Skip to main content

Military Health System

Important Notice about Pharmacy Operations

Change Healthcare Cyberattack Impact on MHS Pharmacy Operations. Read the statement to learn more. 

Surveillance Snapshot: Pseudofolliculitis barbae Cases in Active Component Service Members, 2000–2022

Image of Cover4_7614288. Current grooming standards of the U.S. military mandate facial shaving to ensure adequate fitting and sealing of protective masks, but a shaving waiver may be issued for medical reasons such as Pseudofolliculitis barbae, or for religious reasons, among others.

Pseudofolliculitis barbae, also known as “razor bumps” or “shaving bumps,” results from an inflammatory, foreign body reaction of the skin, caused by shortened and sharpened hair piercing to the epidermis and dermis.1 While PFB can affect any person who regularly shaves, literature demonstrates an increased prevalence for persons with tightly curly hair, particularly African American and Hispanic individuals, including service members in the U.S. military.1-3 Current grooming standards in the U.S. military mandate facial shaving to ensure adequate fitting and sealing of protective masks.1 A shaving waiver may be issued for medical reasons such as PFB, or for religious reasons, among others.1,4 

This Surveillance Snapshot describes the frequency of PFB cases among active component service members of the U.S. military from 2000 through 2022. A PFB case was counted once per year if the ACSM demonstrated either two outpatient or theater medical data store encounters within 60 days, or one inpatient encounter within the year. Overall, the frequency of PFB cases increased over the surveillance period and varied greatly by race/ethnicity, disproportionally affecting Non-Hispanic Black service members (Figure). Non-Hispanic Blacks, who have historically comprised 16-18% of the U.S military in the past 20 years,5-7 constitute a majority (63.5%) of PFB cases. The frequency trend is well out of proportion to the change in troop strength. The increase in reported cases from 50 in 2000 to 2,404 in 2022 may warrant further study. 

This graph depicts the frequency of Pseudofolliculitis barbae (PFB) cases according to race/ethnicity among active component service members of the U.S. military from 2000 through 2022. Four lines on the x-, or horizontal, axis represent 3 racial/ethnic groups, namely Hispanic, Non-Hispanic Black, and Non-Hispanic White, while a fourth line represents “Other/unknown” service members. Each line connects data points that chart, on the y-axis, the annual numbers of reported PFB case counts for each racial/ethnic group for every year from 2000 to 2022. Overall, the frequency of PFB cases increased over the surveillance period, but with a noticeable rise in cases between 2021 and 2022 for all racial/ethnic group categories. Starting in 2006, Non-Hispanic Black service members consistently had far higher numbers of PFB cases, noticeably increasing between 2007 and 2008, and spiking dramatically from 2021 to 2022. From 2008 until 2021, Non-Hispanic Black service members reported around 600 cases per year; that number exceeded 1,400 cases in 2022. From 2008 until 2014, Non-Hispanic White service members reported just in excess of 200 PFB cases per year, but from 2015 to 2021 those cases fell to under 100, in line with Hispanic and Other/unknown service member case numbers. In 2022 Non-Hispanic White service members reported nearly 450 cases, Hispanic service members reported just under 400 cases, and Other/unknown service members reported around 150 cases.

References

  1. Tshudy T, Cho S. Pseudofolliculitis barbae in the U.S. military, a review. Mil Med. 2021;186(1-2):52-57. https://doi.org/10.1093/milmed/usaa243
  2. Perry P, Cook-Bolden F, Rahman Z, Jones E, Taylor S. Defining Pseudofolliculitis barbae in 2001: a review of the literature and current trends. J Am Acad Dermatol. 2002;46(2):113-119. https://doi.org/10.1067/mjd.2002.120789
  3. Gelman A, Norton S, Valdes-Rodriguez R, Yosipovitch G. A review of skin conditions in modern warfare and peacekeeping operations. Mil Med. 2015;180(1):32-37. https://doi.org/10.7205/MILMED-D-14-00240
  4. Department of Defense. DoD Instruction 1300.17: Religious Liberty in the Military Services. 2020. Accessed August 1, 2023. https://www.esd.whs.mil/Portals/54/Documents/DD/issuances/dodi/130017p.pdf
  5. Barroso A. The changing profile of the U.S. military: smaller in size, more diverse, more women in leadership. 2019. Pew Research Center. Accessed August 2, 2023. https://www.pewresearch.org/short-reads/2019/09/10/the-changing-profile-of-the-u-s-military
  6. Department of Defense. 2017 Demographics Profile of the Military Community. 2017. Accessed August 2, 2023. https://download.militaryonesource.mil/12038/MOS/Reports/2017-demographics-report.pdf
  7. Department of Defense. 2021 Demographics Profile of the Military Community. 2021. Accessed August 2, 2023. https://download.militaryonesource.mil/12038/MOS/Reports/2021-demographics-report.pdf

