What are the best methods for removing ingrown hair in a patient with a history of ingrown hairs?

How to Remove Ingrown Hair

For ingrown hairs, the optimal approach is immediate physical extraction by pulling out the embedded hair with sterile forceps or needle, followed by correction of shaving practices to prevent recurrence. 1, 2

Immediate Management: Hair Extraction

The primary treatment is mechanical removal of the ingrown hair itself:

• Locate the embedded hair shaft beneath the skin surface (appears as a black line or visible hair loop) 1, 2
• Use sterile forceps or a sterile needle to gently lift and extract the entire hair shaft from beneath the skin 1, 2
• In cases where the hair has burrowed deeper into the dermis ("intradermal growing hair"), a shallow incision may be necessary to access and remove the hair 2
• If the hair follicle is visible, extract it along with the hair shaft to prevent immediate recurrence 1, 2
• For recurrent ingrown hairs from the same follicle, consider destroying the individual hair follicle to achieve permanent resolution 1

Managing Associated Inflammation

If folliculitis or surrounding inflammation is present:

• Apply topical mupirocin ointment to treat secondary bacterial infection and reduce erythema 2
• Topical antibiotics should be used when pustules or inflammatory papules surround the ingrown hair 3, 4
• For severe inflammatory reactions, intralesional corticosteroid injections may be considered in select cases 3

Prevention: Modifying Hair Removal Practices

The most critical aspect is preventing future ingrown hairs by changing grooming techniques:

• Stop shaving temporarily to allow existing ingrown hairs to resolve naturally 3, 4, 5
• If shaving must continue, use electric clippers instead of manual razors, maintaining hair length at 1-2mm rather than cutting at skin level 4, 5
• Chemical depilatories can be used as an alternative to shaving, though skin irritation may occur 4
• Avoid pulling or extracting beard hairs manually, as this practice directly causes intradermal hair growth 2
• Never shave against the direction of hair growth, as this increases the risk of hair re-entering the skin 3, 4

Long-Term Definitive Treatment

For patients with recurrent pseudofolliculitis or persistent ingrown hairs:

• Laser hair removal is the most effective long-term solution, providing safe and permanent hair reduction in most skin types 5
• The laser system and parameters must be specifically matched to the patient's skin type to avoid complications 5
• This is particularly effective for patients of African descent with curly hair, who are at highest risk for recurrent ingrown hairs 5

Important Caveats

• Curly or wavy hair significantly increases risk of ingrown hairs, particularly in individuals of sub-Saharan African lineage 3, 5
• A genetic predisposition involving keratin 75 gene mutations may synergistically increase risk when combined with curly hair 5
• Recurrence is common if the underlying hair follicle is not addressed or if improper shaving techniques continue 1, 2
• The condition can occur in both men and women, particularly in areas where hair is coarse and subject to traumatic removal (face, neck, bikini area) 5