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pseudofolliculitis barbae

Pseudofolliculitis Barbae

Review of Instruction and Treatment Guidelines

before you begin
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slide3

BUPERSINST 1000.22A

  • Purpose is to provide a standard requirement for uniform wear in the Navy.
  • Allows for facial hair for certain medical conditions such as uncontrollable pseudofolliculitis barbae (PFB) or severe facial scarring.
  • References: (a) BUPERSINST 1000.22A

(b) US Navy Uniform Regulations

(b) OPNAVINST 5100.19E

  • Forms: (a) NAVPERS 1000/1 PFB Shaving Waiver
slide4

Quick review

Which BUPERS Instruction provides the guidance needed for the PFB program?

slide5

Quick review

Which BUPERS Instruction provides the guidance needed for the PFB program?

BUPERSINST 1000.22A

what is it
What is it?
  • Often referred to as “razor bumps” or “barber’s itch,” PFB is the clinical term for persistent irritation caused by shaving.
  • This condition affects mainly the neck area but can affect any area of unshaved skin. In females it happens often when they try to trim their pubic hair, resulting in pseudofolliculitis pubis (PFP).
  • After a hair has been shaved it grows back. Curly hair, especially thick curly hair, has a tendency to curl back onto itself, causing irritation and having the potential to cause an infection.
slide7

Quick review

Which BUPERS Instruction provides the guidance needed for the PFB program?

BUPERSINST 1000.22A

A sailor develops “razor bumps” after some basic hygiene and trimming on her

bikini line. What is the medical term for this condition?

slide8

Quick review

Which BUPERS Instruction provides the guidance needed for the PFB program?

BUPERSINST 1000.22A

A sailor develops “razor bumps” after some basic hygiene and trimming on her

bikini line. What is the medical term for this condition?

Pseudofolliculitis Pubis (PFP)

what is it9
What is it?
  • As the sharp lip of closely shaved hair grows out, it curves sharply, forms a loop, and penetrates the skin adjacent to the hair follicle. Frequent shaving aggravates the problem, causing more and more hairs to become “bumps.”
  • Do not confuse this condition with ingrown hair, as the mechanism of hair entrapment is different.
  • PFB cannot be “cured” with conventional treatments or regimented shaving schedules, but it can be controlled.
slide10

Quick review

Which BUPERS Instruction provides the guidance needed for the PFB program?

BUPERSINST 1000.22A

A sailor develops “razor bumps” after some basic hygiene and trimming on her

bikini line. What is the medical term for this condition?

Pseudofolliculitis Pubis (PFP)

What is the difference between PFB and ingrown hairs?

slide11

Quick review

Which BUPERS Instruction provides the guidance needed for the PFB program?

BUPERSINST 1000.22A

A sailor develops “razor bumps” after some basic hygiene and trimming on her

bikini line. What is the medical term for this condition?

Pseudofolliculitis Pubis (PFP)

What is the difference between PFB and ingrown hairs?

Ingrown hairs never grow out past the skin and instead stay within the follicle, causing irritation and have the potential to cause an infection.

Pseudofolliculitis barbae has hair that grows out past the skin but because of the curly nature of the individual, it curves and grows back into the skin, causing irritation and a greater chance for infection.

uniform hygiene standards and pfb
Uniform / hygiene standards and PFB
  • PFB occurs predominantly in blacks and hispanics, but can affect a person from any race, especially if they have curly hair.
  • The condition is normally not a medical problem unless an individual is required to shave daily, which is what the Navy and Marine Corps take into consideration when deciding upon the “no-shave” status of active duty personnel.
slide13

Quick review

Which BUPERS Instruction provides the guidance needed for the PFB program?

BUPERSINST 1000.22A

A sailor develops “razor bumps” after some basic hygiene and trimming on her

bikini line. What is the medical term for this condition?

Pseudofolliculitis Pubis (PFP)

What is the difference between PFB and ingrown hairs?

Ingrown hairs never grow out past the skin and instead stay within the follicle, causing irritation and have the potential to cause an infection.

Pseudofolliculitis barbae has hair that grows out past the skin but because of the curly nature of the individual, it curves and grows back into the skin, causing irritation and a greater chance for infection.

Which races are at higher risk for developing pseudofolliculitsbarbae?

slide14

Quick review

Which BUPERS Instruction provides the guidance needed for the PFB program?

