Skip main navigation

Military Health System

Clear Your Browser Cache

This website has recently undergone changes. Users finding unexpected concerns may care to clear their browser's cache to ensure a seamless experience.

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
Jun 1, 2022

Absolute and Relative Morbidity Burdens Attributable to Various Illnesses and Injuries, Active Component, U.S. Armed Forces, 2021

In 2021, as in prior years, the medical conditions associated with the most medical encounters, the largest number of affected service members, and the greatest number of hospital days were in the major categories of injuries, musculoskeletal disorders, and mental health disorders. Despite the pandemic, COVID-19 accounted for less than 2% of total ...

Article
Jun 1, 2022

Ambulatory Visits, Active Component, U.S. Armed Forces, 2021

In 2021, the overall numbers and rates of active component service member ambulatory care visits were the highest of any of the last 10 years. Most categories of illness and injury showed modest increases in numbers and rates. The proportions of ambulatory care visits that were accomplished via telehealth encounters fell to under 15% in 2021, compared ...

Article
May 1, 2022

The Association Between Two Bogus Items, Demographics, and Military Characteristics in a 2019 Cross-sectional Survey of U.S. Army Soldiers

NIANTIC, CT, UNITED STATES 06.16.2022 U.S. Army Staff Sgt. John Young, an information technology specialist assigned to Joint Forces Headquarters, Connecticut Army National Guard, works on a computer at Camp Nett, Niantic, Connecticut, June 16, 2022. Young provided threat intelligence to cyber analysts that were part of his "Blue Team" during Cyber Yankee, a cyber training exercise meant to simulate a real world environment to train mission essential tasks for cyber professionals. (U.S. Army photo by Sgt. Matthew Lucibello)

Data from surveys may be used to make public health decisions at both the installation and the Department of the Army level. This study demonstrates that a vast majority of soldiers were likely sufficiently engaged and answered both bogus items correctly. Future surveys should continue to investigate careless responding to ensure data quality in ...

Article
May 1, 2022

Update: Sexually Transmitted Infections, Active Component, U.S. Armed Forces, 2013–2021

This illustration depicts a 3D computer-generated image of a number of drug-resistant Neisseria gonorrhoeae bacteria. CDC/James Archer

This report summarizes incidence rates of the 5 most common sexually transmitted infections (STIs) among active component service members of the U.S. Armed Forces during 2013–2021. In general, compared to their respective counterparts, younger service members, non-Hispanic Black service members, those who were single and other/unknown marital status, ...

Article
Mar 1, 2022

Brief Report: Refractive Surgery Trends at Tri-Service Refractive Surgery Centers and the Impact of the COVID-19 Pandemic, Fiscal Years 2000–2020

Cadet Saverio Macrina, U.S. Military Academy West Point, receives corneal cross-linking procedure at Fort Belvoir Community Hospital, Va., Nov. 21, 2016. (DoD photo by Reese Brown)

Since the official introduction of laser refractive surgery into clinical practice throughout the Military Health System (MHS) in fiscal year 2000, these techniques have been heavily implemented in the tri-service community to better equip and improve the readiness of the U.S. military force.

Article
Mar 1, 2022

Brief report: Using syndromic surveillance to monitor MIS-C associated with COVID-19 in Military Health System beneficiaries

Air Force 1st Lt. Anthony Albina, a critical care nurse assigned to Joint Base Andrews, Md., checks a patient’s breathing and heart rate during an intubation procedure while supporting COVID-19 response operations in Cleveland, Jan. 20, 2022.

SARS CoV-2 and the illness it causes, COVID-19, have exacted a heavy toll on the global community. Most of the identified disease has been in the elderly and adults. The goal of this analysis was to ascertain if user-built ESSENCE queries applied to records of outpatient MHS health care encounters are capable of detecting MIS-C cases that have not ...

Article
Mar 1, 2022

Update: Malaria, U.S. Armed Forces, 2021

Mosquitos – like this one, collected as part of a military study in North Carolina – were used during USAMRDC’s initial RTS,S vaccine studies nearly 40 years ago. (Photo courtesy: AFC Kimberly Barrera)

Malaria infection remains an important health threat to U.S. service members who are located in endemic areas because of long-term duty assignments, participation in shorter-term contingency operations, or personal travel. In 2021, a total of 20 service members were diagnosed with or reported to have malaria.

Article
Mar 1, 2022

Obesity prevalence among active component service members prior to and during the COVID-19 pandemic, January 2018–July 2021

Maintaining a healthy weight is important for military members to stay fit to fight. The body mass index is a tool that can be used to determine if an individual is at an appropriate weight for their height. A person’s index is determined by their weight in kilograms divided by the square of height in meters. (U.S. Air Force photo illustration by Airman 1st Class Destinee Sweeney)

This study examined monthly prevalence of obesity and exercise in active component U.S. military members prior to and during the COVID-19 pandemic. These results suggest that the COVID-19 pandemic had a small effect on the trend of obesity in the active component U.S. military and that obesity prevalence continues to increase.

Article
Mar 1, 2022

Surveillance Snapshot: Medical Separation from Service Among Incident Cases of Osteoarthritis and Spondylosis, Active Component, U.S. Armed Forces, 2016–2020

Marines hike to the next training location during Exercise Baccarat in Aveyron, Occitanie, France, Oct.16, 2021. Exercise Baccarat is a three-week joint exercise with Marines and the French Foreign Legion that challenges forces with physical and tactical training. Photo By: Marine Corps Lance Cpl. Jennifer Reyes

Osteoarthritis (OA) is the most common adult joint disease and predominantly involves the weight-bearing joints. This condition, including spondylosis (OA of the spine), results in significant disability and resource utilization and is a leading cause of medical separation from military service.

Skip subpage navigation
Refine your search
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