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Although this is mostly an administrative problem, it is of importance to the operational primary care provider.  The Department of Defense does not require clean shaven faces merely for the sake of military appearance.  Grooming is important because bearded faces have greater difficulty in obtaining gas tight seals on a gas mask or oxygen breathing apparatus.  The practice of liberally giving "no shave chits" besides being unprofessional may actually harm your patient in certain operational situations.  BUPERS instruction 1000.22 and Marine Corps Order 6310.1B outline the current program and administrative procedures including the phases of therapy and how to properly use them.  

Although some patients truly must grow short, well-trimmed beards as the only way to control their PFB, the majority of motivated patients can be helped by simple measures.  Most PFB patients are quite motivated, but need your interest and guidance.  Your attention to this frequently misunderstood problem will reap great rewards.  You will be rewarded by the respect of your patients and better clinical results.

First of all, make sure that the patient truly has PFB.  Some patients may also have coexistent acne, which is worsened by the act of shaving.   Examine the skin carefully.  Treatment of PFB alone in the presence of coexisting acne is doomed to failure.  Both conditions must be approached simultaneously.

Most cases of PFB require a period of no shaving to give the inflamed hairs a change to grow out to let the inflammation die down.  Mild cases may require only 2 weeks of "no shave" whereas more severe cases frequently need 4 weeks or longer.  Impacted hairs can be delicately dislodged during this period by gently massaging them (barely touching the face) using a circular motion with an extra soft toothbrush.

Once grooming is resumed, remember that the goal is to have some "stubble" remain on the problematic areas.  This is done by "shaving with the grain", whether one is using a PFB razor, electric razor, beard clipper, or removing with a chemical depilatory.  Going "against the grain" defeats the whole strategy of leaving "stubble" because the hairs would be cut shorter.  The act of hair removal is more physically irritating to the skin.

 Chemical depilitory products can play a role in some, but not all patients. Several patients prefer to use these products despite an unpleasant smell during their use.  The most widely available of several commercial products is Magic Shave.  The instructions on the container need to be explicitly followed or else an irritant dermatitis will almost always occur.  Even if properly used, many patients develop a mild tightness and chapping of the face and neck. Be careful.

Written and revised by CAPT Dennis A. Vidmar, MC, USN, Department of Military and Emergency Medicine, and Department of Dermatology, Uniformed Services University of the Health Sciences, Bethesda, MD (1999).