BUPERSINST 1000.22A

A sailor develops “razor bumps” after some basic hygiene and trimming on her

bikini line. What is the medical term for this condition?

Pseudofolliculitis Pubis (PFP)

What is the difference between PFB and ingrown hairs?

Ingrown hairs never grow out past the skin and instead stay within the follicle, causing irritation and have the potential to cause an infection.

Pseudofolliculitis barbae has hair that grows out past the skin but because of the curly nature of the individual, it curves and grows back into the skin, causing irritation and a greater chance for infection.

Which races are at higher risk for developing pseudofolliculitsbarbae?

Hispanics and blacks

uniform hygiene standards and pfb15
Uniform / hygiene standards and PFB
  • Personnel diagnosed with PFB and placed on permanent or temporary “no-shave” status will maintain facial hair at a length no greater than ¼ inch.
  • The beard will not become unkempt and will not be manicured to any style.
  • The member will comply with all four phases of the treatment protocol and understand that although the medical department gives the diagnosis, it is the Commanding Officer that determines whether the “no-shaving” status will granted, or if the member will instead be processed for Administrative Separation under MILPERSMAN article 1910-120.

Incorrect (manicured)

Correct (trimmed, not manicured)

slide16

Quick review

If granting of the permanent “no-shave” status is determined to be detrimental

to good order and discipline by the Commanding Officer, the member may be

recommended for Administrative Separation under which article?

slide17

Quick review

If granting of the permanent “no-shave” status is determined to be detrimental

to good order and discipline by the Commanding Officer, the member may be

recommended for Administrative Separation under which article?

MILPERSMAN article 1910-120

administrative requirements
Administrative Requirements

The following requirements must be met in

order to place sailors and Maries on the PFB

“no-shave” program, as well as to properly

process them out via Administrative Separation:

  • Certified copy of NAVPERS 1000/1 Pseudofolliculitis Barbae Shaving Waiver
  • Commanding Officer’s comments relative to their recommendation. Documentation of command impact of inability to perform military duties must be provided
  • NAVPERSCOM (PERS-00H) will monitor the program as part of the Navy Affirmative Action Plan (NAAP).
slide19

Quick review

If granting of the permanent “no-shave” status is determined to be detrimental

to good order and discipline by the Commanding Officer, the member may be

recommended for Administrative Separation under which article?

MILPERSMAN article 1910-120

What form is filled out when giving a sailor or Marine a waiver from shaving?

slide20

Quick review

If granting of the permanent “no-shave” status is determined to be detrimental

to good order and discipline by the Commanding Officer, the member may be

recommended for Administrative Separation under which article?

MILPERSMAN article 1910-120

What form is filled out when giving a sailor or Marine a waiver from shaving?

NAVPERS 1000/1

the program
The program

The “no-shave” waiver consists of 3-parts:

  • PHASE I: Control of mild cases (less than 20-30 small papules or rare pustules)
  • PHASE II: Control of moderate cases (20 – 60 papules with pustules) or cases unresponsive to Phase 1
  • PHASE III: Control of severe cases or in those cases unresponsive to Phases I and II
  • PHASE IV: Control of severe cases or cases unresponsive to Phases I, II, and III
slide22

Quick review

If granting of the permanent “no-shave” status is determined to be detrimental

to good order and discipline by the Commanding Officer, the member may be

recommended for Administrative Separation under which article?

MILPERSMAN article 1910-120

What form is filled out when giving a sailor or Marine a waiver from shaving?

NAVPERS 1000/1

A Marine with approximately 40 papules and no pustules will be placed in what

Phase of the PseduofolliculitisBarbae treatment protocol?

Phase II

slide23

Quick review

If granting of the permanent “no-shave” status is determined to be detrimental

to good order and discipline by the Commanding Officer, the member may be

recommended for Administrative Separation under which article?

MILPERSMAN article 1910-120

What form is filled out when giving a sailor or Marine a waiver from shaving?

NAVPERS 1000/1

A Marine with approximately 40 papules and no pustules will be placed in what

Phase of the PseduofolliculitisBarbae treatment protocol?