Author Affiliations

Defense Health Agency, Armed Forces Health Surveillance Division, Epidemiology and Analysis Section

You also may be interested in...

Article
Sep 1, 2023

Update: Routine Screening for Antibodies to Human Immunodeficiency Virus, U.S. Armed Forces, Active and Reserve Components, January 2018–June 2023

This report provides an update through June 2023 of routine screening results for antibodies to HIV among members of the U.S. military. From January 2018 through June 2023, approximately 7 million U.S. military service members (active component, reserve component, and national guard) were tested for HIV antibodies; 1,502 were identified as HIV ...

Report
Aug 1, 2023

MSMR Vol. 30 No. 8 - August 2023

.PDF | 1.02 MB

The August 2023 MSMR provides the most recent data from the active surveillance program for acute respiratory disease and Group A Beta-Hemolytic Streptococcus among U.S. Army basic trainees; then summarizes the case report of an extensively resistant E. coli in a returning traveler at Hawai'i's Tripler Army Medical Center; followed by a Surveillance ...

Article
Aug 1, 2023

Active Surveillance for Acute Respiratory Disease Detected No Outbreaks at Four U.S. Army Basic Training Installations in 2022

This article presents the 2022 results of the active surveillance program for acute respiratory disease and Group A Beta-Hemolytic Streptococcus conducted by the Defense Centers for Public Health-Aberdeen at the four Army installations responsible for basic combat training or one-station unit training. This ARD surveillance program rapidly monitors, ...

Article
Aug 1, 2023

Case Report: Complicated Urinary Tract Infection Due to an Extensively Resistant Escherichia coli in a Returning Traveler

This article presents the medical case report of a 76-year-old man who returned to the U.S. following overseas travel and was admitted at Hawai'i's Tri­pler Army Medical Center with a complicated urinary tract infection due to an extensively resistant strain of E. coli.

Report
Jul 1, 2023

MSMR Vol. 30 No. 7 - July 2023

.PDF | 1.30 MB

This continuation of the June issue, which published the annual quantification of health care provided by the Military Health System, continues with the impacts of various illnesses and injuries in 2022 among deployed service members; medical evacuations out of theaters of military operation; health care provision to non-service member MHS ...

Article
Jul 1, 2023

Absolute and Relative Morbidity Burdens Attributable to Various Illnesses and Injuries Among Non-Service Member Beneficiaries of the Military Health System, 2022

This report represents an updated summary of care provided to non-service members in the MHS during calendar year 2022. MHS beneficiaries are diverse and heterogeneous, including active component service members, activated National Guard and Reserve service members, active component immediate family, retirees, and their family members, with differing ...

Article
Jul 1, 2023

Medical Evacuations out of U.S. Central and U.S. Africa Command Among Active and Reserve Components, U.S. Armed Forces, 2022

This report summarizes the nature, numbers, and trends of conditions for which military members were medically evacuated from the U.S. Central Command (CENTCOM) or Africa Central Command (AFRICOM) operations during 2022, with historical comparisons to the previous four years.

Article
Jul 1, 2023

Morbidity Burdens Attributable to Various Illnesses and Injuries Among Deployed Active and Reserve Component Service Members, U.S. Armed Forces, 2022

This annual estimate of illness- and injury-related morbidity and health care burdens on the U.S. Armed Forces and MHS updates previous analyses of these burden distributions among active and reserve component service members in deployed settings. This report focuses on the health encounters of service members during deployment to U.S. Central Command ...

Last Updated: September 13, 2023
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on X Follow us on YouTube Sign up on GovDelivery