What is the treatment for ingrown hair cysts using Polysporin (neomycin and polymyxin B) or steroid cream (hydrocortisone)?

Treatment of Ingrown Hair Cysts: Polysporin and Steroid Creams

Neither Polysporin (neomycin/polymyxin B) nor topical steroid creams are effective primary treatments for ingrown hair cysts, and you should not rely on them for definitive management.

Why These Topical Agents Are Not Appropriate

Polysporin (Topical Antibiotics)

• Polysporin is indicated only for preventing infection in minor cuts, scrapes, and burns—not for treating established cysts or follicular inflammation 1
• Ingrown hair cysts (pseudofolliculitis barbae) are primarily a mechanical problem caused by curved hairs re-entering the skin, creating a foreign body inflammatory reaction rather than a bacterial infection 2, 3
• Topical antibiotics do not address the underlying pathophysiology of trapped hair within the follicle or cyst cavity

Topical Steroid Creams

• While topical steroids like hydrocortisone are mentioned for inflammatory skin conditions in other contexts 4, there is no evidence supporting their use for ingrown hair cysts
• The guidelines for alopecia areata (a completely different condition) discuss topical steroids for hair loss, but note that potent topical corticosteroids have little evidence for efficacy even in that setting 4
• Common pitfall: Folliculitis is actually a documented side effect of potent topical steroid use 4, which could theoretically worsen the condition

What Actually Works for Ingrown Hair Cysts

For Pseudofolliculitis Barbae (Razor Bumps)

• Proper shaving technique modification is the cornerstone of management 2, 3
• Treatment must be individualized, but the pathogenesis lies in the curved hair follicle structure, requiring mechanical rather than pharmacological intervention 2
• For inflammatory papules and pustules, consider oral antibiotics (not topical) if secondary infection is present 3

For True Cysts (Epidermoid or Vellus Hair Cysts)

• Surgical extraction is the definitive treatment and the only curative option 5, 6
• The cyst wall must be completely removed to prevent recurrence 6
• Simple extraction techniques under local anesthesia have low complication rates (2.2%) and can be performed in office 5, 6
• Alternative options include Er:YAG laser ablation for multiple lesions, particularly on the trunk where scarring risk is higher 7

For Severe Cases with Scarring

• Intralesional steroid injections (not topical creams) may be considered for keloidal lesions related to chronic pseudofolliculitis 2
• This requires injection technique, not surface application

Clinical Algorithm

1. Identify the specific problem: Is this pseudofolliculitis (inflammatory papules from shaving) or true cysts (palpable nodules with trapped hair)?
2. For pseudofolliculitis: Stop improper shaving techniques, consider oral antibiotics if infected, avoid topical antibiotics
3. For cysts: Refer for surgical extraction or laser treatment
4. Avoid: Topical antibiotics like Polysporin and topical steroid creams—neither addresses the mechanical problem

The bottom line: Save your patient time and money by skipping ineffective topical treatments and proceeding directly to appropriate mechanical management or surgical intervention.