Phase II

phase i mild cases less than 20 30 papules or rare pustules
Phase I: Mild cases(Less than 20 – 30 papules or rare pustules)

Preparing for the first shave

  • Totally avoid shaving for 3 – 4 weeks or until all lesions have subsided.
  • Apply Vioform-HC cream to affected area each morning and Retin-A cream to affected area each night. Use both medicines as tolerated.
  • Brush the beard in a circular motion with a soft brush or medium-to-firm toothbrush 4 times a day for 3-5 minutes each time.
slide25

Quick review

If granting of the permanent “no-shave” status is determined to be detrimental

to good order and discipline by the Commanding Officer, the member may be

recommended for Administrative Separation under which article?

MILPERSMAN article 1910-120

What form is filled out when giving a sailor or Marine a waiver from shaving?

NAVPERS 1000/1

A Marine with approximately 40 papules and no pustules will be placed in what

Phase of the PseduofolliculitisBarbae treatment protocol?

Phase II

How long should a member wait to shave when placed on the program?

slide26

Quick review

If granting of the permanent “no-shave” status is determined to be detrimental

to good order and discipline by the Commanding Officer, the member may be

recommended for Administrative Separation under which article?

MILPERSMAN article 1910-120

What form is filled out when giving a sailor or Marine a waiver from shaving?

NAVPERS 1000/1

A Marine with approximately 40 papules and no pustules will be placed in what

Phase of the PseduofolliculitisBarbae treatment protocol?

Phase II

How long should a member wait to shave when placed on the program?

3 – 4 weeks or until all bumps have subsided

phase i mild cases less than 20 30 papules or rare pustules27
Phase I: Mild cases(Less than 20 – 30 papules or rare pustules)

The first shave and beyond

  • Soften the beard first with a hot and wet washcloth for at least 5 minutes
  • Use a lubricating shave gel and a single blade shaving razor. You can also use an electric razor or trimmer as long as its designed for use with PFB.
  • Shave with the grain of the beard and DO NOT stretch the skin. Use only one stroke over each area of the beard.
  • Shave only every 2 to 3 days if using a manual shaver, or every other day if using an electrical shaver.
  • Apply Vioform-HC cream at the first sign of irritation or papule formation.

Use only single-bladed razors!

slide28

Quick review

If granting of the permanent “no-shave” status is determined to be detrimental

to good order and discipline by the Commanding Officer, the member may be

recommended for Administrative Separation under which article?

MILPERSMAN article 1910-120

What form is filled out when giving a sailor or Marine a waiver from shaving?

NAVPERS 1000/1

A Marine with approximately 40 papules and no pustules will be placed in what

Phase of the PseduofolliculitisBarbae treatment protocol?

Phase II

How long should a member wait to shave when placed on the program?

3 – 4 weeks or until all bumps have subsided

What are the basic guidelines to follow in Phase I of the PFB Treatment Protocol?

slide29

Quick review

If granting of the permanent “no-shave” status is determined to be detrimental

to good order and discipline by the Commanding Officer, the member may be

recommended for Administrative Separation under which article?

MILPERSMAN article 1910-120

What form is filled out when giving a sailor or Marine a waiver from shaving?

NAVPERS 1000/1

A Marine with approximately 40 papules and no pustules will be placed in what

Phase of the PseduofolliculitisBarbae treatment protocol?

Phase II

How long should a member wait to shave when placed on the program?

3 – 4 weeks or until all bumps have subsided

What are the basic guidelines to follow in Phase I of the PFB Treatment Protocol?

Soften beard with warm, wet washcloth before shaving

Use only approved razors and moisturizing lotions

Shave with the grain

Shave every 2 days if using electric razor, or every 3-4 days if using manual razor Apply Vioform-HC cream at first sign of irritation

slide30

Phase II: Moderate cases(Less than 20 – 60 papules or cases unresponsive to Phase I)

Phase II continues the same basic principles

as the first phase but provides for the use of

depilatories to help clear up stubborn areas.

