Ingrown Hair

The most common causes of ingrown hairs are shaving, waxing, and tweezing unwanted facial and body hair. By removing hair and leaving the sharp tip of the hair so short and close to the skin surface, it is more prone to grow sideways or curl back into the hair follicle and get stuck under the skin surface, leading to irritation and inflammation of the overlying skin. Using incorrect shaving techniques and failing to take precautionary measures when shaving or removing hair increases your chances of developing ingrown hairs.

Ingrown hairs more commonly occur in individuals who have curly or coarse hair, such as African-Americans and Hispanics, although anyone can develop ingrown hairs. Ingrown hairs can also develop when the hair follicle becomes clogged with dead skin cells and debris, causing the tip of the hair to grow sideways. Tight clothing can also lead to and irritate existing ingrown hairs.

Ingrown hairs generally develop several days after hair removal as the hair is growing back. In males, ingrown hairs commonly affect the cheeks, chin, and neck after shaving, sometimes leading to "razor bumps" (also termed pseudofolliculitis barbae). Females frequently develop ingrown hairs in the armpits, pubic region/bikini area, and on the legs.

Ingrown hairs typically appear as small, raised red, pink, or tan bumps on the skin, often in clusters. They are usually scattered throughout the area that was recently shaved. They may sometimes appear like tiny pimples with a pustular "head," and you may be able to see a tiny black dot at the center of the bump where the hair is trapped. At times, the base around this localized area of skin inflammation can be red in color. Ingrown hairs are often itchy and they can cause pain and discomfort.

There are other skin conditions and diseases that can sometimes resemble ingrown hairs. Some of the more common conditions that can occasionally be mistaken for ingrown hairs include:

• acne,
• cysts,
• abscesses,
• folliculitis,
• keratosis pilaris,
• eczema,
• heat rash,
• impetigo,
• dry skin,
• atopic dermatitis, and
• contact dermatitis.

Ingrown hairs are generally treated by a primary care provider (PCP), such as a family physician, a child’s pediatrician, or internist. In severe cases or when the diagnosis may not be clear, a dermatologist (specialist in conditions affecting the skin) may be consulted.

Your doctor can diagnose an ingrown hair simply by examining your skin and noting the distribution of the skin lesions. Obtaining a thorough history of the skin rash, in particular your shaving and hair-removal habits, will further assist your doctor in making the diagnosis of an ingrown hair. No blood tests or additional medical studies are typically necessary.

Treatment for ingrown hairs can vary, and sometimes the ingrown hair will heal spontaneously without any specific treatment at all. Your doctor can help determine which treatment is safest and best suited to your individual situation. Sometimes, ingrown hairs can become secondarily infected. Treatment options include the following:

• A doctor may use a sterile small needle or scalpel to help dislodge the ingrown hair.
• Topical steroid creams may be prescribed to help decrease the inflammatory reaction of the skin.
• Topical retinoid creams (Retin-A) may be prescribed to help thin the top layer of the skin and decrease the build-up of dead skin cells that can block the hair follicle. Furthermore, these creams can help decrease the skin discoloration that sometimes occurs with ingrown hairs.
• Topical antibiotics, and rarely oral antibiotics, may be prescribed if a secondary bacterial infection of the ingrown hair has developed.

Treatment options for ingrown hairs that can be attempted at home include washing and gently scrubbing the area of the ingrown hair with a moist warm washcloth or an exfoliating scrub. Using an exfoliant scrub can also be preventive, as it can lift hairs that may be starting to grow inward, and it also removes dead skin cells and debris, which helps to prevent the blockage of the hair follicles.

Though not often recommended because of the risk of secondary infection and skin damage, sometimes a sterile needle or tweezers can be used to gently and carefully dislodge the tip of the ingrown hair out from under the skin.

• Ingrown hairs can sometimes lead to a secondary bacterial skin infection and/or an abscess (a collection of pus under the skin).
• This complication can sometimes arise when individuals pick or scratch the area of the ingrown hair.
• Individuals who develop an abscess may require incision and drainage (opening the skin and draining the pus) in order to resolve this complication.
• If a secondary bacterial skin infection (cellulitis) develops, individuals may be prescribed a topical or oral antibiotic.
• Ingrown hairs can also lead to skin discoloration, thickening of the skin, and permanent scarring.

In general, the prognosis is excellent if the condition is managed appropriately and measures are taken to prevent the development of ingrown hairs. There are individuals, however, who are more prone to developing ingrown hairs and thus suffer from ingrown hairs on a chronic basis.

There are various measures available to prevent the development of ingrown hairs. The most effective preventive measure is to avoid shaving, waxing, and tweezing, thus allowing facial and body hair to grow out naturally. However, this is not a realistic or desirable option for many people. The following suggestions for hair removal and proper skin hygiene can help decrease the chances of developing ingrown hairs or prevent them altogether.

If you shave,

• wet your skin and the hair to be removed with warm water and use lubricating gels or creams when shaving;
• shave in the direction of hair growth;
• use a sharp multi-blade razor;
• do not push too hard when shaving, and avoid pulling the skin taut;
• avoid shaving hair too short, and consider leaving very short stubble (about 1 mm);
• if using an electric razor, shave in slow circular motions without pressing too hard; and
• apply a cool washcloth to the shaved area when finished.

There are other hair-removal methods that may also help prevent ingrown hairs. These include

• topical chemical depilatory creams or liquids (such as Neet or Nair),
• topical eflornithine HCL cream (Vaniqa), which decreases hair regrowth, and
• laser hair removal or electrolysis.