Treatment of Painful Ingrown Hair Cyst
For a painful ingrown hair cyst, perform incision and drainage with thorough evacuation of contents, probing to break up loculations, and apply a dry dressing—systemic antibiotics are rarely needed unless there is extensive cellulitis or systemic signs of infection. 1
Understanding the Condition
The painful "cyst" from an ingrown hair is typically an inflamed epidermoid cyst, not a true infection. 1 The pain and inflammation result from rupture of the cyst wall and extrusion of keratinous contents into surrounding tissue, triggering a foreign body reaction rather than bacterial infection. 1 These cysts contain normal skin flora even when uninflamed and appear as cheesy keratinous material. 1
Primary Treatment Approach
Surgical Drainage (First-Line)
- Make an incision and thoroughly evacuate all cyst contents—this is the definitive treatment. 1
- Probe the cavity to break up any loculations to ensure complete drainage. 1
- Cover with a dry dressing after evacuation. 1
- The procedure can be performed under local anesthesia in most cases. 2
When Antibiotics Are Actually Needed
Systemic antibiotics are rarely necessary and should be reserved for specific complications: 1, 3
- Extensive surrounding cellulitis
- Severe systemic manifestations (fever, malaise)
- Multiple lesions
- Severely impaired immune function
- Signs of cutaneous gangrene 1
Pain Management
- Use ibuprofen 400 mg every 4-6 hours for pain relief as needed. 4
- Take with food or milk to minimize gastrointestinal side effects. 4
Definitive Management
For complete cure and prevention of recurrence, the entire cyst wall must be surgically excised once inflammation resolves. 2
- Incomplete removal leads to recurrence. 2
- This can be performed as a separate procedure after the acute inflammation subsides. 2
- Complication rates for complete excision are low (approximately 2.2%). 2
Prevention of Future Ingrown Hairs
- Ingrown hairs result from curved hair follicles and improper shaving techniques. 5
- Treatment must be individualized as different prevention strategies work for different patients. 5
- With proper technique modifications, the condition can often be controlled. 5
Key Clinical Pitfall
Do not assume all painful cysts require antibiotics. The inflammation is usually sterile and represents a foreign body reaction to cyst contents, not bacterial infection. 1 Unnecessary antibiotic use exposes patients to side effects without benefit and contributes to antimicrobial resistance.