The two depilatories are:

  • Barium sulfide
  • Calcium triglycolate

The patient must be educated thoroughly on

how to properly use either depilatory because of

their caustic nature and ability to cause severe

irritation to the already affected area

slide31

Phase II: Moderate cases(Less than 20 – 60 papules or cases unresponsive to Phase I)

Barium sulfide

  • Use only every 2 – 3 days.
  • Use only the mildest form that works.
  • Apply to small areas at a time, about ¼ to ½ of the face and remove no later than 3 minutes after applying.
  • Give the patient a spatula or tongue blade or other blunt straight edge instrument to remove. He can also use a butter knife if needed.
  • If some hairs remain after removing the cream, wait 30 – 60 seconds and reapply.
  • When done, neutralize the depilatory with a diluted vinegar solution (1 teaspoon per pint of water) then rinse again with tap water.
  • Apply Vioform-HC cream if irritation develops
slide32

Phase II: Moderate cases(Less than 20 – 60 papules or cases unresponsive to Phase I)

Calcium triglycolate

  • Apply only to bearded areas
  • Leave on for 5 to 10 minutes
  • Use spatula, tongue blade, butter knife, or other blunt straight edge to remove the material with strokes against the direction of hair growth
  • Rinse thoroughly 2 – 3 times
  • Apply Vioform-HC cream if irritation develops
slide33

Quick review

What is the main difference between Phase I and Phase II of the PFB

Treatment Protocol?

slide34

Quick review

What is the main difference between Phase I and Phase II of the PFB

Treatment Protocol?

Phase II incorporates the use of depilatories to help with hair removal

slide35

Quick review

What is the main difference between Phase I and Phase II of the PFB

Treatment Protocol?

Phase II incorporates the use of depilatories to help with hair removal

What should be applied to the face if irritation develops after using either of

the two recommended depilatories?

slide36

Quick review

What is the main difference between Phase I and Phase II of the PFB

Treatment Protocol?

Phase II incorporates the use of depilatories to help with hair removal

What should be applied to the face if irritation develops after using either of

the two recommended depilatories?

Vioform-HC

slide37

Phase III: Severe cases(Severe cases or those unresponsive to Phases I and II)

Phase III is the final phase of the protocol

before the patient is referred to dermatology

  • Discontinue use of depilatory cream prescribed in Phase II
  • Return to Phase I protocol and avoid shaving for 3 - 4 weeks and resume applying Retin-A cream nightly and Vioform-HC cream every morning.
  • After 3 - 4 weeks resume shaving with a barber’s clipper. Be sure to use the clipping guard to prevent a shave closer than 1mm. Shave against the direction of hair growth.
  • Shave daily while on Phase III of the protocol
slide38

Quick review

What is the main difference between Phase I and Phase II of the PFB

Treatment Protocol?

Phase II incorporates the use of depilatories to help with hair removal

What should be applied to the face if irritation develops after using either of

the two recommended depilatories?

Vioform-HC

TRUE OR FALSE: Phase III of the Treatment Protocol involves shaving daily

with barber’s clippers as well as using depilatory creams on problem areas.

slide39

Quick review

What is the main difference between Phase I and Phase II of the PFB

Treatment Protocol?

Phase II incorporates the use of depilatories to help with hair removal

What should be applied to the face if irritation develops after using either of

the two recommended depilatories?

Vioform-HC

TRUE OR FALSE: Phase III of the Treatment Protocol involves shaving daily

with barber’s clippers as well as using depilatory creams on problem areas.

False. Phase III includes shaving with barber’s clippers, however, use of depilatory creams should be discontinued.

slide40

Quick review

What is the main difference between Phase I and Phase II of the PFB

Treatment Protocol?

Phase II incorporates the use of depilatories to help with hair removal

What should be applied to the face if irritation develops after using either of

the two recommended depilatories?

Vioform-HC

TRUE OR FALSE: Phase III of the Treatment Protocol involves shaving daily

with barber’s clippers as well as using depilatory creams on problem areas.

False. Phase III includes shaving with barber’s clippers, however, use of depilatory creams should be discontinued.

What happens in Phase IV of the Treatment Protocol?

slide41

Quick review

What is the main difference between Phase I and Phase II of the PFB

Treatment Protocol?

Phase II incorporates the use of depilatories to help with hair removal

What should be applied to the face if irritation develops after using either of

the two recommended depilatories?

Vioform-HC

TRUE OR FALSE: Phase III of the Treatment Protocol involves shaving daily

with barber’s clippers as well as using depilatory creams on problem areas.

False. Phase III includes shaving with barber’s clippers, however, use of depilatory creams should be discontinued.

What happens in Phase IV of the Treatment Protocol?

Referral to dermatology for advanced care

slide42

End of slideshow

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