Treatment Options for Ingrown Facial Hair
The most effective treatment approach for ingrown facial hair includes proper shaving techniques, topical exfoliants like glycolic acid, and in some cases, oral antibiotics for inflammation. 1
Understanding Ingrown Facial Hair
- Ingrown facial hair (pseudofolliculitis barbae) is a foreign-body inflammatory reaction surrounding ingrown facial hairs that results from shaving 1
- The condition occurs most commonly in individuals with curly hair, with an incidence of over 50% in Black men 1, 2
- Hairs curl back and penetrate the skin, causing inflammation, papules, and pustules 2
First-Line Treatment Options
Proper Shaving Techniques
- Shave carefully using proper techniques to minimize trauma to hair follicles 3
- Use very mild shampoos and gentle soaps with pH5 neutral formulations 3
- Pat skin dry after washing rather than rubbing, which can cause irritation 3
- Wear fine cotton clothes instead of synthetic materials that may irritate the skin 3
Topical Treatments
- Glycolic acid (10%) pads or lotion: Significantly effective in treating pseudofolliculitis barbae with over 60% reduction in lesions, allowing for daily shaving with minimal irritation 1
- Application instructions: Use 1-3 times daily on affected areas after cleansing; reduce frequency if excessive dryness occurs 4
- Topical moisturizers: Apply hypoallergenic moisturizing creams daily to prevent skin dryness 3
Other Physical Methods
- Electric clippers (rather than razors): Maintain hair at a length that prevents it from curling back into the skin 2
- Chemical depilatories: Offer temporary removal without the sharp edge created by shaving 2, 5
- Avoid manipulation of the skin to reduce risk of infection 3
Second-Line Treatment Options
Oral Medications
- Oral tetracyclines (doxycycline or minocycline): Effective for reducing inflammation and severity of skin reactions due to their immunomodulating and anti-inflammatory effects 3
- These are recommended when topical treatments are insufficient and significant inflammation is present 3
Advanced Procedures
- Laser hair removal: More strictly regulated and better studied than most methods, though not permanently effective for all patients 5, 6
- Q-switched Nd:YAG laser with topical carbon suspension: Effective for treating pseudofolliculitis barbae with results persisting at least 2 months after treatment 6
- Electrolysis: The only permanent treatment option short of surgical removal of hair follicles, though practice lacks standardization 5
Topical Medications
- Eflornithine 13.9% cream: Reduces the rate of hair growth rather than removing hair; effective for unwanted facial hair on mustache and chin areas 7
- Can be used in combination with other treatments such as lasers for better results 7
- Topical corticosteroids: Low-potency preparations like hydrocortisone 1% cream may help reduce inflammation 3
Treatment to Avoid
- Greasy creams: May facilitate development of folliculitis due to occlusive properties 3
- Topical acne medications: May irritate and worsen skin conditions due to drying effects 3
- Topical steroids (high potency): May cause perioral dermatitis and skin atrophy if used inappropriately 3
Special Considerations
- For patients with significant inflammation, consider short-term oral systemic steroids 3
- Sun protection is important when using products containing alpha hydroxy acids (like glycolic acid), as they can increase skin sensitivity to the sun 4
- Patients should be advised that most treatments (except electrolysis) provide temporary results and require ongoing maintenance 5