By Hope Mitchell, MD, FAAD
The Truth Contributor
It sometimes starts after shaving, razor bumps appear, followed by dark marks and bumps that linger long after the skin calms down. These can be signs of pseudofolliculitis barbae or PFB, a condition that many men with curly or coiled hair know all too well.
PFB isn’t just about discomfort after shaving. It is a medical condition that can lead to inflammation beneath the skin, resulting in hyperpigmentation and in some cases even scarring. That pigmentation isn’t just a cosmetic issue. Darker patches or uneven skin tone can affect confidence, emotional well-being, and even professional opportunities.
Recently, The U.S. Army published guidance that could change how PFB is managed in active duty. Under the new policy, soldiers with chronic cases of PFB who need shaving waivers for more than 12 months within two years may face removal from service. Permanent waivers may no longer be allowed, and units will be required to rebrief grooming standards. Medical personnel will need to prepare formal treatment plans for affected soldiers.
Laser therapy is mentioned as an option, although it entails cost, downtime, multiple treatments and a potential risk of pigment discoloration and scarring in melanin-rich skin AND there are no lasers on the market currently that treat gray hairs. The condition disproportionately affects Black men, and many experts estimate that up to sixty percent of Black men experience PFB.
The physiology behind PFB matters. Curly hair shafts are more likely to re-enter the skin when shaved too closely or pushed by pulling. Every time the skin is irritated, it responds with inflammation and potential infection. In melanin-rich skin, that inflammation often leaves dark marks that may remain longer than in other skin types. Repeated injury, if not managed, can accelerate changes in color, texture, and tone of the skin.
The intent to standardize grooming and appearance expectations and avoid open ended waivers while ensuring treatment for PFB is recognized. However, when these standards intersect with physiology that has a strong correlation with race or disproportionately affects a racial group – policy must be careful to avoid institutional inequality or discrimination.
From a dermatology standpoint, growing and maintaining a well-groomed beard may be the best solution for some patients. Furthermore, there is no conclusive data that a “modest beard interferes with mask function” (https://academic.oup.com/milmed/article/186/7-8/187/6040786?login=false).
So what can be done not just by those in uniform (military, law enforcement, public safety and first responders), but by anyone living with shaving irritation and its aftermath? First, early care matters. If you see razor bumps, notice swelling, or observe dark marks that don’t fade, see a dermatologist to obtain a proper diagnosis. Adjusting shaving practices and using soothing after-care: lightweight, anti-inflammatory ingredients like aloe, niacinamide, or dermatologist-guided creams can be beneficial. Protect your skin with daily broad-spectrum sunscreen—even on areas affected by PFB. UV exposure only deepens pigmentation and slows fading. Treatment plans may include anti-inflammatory topical or oral medications, medicated cleansers, and—when appropriate—procedures like peels or carefully chosen lasers, always tailored for melanin-rich skin.
Your Self-Care Prescription to managing PFB starts here:
- Shave smart: always in the direction of growth, with sharp blades, and without tugging.
- Soothe after: use calming, dermatologist-recommended ingredients to reduce inflammation.
- Protect daily: broad-spectrum sunscreen is non-negotiable, even for melanin-rich skin.
- Seek help early: don’t wait for scars—schedule a dermatology visit if irritation or pigment changes persist.