Comparative Effectiveness of Hair Removal-Based Versus Topical/Light Therapies in the Management of Pseudofolliculitis Barbae and Related Follicular Occlusion Disorders

Authors

• Jeffery A. Rueben, University of LynchburgFollow

Specialty

Family Practice

Advisor

Dr. Sandra Keavey

Abstract

This systematic review evaluates and compares the clinical effectiveness of conservative topical therapies, hair removal-based interventions, and light or energy-based modalities for the management of pseudofolliculitis barbae (PFB) and related follicular occlusion disorders to include acne keloidalis nuchae (AKN) and hidradenitis suppurativa (HS). A comprehensive search of electronic databases including PubMed, Google Scholar, the Cochrane Library, Military Technical Bulletins, and the Defense Technical Information Center was conducted to identify relevant, peer-reviewed primary studies and systematic reviews published between 2020 and 2026 involving adult populations. The body of evidence demonstrates a clear therapeutic continuum, progressing from conservative behavioral modifications and topical agents to more definitive energy-based procedures, with laser hair removal (LHR) emerging as the primary definitive intervention. Although a true cure remains elusive, LHR offers superior long-term disease management and symptom control compared with traditional topical regimens. Nevertheless, current literature is constrained by significant methodological limitations and key evidence gaps, including small sample sizes, female-predominant study cohorts, a paucity of randomized controlled trials, and a distinct lack of long-term post-treatment follow-up data. Furthermore, clinical practice suffers from an absence of standardized treatment guidelines, alongside marked variability in laser modalities and energy parameters utilized across published studies. Future research must prioritize the development of standardized clinical treatment algorithms, the rigorous evaluation of long-term outcomes, and direct comparative effectiveness trials of various laser platforms in both military and civilian populations. In conclusion, current evidence supports the safety and clinical efficacy of laser hair removal as the principal definitive treatment for severe or recalcitrant PFB, while underscoring the urgent necessity for standardized treatment protocols and high-quality, long-term comparative investigations.

Recommended Citation

Rueben JA. Comparative Effectiveness of Hair Removal-Based Versus Topical/Light Therapies in the Management of Pseudofolliculitis Barbae and Related Follicular Occlusion Disorders. University of Lynchburg Doctoral Project Assignment Repository. 2026; 8(3).