Best Practices for Managing Pseudofolliculitis Barbae

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.