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Biloxi Days: Pseudo-Folliculitis

In 1974 an Okinawa-based dermatologist and Army Major named Alvin Alexander and his co-author, a physician at Montefiore Hospital in New York, wrote a paper entitled “Pseudofolliculitis Barbae (PFB) in the Military.”

Some excerpts:

"Pseudofolliculitis Barbae, colloquially known as ‘razor bumps’ or ‘shaving bumps,’ undoubtedly has been with us for centuries, but it was not accurately described and named until 1956 when Strauss and Clinton delineated the pathogenesis of the disorder Pseudofolliculitis Barbae that caused the problem. 

"This condition is far more common and much more severe among black males, and is facilitated by the natural curvature of the hair and hair follicle in this race. … They noted regular shaving to be the precipitating stimulus." …

"The most effective treatment is the beard. Not only has this been our experience but the experience of most dermatologists. By allowing the beard to grow, the hairs are ultimately freed from their pseudo-follicles by a combination of physical force that results in the upward movement of the hair so that the embedded hairs in the skin are dislodged. The net effect of this is the healing of the lesions with or without scarring."

The paper goes on at embarrassing length to debunk and argue against the plethora of reasons devised by the military at the time for the prohibition of beards, especially in the Army and the Air Force.

“Managing PFB in the Air Force is particularly frustrating,” Major Alexander wrote. “Discrepancies arise because no practical guideline is given for PFB or other specific dermatologic problems, therefore, local bases are allowed to ‘invent’ policy dependent upon the opinion of area commanders. To validate these policies, the Air Force draws on its career medical officers who, too often, find it easy to go along with the commander's opinion. These validations, highly susceptible to challenge, are used exclusively to override previous medical data based on unbiased scientific investigation. This unfortunate sequence of events is being used in the Air Force to justify the continual harassment of black airmen.” …

“One of the guidelines for treatment implies that with proper care and adherence to a given shaving procedure PFB will not recur; and it goes so far as to state, ‘If the disease recurs after resumption of shaving, the patient (typically a black airman) is doing something wrong’.”

“Prevailing military attitudes as to why blacks primarily have PFB completely negate the facts that have already been documented in existing medical literature. Commanders and supervisors instead insist on making purely racist allegations such as that servicemen deliberately have placed gasoline, lighter fluid or jet fuel on their face to ‘create’ the condition. While it is true that these agents may cause damage to the skin, they cannot produce PFB.” …

" ‘Only militants and radicals wear beards’ is the cry by many in leadership positions. As a result of these judgments, fines and harassment have plagued numerous blacks who have refused to submit themselves to the existing regulations which spawn intimidation and smack of ignorance." …

"Existing Air Force regulations do not permit the treatment that is required (a beard). But it has already been demonstrated that there is no shaving method that can be relied upon to properly or satisfactorily controlled yet be. Therefore men with the problem are authorized by physicians to wear beards. This medical recommendation is met by the Air Force with constant administrative surveillance of the treatment. Every two weeks the patient is reevaluated and may be ordered to shave at any time. The fact that the condition will simply recur has no credibility in this kind of system. The fact that it is decidedly uncomfortable and some cases painful to allow the beard to grow out again is of no issue. The fact that thousands of men must report to the dispensary to receive this evaluation periodically instead of being constructive in their career fields is meaningless and insignificant. And the fact that increasing resentment is developing among the ranks of black servicemen because of unjust treatment is and will continue to be denied until a major confrontation occurs. American history is full of such ex post facto remedial maneuvers that, because of their tardiness, are only partially effective and of highly questionable sincerity." …

"It's because the existing military system of monitoring shaving profiles (providing waivers) stimulates the development of an adversary relationship between the black serviceman and his supervisor and/or commander, who is usually white, a large number of blacks feel they are victims of unfair discrimination. In fact, when asked if they felt they were being unfairly harassed because they wore beards, only 50% of black servicemen said no. Of those who felt they had been unfairly harassed, 72% were of the opinion that the harassment was racially motivated." …

"We can find no justification for prolonging the continual denial of the medical nature of PFB. We can no longer stand idly by and allow the military to think that black personnel wearing beards as treatment for PFB can be hidden from public view, harassed by bigoted, narrow-minded commanders and supervisors blind to any form of reason and deprived of promotion or continuation in the military because this dermatological condition is best and often treated by not shaving." …

"We submit that the entire problem of Pseudofolliculitis Barbae in the military, its medical, administrative and social ramifications, can be best and most effectively dealt with by the servicewide acceptance of a voluntary growth of a beard by any service member."

Four years before this paper was written, I might have been one of those "bigoted, narrow-minded commanders" the Army major was talking about, "blind to any form of reason." 

One afternoon in late 1969, my Field Maintenance Squadron First Sergeant, Sergeant Johnson, white, said that a black airman wanted to speak to me about his beard.

"Of course, send him in," I loftily replied, a shavetail lieutenant age 24 shoved into the position of Squadron Commander that called for an experienced Lieutenant Colonel that I had no real experience for because most experienced aircraft maintenance officers were in Vietnam at the time, not at a Keesler AFB overseeing a pilot training maintenance organization.

The airman proceeded to show me how frequent shaving was irritating his skin. He said he needed to stop shaving in order to solve the problem but that Air Force regulations prohibited beards. This, of course, was the first I'd heard of the problem, so I told the airman I’d get back to him.

As far as I was concerned, as long as the beard didn't interfere with his duties or the good order and discipline of the squadron, I didn't care whether he wore a beard or not. But could I simply say Go ahead in defiance of USAF regs?

Sergeant Johnson came in the office and told me that if I authorized the airman to wear a beard, it wouldn't be long before all the black airmen would want to wear beards even though the skin problem didn't seem prevalent. Surely Sergeant Johnson was exaggerating.

"Well, can we require him to get a doctor’s diagnosis from the base hospital?"

"Sure, but everybody gets those. They're easy to get. The doctors just hand out waiver forms to anyone who wants one."

I called up the hospital’s presiding physician who emphatically stated that his staff did not just give them out, but did issue waivers when they diagnosed the actual condition. That seemed reasonable to me so that's what we decided to do — waivers as needed.

It turned out Sergeant Johnson was right, that almost all the black airmen in the squadron wanted beard waivers. And it was almost impossible to turn anyone down once the waiver policy was established.

This was in the late 60s and early 70s when longer hair and beards were common in the civilian population, and many airmen of whatever ethnicity believed that long hair and beards were essential to their general grooviness and all-round appeal to the opposite sex. Skin condition was not the primary consideration.

And so it was not surprising to learn that as more and more black airmen started growing beards, the whining commenced among white airmen that black airmen were getting favorable treatment by being allowed to grow beards.

I continued to tell anyone who asked that as long as it didn't affect job performance, what the hell? 

Fortunately, I was transferred to a non-command staff position in late 1972, and as far as I know, the problem, such as it is, has not reached the levels that Major Alexander was worried about. In fact, race relations in the military were and are probably better than in the general civilian population.

The last report I’ve seen on the issue was from a USAF press release from Beale AFB (near Yuba City) last March: “The goal of the shaving waiver is to allow the skin to heal and prevent the recurrence of PFB. In accordance with Air Force Instruction 36-2903, Dress and Appearance, the length of facial hair cannot exceed one-quarter of an inch. Facial hair must be grown out naturally, any shaping or styling of facial hair is not allowed, and facial hair cannot interfere with the wearing of any personal protective gear, such as a gas mask or performance of duties. If this should happen, the member's ability to perform duties safely is compromised and they may require an evaluation to determine fitness for particular military duties.”

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