologists with expertise in PFB. Consensus statements addressing diagnostic criteria, behavioral modification, topical and systemic therapies, procedural interventions, and occupational considerations were developed and evaluated using a 9-point Likert scale. Consensus was predefined as greater than or equal to 75% agreement.
Findings:
Forty statements associated with diagnostic criteria, medical and procedural management, and occupational considerations reached consensus. Behavioral modification of hair removal practices as first-line therapy, use of targeted topical and systemic treatments, and procedural interventions, such as laser hair removal, were supported. No agreement was reached regarding a standardized grading scale, the use of oral isotretinoin for refractory disease, superficial chemical peels, or the use of multiblade razors.
Conclusions And Relevance:
Using a Delphi consensus study approach, expert consensus guidelines were established for diagnosing and managing PFB. These recommendations provide an evidence-informed framework to support clinical decision-making, guide future research efforts, and help inform policy considerations associated with PFB management.
