A dermatologist’s tips for ingrown hairs | Dr Dray

by | Nov 14, 2017 | Blog, skin care

 

Ingrown hairs (pseudofolliculitis barbae)

Ingrown hairs  are a pesky skin problem that occur after shaving, plucking, tweezing, threading, or waxing hair. Also referred to as “ingrowns” or “razor bumps,” they can occur on any body site where the hair is removed, including the face, neck, armpits, thighs, buttocks, bikini line, pubic area, and legs. They also can occur in skin folds and scars.  The medical term for this condition is pseudofolliculitis barbae.

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What causes ingrown hairs?

Ingrown hairs happen because as the cut hair starts to grow back, the curve of the growing hair pierces the skin next to the hair.  Rather than growing outward, the hair grows downward into the pierced skin.  The body mounts an inflammatory response to the ingrown hair.  This is called a foreign body reaction and is similar to what happens when a wooden splinter gets stuck under the skin.

Who gets ingrown hairs?

It occurs more often in people with curly hair, because the curl of the hair facilitates the sharp pointed end of a recently cut hair in piercing the nearby skin as it grows back.  This problem is more prevalent in men of African ancestry than among Caucasian men.  Women of all races are also affected. 

What do ingrown hairs look like?

Ingrown hairs commonly occur in the beard area and present as pimple-like, itchy or painful, red bumps.  These bumps often look like acne and bleed easily when shaved.  Because the hair and neighboring skin become inflamed, the affected area is susceptible to bacterial infections, leading to painful pus bumps.    

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A dermatologist's tips for ingrown hairs Pseudofolliculitis Barbae folliculitis face & neck ICD 10 L73.1

Ingrown hairs along the jaw, presenting as inflammed, red, pimple-like bumps.

 

What complications can happen from ingrown hairs?

In addition to skin infections, other complications include:

  • Hyperpigmentation and dark spots in the inflamed areas.
  • Thick and/or keloid scar formation.
  • Temporary or permanent hair loss.

How can I prevent ingrown hairs?

If possible, stop hair removal for 30 days to eliminate ingrown hairs. When ready to shave again:

  1. Remove pre-existing hairs with electric clippers, leaving about 1–2 mm of stubble
  2. Wash the area with a non-abrasive, over-the-counter medicated acne soap containing either salicylic acid, glycolic acid, or benzoyl peroxide.  These ingredients exfoliate the surface skin cells and reduce the likelihood of new inflamed spots.
  3. Rinse area with water, then compress face with warm tap water for several minutes
  4. Use a shaving cream of your choice and massage it onto the skin prior to hair removal.  Do not allow the lather to dry; if it does, then reapply it.
  5. Use a sharp blade (whichever type seems to cut best but not too close) and shave with the grain of the hair using short even strokes with minimal tension (and no more than twice over one area).  In hard-to-shave areas, shaving against the grain may be unavoidable.
  6. After shaving, rinse with tap water and then apply the most soothing and moisturizing aftershave preparation of your choice.

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Helpful washes, shaving creams, & aftershaves

Benzoyl peroxide washes

Salicylic acid washes

Shaving creams/foams

Soothing aftershave

Are there medical treatments for ingrown hairs?

Because ingrown hairs can lead to skin infections, hyperpigmentation, scarring, and hair loss, seeing a dermatologist for evaluation and management is important, as some cases require prescription medications to prevent or treat these complications.  Examples of treatments that a dermatologist might offer or prescribe include:

1.  Steroid creams to reduce mild inflammation and itching.

2.  Acne medications, like prescription tretinoin, to soften the skin around the hair and prevent ingrown hairs.

3.  Prescription hydroquinone cream to decrease hyperpigmentation.

4.  Oral or topical antibiotics to both decrease inflammation and treat any skin infection. 

5.  Photodynamic therapy has been successful.   

6.  Eflornithine cream, intense pulse light therapy, and laser hair removal to prevent recurrences.

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References

Callender V, Young CM. Combination Laser and Eflornithine HCL 13.9% Cream: A First-line Therapy for Fitzpatrick Type IV-VI Patients With Excessive Facial Hair. J Am Acad Dermatol. Mar 2005.

Diernaes JE, Bygum A. Successful treatment of recalcitrant folliculitis barbae and pseudofolliculitis barbae with photodynamic therapy. Photodiagnosis Photodyn Ther. 2013;10(4):651–3. PubMed.

Emer JJ. Best practices and evidenced-based use of the 800 nm diode laser for the treatment of pseudofolliculitis barbae in skin of color. J Drugs Dermatol. 2011 Dec. 10(12 Suppl):s20-2. PubMed.

Garcia-Zuazaga J. Pseudofolliculitis barbae: review and update on new treatment modalities. Mil Med. 2003 Jul. 168(7):561-4.

Quarles FN, Brody H, Johnson BA, et al. Pseudofolliculitis barbae. Dermatol Ther. 2007 May-Jun. 20(3):133-6.

Schulze R, Meehan KJ, Lopez A, et al. Low-fluence 1,064-nm laser hair reduction for pseudofolliculitis barbae in skin types IV, V, and VI. Dermatol Surg. 2009 Jan. 35(1):98-107. PubMed.

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