Best Practices for Managing Pseudofolliculitis Barbae: An Expert Consensus Delphi Study.

IMPORTANCE: Pseudofolliculitis barbae (PFB) is a chronic inflammatory disease caused by penetration of a shaved, curved hair shaft into the skin. Standardized recommendations for diagnosing and managing PFB are needed. OBJECTIVE: To establish expert consensus recommendations outlining best practices for diagnosing and managing PFB. EVIDENCE REVIEW: A 3-round Delphi consensus study was conducted using a panel of board-certified US dermatologists with expertise in PFB. Consensus statements addressing diagnostic criteria, behavioral modification, topical and systemic therapies, procedural interventions, and occupational considerations were developed and evaluated using a 9-point Likert scale. Consensus was predefined as greater than or equal to 75% agreement. FINDINGS: Forty statements associated with diagnostic criteria, medical and procedural management, and occupational considerations reached consensus. Behavioral modification of hair removal practices as first-line therapy, use of targeted topical and systemic treatments, and procedural interventions, such as laser hair removal, were supported. No agreement was reached regarding a standardized grading scale, the use of oral isotretinoin for refractory disease, superficial chemical peels, or the use of multiblade razors. CONCLUSIONS AND RELEVANCE: Using a Delphi consensus study approach, expert consensus guidelines were established for diagnosing and managing PFB. These recommendations provide an evidence-informed framework to support clinical decision-making, guide future research efforts, and help inform policy considerations associated with PFB management.