Ethnic Equity Implications in the Management of Pseudofolliculitis Barbae

Challenges: Past and Present

Little research was done about this disease until the 1960s and 1970s, a time when more and more Black men were enrolling in the military and were subsequently subject to its “clean shave policy.” This policy was initially enforced to ensure good personal hygiene and a secure gas mask seal and to instill discipline.^3,4 Thus, interpersonal friction and stigma arose if Black men were not able to shave due to PFB and consequently had an appearance violating the previously mentioned policy. There was a recent publication in Military Medicine addressing the discrimination Black men in the military face with regards to shaving, with additional studies showing Black men in the US Army were more likely to underreport the severity of PFB or refuse medical help for fear of harassment.^3,5 Outside the military, Black men who are not clean-shaven are often deemed as unprofessional and subjected to discrimination.^6,7 Ethnocentric societal pressures, stigma, and racial biases have persisted in our society. For example, a police officer had to have a medical waiver from the cleanly shaven policy renewed every 60 days.⁷ The time and costs associated with obtaining this waiver place an unfair burden on those afflicted with this condition.

Action Statement

This societal mistreatment of patients with PFB not only represents a failure of our country to treat these men with dignity but also an opportunity for our profession to advocate for these patients. Increased awareness of this condition and its management by primary care providers may help reduce the impact of this disease on our patients. Therefore, it is imperative the primary care provider can diagnose and provide patient-centric care, which includes the documentation and support needed to stop workplace discrimination. In light of various professional organizations, including the Centers for Disease Control and Prevention, recognizing racial injustice as a serious public health issue, all physicians can work toward educating the general population, including employers, about the legitimacy of PFB.

We must also continue to pursue research in this condition to provide affordable and practical management options for patients who strongly desire keeping a beard. Our professional support actions can help reduce stigma and lead to improvements in the physical and psychological well-being of this historically mistreated population.

Image used with permission from VisualDx (www.visualdx.com).