Military cases of a medical condition made worse by shaving have skyrocketed since 2000, with most of the growth in the past two years, a new Defense Department medical report shows.
As multiple services consider relaxing or amending the military-wide prohibition on beards, data shows that cases of pseudofolliculitis barbae, or PFB, are soaring.
The condition, which causes painful inflammation and razor bumps, affecting some 45% of Black service members, is one of a few reasons for granting a rare military shaving waiver.
In 2000, there were 50 reported cases of pseudofolliculitis barbae, according to the Defense Health Agency’s Medical Surveillance Monthly Report for August. In 2022, there were 2,404 ― an increase of 4,708%.
Just since 2020, the increase in pseudofolliculitis barbae cases has been drastic. They’re up from about 500 Black troops to more than 1,400 among Black troops in that time frame, and from 150 troops to about 400 troops each for White and Hispanic troops.
The report states that Black troops have composed a relatively steady 16%–18% of the total military force over the last 20 years.
The data survey did not address the entire population of troops with beard waivers, which can also be granted in conjunction with religious exemptions.
“The frequency trend is well out of proportion to the change in troop strength,” the short report states, adding that the matter “may warrant further study.”
In light of repeated requests from troops to reexamine the beard prohibition, the Navy in 2022 launched a study to examine whether facial hair impairs an oxygen mask’s ability to seal, a longstanding objection to allowing beards.
The Air Force, meanwhile, in 2022 completed an examination of “inclusive male grooming standards” led by military medical providers that concluded a more permissive facial hair policy would promote equity in the force.
Does the recent sharp rise in pseudofolliculitis barbae cases indicate then a growing awareness of the waiver option or a rising eagerness to exploit a policy loophole? Probably both, said Lt. Col. Simon Ritchie, an Air Force dermatologist at Joint Base Andrews, Maryland, who led the service’s inclusive grooming standards study.
Ritchie told Military Times that his interest in the subject began with his friendship with a Black colleague who confided that he’d missed out on a number of career opportunities, including a recruiter assignment and meetings with senior leaders, because his waiver-permitted beard was perceived as unprofessional.
“He ended up separating from the military because of that,” Ritchie said, despite his exemplary work performance.
The study Ritchie led for the Air Force, which began in 2018 and was released in 2022, found that the process of reviewing and granting shaving waivers was a drain on service resources, adding up to 18,000 annual office visits and nearly $5 million in costs.
It also demonstrated that the experience of Ritchie’s colleague was a common one: Shaving waivers were associated with longer times to promotion, reduced selection for special duty opportunities and lower retention, even when controlling for other factors like race, grade and education level. The study group ultimately recommended that the Air Force allow up to 1/4 inch of “neatly groomed” facial hair to eliminate the professional stigma and negative career outcomes.
“The big, real salient point here that was a surprise is that this is not in itself a race-based effect,” Ritchie said of the professional impact of shaving waivers. “But it becomes racially discriminatory when you look at the breakdown of shaving waiver holders, and that of course, is because of the prevalence of pseudofolliculitis bfarbae in that population.”
Black troops made up about 64% of the pseudofolliculitis barbae cases assessed in the Medical Surveillance Monthly Report report.
Earlier in his career, when he ran a shaving clinic for new trainees in San Antonio, Ritchie saw “dozens” of pseudofolliculitis barbae cases each week, he said. Allowing even 1/8 of an inch of hair growth, he said, precludes 99% of these cases.
That’s not to say that all reported cases are medically valid. Ritchie, who emphasized that he was just speculating based on experience, said it’s likely growing awareness of the shaving waiver option and a growing dismantling of some of the negative stereotypes around it have contributed to the increase in reported pseudofolliculitis barbae cases. But, he said, it remains incredibly easy to secure a diagnosis and waiver without a proven occurrence of the condition.
“People are looking around, [saying], ‘They have a beard; I want a beard. I don’t like shaving,’” Ritchie said. “‘So I’m going to go ahead and do it any way I can.’”
In the overworked field of military primary medical care, he said, providers are constantly under pressure to get to the next patient and shaving waiver requests are “an easy kill” when it comes to solving a patient’s problems. Then, he said, a lot of troops fail to understand the difference between pseudofolliculitis barbae and shaving dermatitis, or simple skin irritation from shaving.
“Shaving dermatitis is something that everybody gets because shaving is not a natural thing, and irritates the skin,” he said. “There’s a lack of understanding in the patient population, there’s a lack of understanding and primary care providers. And I don’t think it is their job to understand.”
While the Navy has yet to release findings from its study on mask fit with facial hair, Ritchie’s work included a review of prior studies. The most recent ones, from 2016, and 2018, found beards did not interfere with mask fit.
One proposal from Ritchie’s research team was to make the ability to fit and seal a mask a precondition for facial hair ― or require that troops agree to shave “if needed for readiness purposes.”
“At a time right now, where retention and recruitment is at an all-time low, we don’t feel like this is a smart way to be treating our people and our airmen,” Ritchie said, adding that many other militaries in the NATO alliance allow beards without any drawbacks to military readiness.
“We’ve talked about other forms of racial discrimination in the Air Force; this is a numbers-proven one,” he said. “And yet we’re not willing to do anything about it.”
Hope Hodge Seck is an award-winning investigative and enterprise reporter covering the U.S. military and national defense. The former managing editor of Military.com, her work has also appeared in the Washington Post, Politico Magazine, USA Today and Popular Mechanics.