What is the treatment for ingrown hairs?

Treatment for Ingrown Hairs

The most effective treatment for ingrown hairs is daily exfoliation with glycolic acid, which has been shown to reduce lesions by over 60% and allows resumption of daily shaving with minimal irritation. 1

Understanding Ingrown Hairs (Pseudofolliculitis Barbae)

Ingrown hairs, medically known as pseudofolliculitis barbae (PFB), represent a chronic inflammatory condition of hair follicles caused by hairs growing back into the skin, producing an inflammatory foreign body reaction. This condition is particularly common in individuals with curly hair, with an incidence of over 50% in Black men 1.

Treatment Algorithm

First-Line Treatments:

1. Topical Glycolic Acid

   • Apply daily to affected areas
   • Provides significant reduction in lesions (>60%)
   • Allows resumption of daily shaving with minimal irritation 1
   • Results typically seen within weeks of consistent use

2. Proper Shaving Techniques

   • Use a single-blade razor rather than multi-blade
   • Shave in the direction of hair growth
   • Avoid pulling skin taut while shaving
   • Use warm water to soften hair before shaving
   • Apply moisturizing aftershave lotion

3. Exfoliation

   • Regular gentle exfoliation with a soft brush or cloth
   • Helps remove dead skin cells that can trap hairs
   • Should be done 1-2 times weekly

Second-Line Treatments:

1. Topical Corticosteroids

   • For inflammatory lesions
   • Apply low to medium potency preparations to reduce inflammation
   • Use for short periods (1-2 weeks) to avoid skin thinning

2. Topical Antibiotics

   • For infected ingrown hairs
   • Clindamycin or erythromycin solutions
   • Apply twice daily until infection resolves

For Severe or Persistent Cases:

1. Intralesional Steroid Injections

   • For hypertrophic or keloidal lesions
   • Particularly effective for dermatitis papillaris capillitii (related condition affecting the scalp) 2

2. Laser Hair Removal

   • Permanent reduction of hair growth
   • Multiple sessions required
   • Particularly effective for recurrent cases

Special Considerations

• Prevention is key: Regular exfoliation and proper shaving techniques can prevent recurrence
• Beard growth: Growing a beard may be the most effective solution for severe cases
• Scarring risk: Untreated ingrown hairs can lead to permanent scarring and occasionally keloids, particularly in predisposed individuals 3
• Military personnel: Special consideration for those requiring clean-shaven faces for gas mask fitting 4

Common Pitfalls to Avoid

• Aggressive picking or digging: This can lead to infection and scarring
• Continuing to shave improperly: Maintaining poor shaving habits will perpetuate the condition
• Inadequate exfoliation: Failure to remove dead skin cells regularly allows hairs to become trapped
• Ignoring signs of infection: Increased redness, warmth, pain, or pus require prompt treatment with antibiotics
• Overuse of topical steroids: Can lead to skin thinning and other adverse effects

By following this treatment approach and addressing the underlying causes of ingrown hairs, most patients can achieve significant improvement in their condition and prevent recurrence.