A three-round Delphi study asked a panel of US dermatologists with expertise in pseudofolliculitis barbae to rate statements on diagnosis, behaviour change, medical and procedural treatment and occupational issues. Agreement required at least 75%. Published in JAMA Dermatology on 23 September 2026.
Forty statements reached consensus. Changing hair-removal practice was supported as first-line treatment, with targeted topical and systemic therapy and procedures such as laser hair removal. There was no agreement on a standard grading scale, on oral isotretinoin for refractory disease, on superficial chemical peels or on multiblade razors.
A Delphi panel records expert opinion, not trial results, and this one was entirely from the US. The condition is common in men with tightly curled hair, including many patients in India, and occupational shaving rules in the armed forces, police and some private employers can make it chronic. The occupational statements give dermatologists a basis for supporting a patient who needs an exemption.
- Start with changes to hair removal, such as not shaving close or stopping shaving if possible
- Treat inflammation and post-inflammatory pigmentation alongside behaviour change
- Consider laser hair removal for persistent disease, choosing settings suited to darker skin
- Document occupational shaving requirements and support exemptions where justified
Why it matters
It gives clinicians a structured plan, and occupational backing, for a condition often dismissed as cosmetic.
Don't overread it
This is expert consensus, not trial evidence, and the panel did not agree on isotretinoin or multiblade razors.
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