How should an ingrown hair (pili incarnati) be managed?

Management of Ingrown Hair (Pili Incarnati)

The optimal management of ingrown hair involves modifying hair removal practices as the primary intervention, with topical mupirocin for secondary bacterial infection, and laser hair removal as the definitive long-term solution for recurrent cases. 1

Understanding the Condition

Ingrown hair (pseudofolliculitis cutis) occurs when hair shafts re-enter the skin after removal, triggering a chronic inflammatory response. 1 This condition is most common in individuals with curly hair, particularly those of sub-Saharan African lineage, and affects areas where hair is coarse and subject to traumatic removal. 1

Primary Management Strategy: Modify Hair Removal Practices

• Stop all traumatic hair removal immediately (shaving, plucking, waxing) and allow hair to grow out for at least 2-4 weeks to permit trapped hairs to emerge naturally. 1, 2
• If shaving must continue, use proper technique: shave in the direction of hair growth, use a single-blade razor, avoid stretching the skin, and never shave too closely. 2
• Avoid pulling or extracting hairs manually, as this practice can cause the hair to grow beneath the skin and create recurrent lesions. 3

Treatment of Active Lesions

• Apply topical mupirocin 2% ointment to areas with secondary bacterial infection (folliculitis, pustules, or erythema). 3
• For individual trapped hairs visible beneath the skin, perform a shallow incision to release the hair shaft rather than pulling it out forcefully. 3
• The involved hair should be gently lifted out, and the bad practice of traumatic hair removal must be corrected to prevent recurrence. 3

Definitive Long-Term Solution

• Laser hair removal is the most effective treatment for recurrent or chronic pseudofolliculitis cutis, providing safe and effective permanent hair reduction in most skin types. 1
• The laser system and parameters must be specifically matched to the patient's skin type to ensure safety and efficacy. 1
• This approach addresses the root cause by eliminating the hair follicles that produce problematic curved hairs. 1

Treatment Algorithm

1. Immediate phase (weeks 1-4): Stop all hair removal, apply topical mupirocin to infected areas, release visible trapped hairs with shallow incision if needed. 1, 3
2. Maintenance phase (ongoing): If hair removal must resume, use proper shaving technique with single-blade razor in direction of growth. 2
3. Definitive phase: Refer for laser hair removal consultation for recurrent or persistent cases. 1

Critical Pitfalls to Avoid

• Do not continue aggressive shaving or plucking during active inflammation, as this perpetuates the cycle of ingrown hairs. 1, 2
• Do not forcefully extract hairs by pulling, as this can cause the hair to burrow deeper into the dermis and create new lesions. 3
• Do not use laser therapy without proper skin type assessment, as inappropriate parameters can cause complications in darker skin types. 1