What is the treatment for ingrown hair?

Treatment for Ingrown Hair

The primary treatment for ingrown hair (pseudofolliculitis barbae) is to stop shaving and allow the hair to grow out, combined with gentle manual release of trapped hairs using a sterile needle or tweezers when visible. 1, 2

Understanding the Condition

Ingrown hair occurs when curved or curly hair re-enters the skin after shaving, creating a foreign body inflammatory reaction. 1 This is particularly common in individuals with wavy or curly hair, especially Black men who shave. 1, 2 The pathogenesis involves both transfollicular penetration (hair curves back into the follicle) and extrafollicular penetration (sharp hair tip pierces adjacent skin). 2

Primary Treatment Approach

Immediate Management

• Cease shaving completely for at least 3-4 weeks to allow trapped hairs to grow out and inflammation to resolve. 1, 2
• Manually release visible ingrown hairs using a sterile needle or tweezers to lift the hair tip out of the skin without plucking the entire hair. 1
• Apply warm compresses to reduce inflammation and help hairs emerge from the skin. 1

Long-Term Hair Removal Modifications

If continued hair removal is necessary, implement these techniques in order of preference:

1. Electric clippers set to leave 1mm stubble - this prevents hair tips from becoming sharp enough to penetrate skin. 1, 2

2. Chemical depilatories (e.g., barium sulfide or calcium thioglycolate products) applied every 2-3 days - these dissolve hair at skin level without creating sharp tips. 1, 3 However, these can cause chemical irritation in some patients. 1

3. Manual razor with proper technique only if above methods fail:

   • Shave in direction of hair growth only 1
   • Use single-blade razor 2
   • Avoid stretching skin while shaving 1
   • Never shave too closely 2

4. Laser hair removal or electrolysis for permanent reduction - electrolysis is the only truly permanent method. 3

Adjunctive Medical Treatments

For Active Inflammation

• Topical or oral antibiotics when secondary bacterial infection is present (pustules, significant erythema). 1
• Topical corticosteroids to reduce inflammatory response around ingrown hairs. 1

For Severe or Refractory Cases

• Topical tretinoin (retinoic acid) 0.025-0.05% applied nightly can help normalize follicular keratinization and reduce ingrown hair formation. 1 This should be reserved for special cases as it can cause significant irritation. 1

• Eflornithine hydrochloride 13.9% cream (Vaniqa) is FDA-approved to slow facial hair growth and can be used in combination with other hair removal methods. 3

For Scarring or Keloid Formation

• Intralesional corticosteroid injections (triamcinolone acetonide) for keloidal lesions or significant scarring. 2
• Surgical excision may be required for severely scarred or keloidal areas. 2

Important Caveats

Avoid these common pitfalls:

• Never pluck ingrown hairs completely out, as this perpetuates the cycle - only lift the tip free. 1
• Improper shaving techniques (shaving against the grain, stretching skin, using multi-blade razors) are the primary cause and must be corrected. 2
• Chemical depilatories must be patch-tested first and should not be left on longer than recommended due to irritation risk. 1
• Treatment must be maintained long-term, as there is no permanent cure except complete hair removal via electrolysis. 2

Special consideration for frizzy/curly hair: The tight coiling of hair fibers makes this population particularly susceptible, and unsuitable grooming practices can cause chronic complications including permanent alopecia. 4 Prevention through proper technique is more effective than treating established disease. 4