Expert Consensus Supports Hair Removal Modification as First-Line Treatment for Pseudofolliculitis Barbae

A three-round Delphi consensus study published in JAMA Dermatology developed recommendations for diagnosing and managing pseudofolliculitis barbae (PFB), a chronic inflammatory condition caused by penetration of shaved, curved hair shafts into the skin. A panel of board-certified US dermatologists with PFB expertise evaluated statements using a nine-point Likert scale, with consensus predefined as at least 75% agreement. The available abstract does not report the panel size.

Forty statements covering diagnosis, medical and procedural management, and occupational considerations reached consensus. Experts supported modification of hair removal practices as first-line therapy, targeted topical and systemic treatments, and procedural interventions such as laser hair removal. No consensus was reached on a standardized grading scale, oral isotretinoin for refractory disease, superficial chemical peels, or multiblade razors.

The recommendations offer an expert-informed framework for clinical decision-making and occupational policy considerations. However, this was a consensus exercise rather than a comparative treatment trial and does not establish treatment effect sizes. The full text was unavailable for this update, limiting assessment of individual recommendations and their supporting evidence. Lack of consensus should not be interpreted as evidence that an intervention is ineffective.