What is the treatment for ingrown hair?

Treatment of Ingrown Hair

For ingrown hairs (pseudofolliculitis barbae), stop shaving immediately and allow the hair to grow out, which is the most effective initial treatment, combined with gentle manual extraction of visible ingrown hairs and topical antibiotics if secondary infection is present. 1, 2

Primary Management Strategy

Immediate Cessation of Shaving

• Stop all shaving for at least 3-4 weeks to allow ingrown hairs to emerge naturally and inflammation to resolve. 2, 3
• This is the single most effective intervention, as shaving is the primary causative factor in individuals with curly or wavy hair. 1, 2

Manual Extraction

• Visible ingrown hairs should be gently lifted out using sterile instruments under direct visualization. 4
• Dermatoscopy can be used to identify and guide extraction of ingrown hairs, particularly in persistent cases. 4
• In one recent study, 5 of 6 patients with persistent kerion-associated ingrown hairs were cured by removal alone without additional antifungal therapy. 4

Secondary Treatment Options (If Shaving Must Continue)

Modified Shaving Techniques

• Use electric clippers set to leave 1mm of stubble rather than achieving a close shave. 2, 3
• This prevents the hair from retracting below the skin surface where it can penetrate the follicle wall. 1, 2
• Manual razors should be avoided if possible, but if used, shave in the direction of hair growth only. 2, 3

Chemical Depilatories

• Chemical depilatories (barium sulfide or calcium thioglycolate products) can be used as an alternative to shaving. 2
• Apply for no longer than manufacturer-recommended time to avoid chemical irritation. 2
• Test on a small area first to assess for contact dermatitis. 2

Adjunctive Medical Therapy

Topical Antibiotics

• Apply topical antibiotics (such as clindamycin or erythromycin) if secondary bacterial infection or pustules are present. 2
• This addresses the inflammatory component but does not treat the underlying mechanical problem. 1

Topical Retinoids

• Topical retinoic acid can be considered in very select cases to reduce follicular hyperkeratosis. 2
• Use cautiously as it may cause additional irritation. 2

Intralesional Corticosteroids

• For severe scarring or keloidal lesions, intralesional steroid injections may be beneficial. 1
• This is particularly relevant for related conditions like dermatitis papillaris capillitii. 1

Important Clinical Pitfalls

The curved hair follicle common in individuals of African descent is the fundamental anatomic predisposition—no treatment will "cure" this condition, only control it. 1, 3

• Improper shaving causes ingrown hairs through both transfollicular penetration (hair pierces follicle wall from inside) and extrafollicular penetration (shaved hair re-enters skin from outside). 1
• Treatment must be maintained long-term, as the condition will recur immediately upon resumption of close shaving. 1, 3
• In occupational settings requiring clean-shaven appearance (such as military service), medical exemptions may be necessary as strict shaving policies directly conflict with effective treatment. 5

When to Consider Alternative Approaches

• For patients who cannot stop shaving due to occupational requirements, laser hair removal represents the only definitive long-term solution. 3
• Complete permanent epilation eliminates the source of ingrown hairs entirely. 2
• Surgical excision is reserved only for severely scarred or keloidal areas that have not responded to conservative management. 1