Ingrown Hair

Ingrown hairs are a common, benign skin disorder seen in all age groups.

An ingrown hair happens when the sharp tip of the hair curls back or grows sideways into the skin of the hair follicle. It is a benign condition, which usually appears as a small tan or sometimes pink bump under the skin. Often, a small pinpoint (often dark) part of the underlying hair may be seen under the skin bump. In severe cases, multiple small red or pink bumps at hair follicles may be seen on any skin area that normally grows hair.

• An ingrown hair is a very common skin condition occurring primarily after puberty.
• Ingrown hairs tend to be more common in areas with coarse hairs, like the bikini area in women, and beard and neck in men.
• Individuals with thicker, tightly curled hairs, such as African Americans, tend to have the highest rate of problems with ingrown hairs, particularly in the beard area.

Rarely, ingrown hair may also appear in other skin parts, such as the eyelid or thighs. An ingrown hair is medically harmless, yet it may become cosmetically disfiguring and lead to scarring, skin discoloration (referred to as post-inflammatory hyperpigmentation), skin infection, and rarely keloid scar formation.

One type of ingrown hair is pseudofolliculitis, also called "razor bumps," in which small red bumps appear on the beard area (lower face and neck) and may flare with repeat shaving.

• Razor bumps are commonly experienced by African-American men, especially those who shave frequently.
• Flesh-colored red bumps with a hair shaft in their center are seen in shaved areas adjacent to the hair follicle opening.
• Pustules and abscesses may occasionally form, especially if there are bacteria on the skin.

In chronic or inadequately treated situations, post-inflammatory hyperpigmentation, scarring, and rare keloid formation may occur. This skin condition is mostly seen in darker skin or African skin with facial hair because of the curvature of these patients' hair follicles.

Common causes of ingrown hairs include the following:

• Hair that is cut close to or below the follicular opening may have a sharp tip that can pierce the skin to cause an ingrown hair.
• Improper shaving techniques are the major cause of ingrown hairs.
• Other hair-removal methods, including waxing, as well as common friction from tight clothing, may worsen the situation.

Although ingrown hair is primarily caused by improper or aggressive hair removal, it sometimes occurs naturally as too much dead skin debris blocks the hair follicle opening, causing the hair to grow sideways.

Does diet have anything to do with ingrown hair?

Overall, diet does not seem to affect ingrown hairs.

Nearly everyone will have ingrown hair at some time. Overall, teenagers and adults are more prone to ingrown hairs. African-American individuals with thicker, coarser tightly curling hairs tend to have the highest rate of problems with ingrown hairs.

An ingrown hair can lead to a localized foreign-body inflammatory reaction, which causes pinpoint red or pink bumps on the skin.

Symptoms include itch and tenderness, as well as the following:

• Some of the bumps may be slightly red or have an accompanying light-red halo indicating inflammation.
• Sometimes, the curled hair can be barely visible at the center of the bump.
• Small pustules or dry red bumps are often scattered over an area that has been shaved recently. Often the bumps start a few days to weeks after hair removal and get worse as the hairs grow back.
• Pustules may be a sign of folliculitis due to the infection with common skin bacteria, such as Staphylococcus.

Ingrown hairs most characteristically involve areas that are shaved, like the beard, bikini area, and legs. Other common locations of ingrown hairs include the face, neck, thighs, and buttocks. Although possible, it is rare to have ingrown hairs all over the body. Ingrown hairs do not affect the mouth, palms, vagina, or soles of the feet, as there are no hair follicles in these locations.

Other medical conditions can mimic ingrown hairs.

Some possible look-alike skin conditions include:

• Folliculitis
• Keratosis pilaris
• Acne
• Cyst
• An abscess (furuncle)
• Milia (whiteheads)
• Eczema
• Impetigo
• Atopic dermatitis
• Contact dermatitis
• Heat rash (miliaria)
• Dry skin (xerosis)

Less common mimickers include:

• Chickenpox
• Herpes
• Pustular psoriasis
• Molluscum contagiosum
• Viral warts
• Fox-Fordyce disease
• Graham-Little-Piccardi-Lasseur syndrome
• Pruritic papular eruption of HIV disease
• Erythema toxicum neonatorum

Folliculitis of ingrown hairs may also resemble uncommon skin conditions like:

• Lichen spinulosus
• pityriasis rubra pilaris
• Phrynoderma (vitamin A deficiency)
• Ulerythema ophryogenes
• Ichthyosis vulgaris
• Eruptive vellus hair pseudofolliculitis barbae
• Erythromelanosis follicularis faciei et colli
• Keratosis follicularis (Darier disease)
• Kyrle disease
• Lichen nitidus
• Lichen spinulosus
• Perforating folliculitis
• Trichostasis spinulosa

The diagnosis of ingrown hair is typically very straightforward and based on the skin's appearance. In some cases, a small skin biopsy may be used to help the doctor confirm the diagnosis. Other times, a skin bacterial culture may be taken by a cotton-tip applicator to assist in determining an infectious cause.

