Treatment for Ingrown Hair
The primary treatment for ingrown hairs (pseudofolliculitis barbae) is prevention through proper hair removal techniques, with acute management involving gentle hair liberation, topical antibiotics for secondary infection, and modification of shaving practices.
Understanding the Condition
Ingrown hairs occur when curved or curly hair re-enters the skin after shaving, creating a foreign body inflammatory reaction 1, 2. This is particularly common in individuals with curly hair, especially Black men who shave 1, 3.
The pathogenesis involves two mechanisms 2:
- Transfollicular penetration: Hair curves back and penetrates the follicle wall
- Extrafollicular penetration: Shaved hair exits the skin then re-enters adjacent skin
Treatment Algorithm
First-Line Management
Stop shaving temporarily to allow existing ingrown hairs to resolve 1, 3. This is the most effective immediate intervention.
For acute lesions with visible ingrown hairs:
- Gently liberate the hair using a sterile needle or tweezers to lift the embedded hair tip out of the skin 4
- Do not pluck the entire hair, as this can worsen inflammation 2
- Apply topical antibiotics if secondary infection is present (pustules, increased warmth) 1
Long-Term Prevention Strategies
Electric clippers are preferred over razors 1, 2. Set clippers to leave 1mm of stubble rather than achieving a completely smooth shave, which prevents hair tips from becoming sharp enough to penetrate skin 1.
If shaving must continue:
- Use a single-blade razor (multi-blade razors cut hair too short) 3
- Shave in the direction of hair growth only 1, 3
- Avoid stretching the skin while shaving 3
- Use proper shaving preparation with warm water and lubricating shaving cream 1
Chemical depilatories (barium sulfide or calcium thioglycolate products) can be used as an alternative, though skin irritation may occur 1, 5. Test on a small area first and limit application time per product instructions 5.
Adjunctive Treatments
For persistent inflammatory papules and pustules:
- Topical or oral antibiotics for secondary bacterial infection 1
- Topical corticosteroids may reduce inflammation in severe cases 2
Retinoic acid (tretinoin) has been used in very select cases to reduce follicular hyperkeratosis, though this is reserved for refractory cases due to potential irritation 1.
Definitive Treatment Options
For severe, refractory cases:
- Laser hair removal provides permanent reduction in hair growth and is highly effective 5
- Electrolysis offers permanent hair removal but is time-consuming 5
- Individual follicle destruction may be necessary for recurrent intradermal growing hairs 4
Critical Pitfalls to Avoid
Never pluck hairs completely during acute episodes, as this perpetuates the cycle 2. Only lift the embedded tip.
Avoid close shaving - the closer the shave, the higher the risk of ingrown hairs 1, 3. Leaving minimal stubble is protective.
Do not use multi-blade razors in susceptible individuals, as they lift and cut hair below the skin surface, creating sharp tips that easily penetrate skin 3.
Special Considerations
For intradermal growing hairs (hair growing horizontally within the dermis creating visible black lines), extraction of the hair is curative, though follicle destruction may be needed if recurrence occurs 4.
In cases with keloidal scarring from chronic pseudofolliculitis, intralesional corticosteroid injections may be required 2.