A few other medical conditions may look just like ingrown hairs and need to be examined more closely by a physician specializing in conditions of the skin called a dermatologist.

Although an ingrown hair can heal on its own and spontaneously dislodge, in some cases, it may be tough to get rid of it.

Available treatments include:

• Chemical depilatories
• Improved shaving techniques
• Topical antibiotics if infected
• Medical removal of the ingrown hair by small incision and pulling out the hair
• Hair-removal laser

Best results may be achieved with combination therapy. Consulting a medical doctor who specializes in dermatology may be necessary for the optimal treatment of more severe cases.

Chemical depilatories like Neet or Nair can loosen the structure of hair, resulting in blunt tips of shaved hairs at the follicular opening. Chemical depilatories may be used every second or third day rather than every day to avoid chemical irritation on the skin. Hydrocortisone cream can be applied to alleviate the irritation caused by chemical depilatories.

Tretinoin (Retin A) cream can help decrease skin plugging or hyperkeratosis. Topical tretinoin cream may thin out the epidermis, reduce the buildup of dead skin cells, and decrease hair embedding into the follicles. Topical corticosteroid creams are applied to reduce inflammation of inflamed ingrown hairs.

Topical and oral antibiotics may be required for severe cases that form pustules and abscesses, which indicate secondary infection.

• Topical antibiotics, including erythromycin (E-Mycin, Ilosone) and clindamycin (Cleocin), topical antibacterial agents, such as benzoyl peroxide (Persa-Gel), and the combinations of topical antibiotics and antibacterial agents, can help reduce the growth of skin bacteria and treat a secondary infection.
• Oral antibiotics, such as tetracycline (Sumycin) or cephalexin (Keflex, Keftabs), are used to control infected pustules or abscess formation.

Antibacterial washes, such as benzoyl peroxide (Clearasil, Proactiv) or chlorhexidine (Hibiclens), can be used once or twice a day to control the infection. Topical eflornithine HCl 13.9% cream (Vaniqa) is a prescription that can reduce the rate of hair growth when applied to the skin twice a day over one to two months. Hence, it can be useful as long-term therapy in individuals with excessive facial hair or patients who have pseudofolliculitis barbae.

For skin discoloration, prescribed fading creams such as hydroquinone 4% (Eldoquin), kojic acid, azelaic acid 15%-20%, or over-the-counter fading creams with 2% hydroquinone can help improve any residual or persistent discoloration.

Laser hair removal may be an option for preventing ingrown hairs. Laser treatments applied to an area help to permanently decrease the number of hairs. Currently, laser removal works primarily on dark hairs only. Laser hair removal is generally very fast, efficient, and safe. Laser treatment risks include skin discoloration.

Electrolysis may be used to permanently remove hair. This procedure targets individual hair follicles and can be performed on any color of skin and any size and color of hair. The destruction of hair follicles is permanent. Electrolysis is often slow, tedious, and requires multiple treatments.

Although no cure exists, it is possible to decrease the occurrence of ingrown hairs. The easiest way to do this is through proper hair and skin hygiene.

• Hydrate and soften both the skin and the hair before shaving. This can result in a duller, rounded tip to the hair, which decreases the likelihood for hairs to reenter the skin.
• Use a moistened washcloth, a wet sponge, or a soft-bristled toothbrush with mild soap to wash the beard or hair for several minutes via a circular motion to help dislodge stubborn tips.
• Some natural mild exfoliators, such as salt and sugar, can be applied to treat the redness or irritation that comes with ingrown hair.
• Do not shave against the direction or grain of the hair growth.
• Avoid shaving too close to the skin.
• When using electric razors, some shaving techniques may help prevent ingrown hair. Keep the head of the electric razor slightly off the surface of the skin and shave in a slow, circular motion. Pressing the razor too close to the skin or pulling the skin taut can result in too close of a shave.
• Leave very short 1 mm-2 mm stubble with shaving to help reduce the tendency of shaving too closely. These shaving techniques can avoid creating a sharp tip when shaving and prevent hair from reentering the skin by leaving slightly longer stubble.
• Another way to prevent ingrown hair is by avoiding shaving and allowing hair to grow naturally.

The simplest way to prevent ingrown hair is to allow hair to grow without cutting it too short.

Other methods to preventing ingrown hair include the following:

• Shaving and waxing can cause or exacerbate ingrown hairs. The shaving techniques described above can be applied to prevent or decrease the occurrence of ingrown hairs.
• Topical hair-growth-inhibitor cream eflornithine (Vaniqa), electrolysis, or hair-removal lasers can also effectively help decrease ingrown hairs.