The Skin Center
Laguna Hills, CA 92653
Nili N. Alai, MD, FAAD
Diplomat, American Board of Dermatology
Fellow, American Academy of Dermatology
Fellow, American Society of Mohs Surgery
Assistant Clinical Professor of Dermatology, University of California, Irvine
What is an ingrown hair?
Ingrown hair is a very common skin condition occurring primarily in post pubertal individuals. An ingrown hair happens when the sharp tip of the hair curls back or grows sideways into the skin. 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 more extensive cases, multiple small red or pink little bumps around hair follicles may be seen on any skin area that has been frequently shaved, such as face, neck, armpits, legs, and pubic region.
Ingrown hairs tend to be more common in areas with coarse hairs like the bikini area in women, and beard and neck in men. Accordingly, African American individuals with thicker, coarser hairs tend to have the highest rate of problems with ingrown hairs, particularly of the beard area. Rarely, an ingrown hair may also appear in other skin parts such as the eyelid. Generally, ingrown hair is medically harmless, yet it may often become cosmetically disfiguring and lead to scarring, skin discoloration called post-inflammatory hyperpigmentation, secondary skin infection, and rarely keloid scar formation.
What causes ingrown hairs?
Hair cut short and close to the skin creates a sharp tip, thereby potentially causing an ingrown hair. An ingrown hair often undergoes the following two mechanisms and irritates the skin:
(1) Extrafollicular (outside the hair follicle) penetration: a curly hair reenters into the skin
(2) Transfollicular (across the hair follicle) penetration: the sharp tip of a growing hair passes through the follicle wall
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 an 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.
Who gets ingrown hairs?
Nearly everyone will have at least one ingrown hair in their lifetime. Overall teenagers and adults are more prone to ingrown hairs. African American individuals with thicker, coarser hairs tend to have the highest rate of problems with ingrown hairs.
What are symptoms and signs of an ingrown hair?
Symptoms include itch and tenderness at the ingrown hair area. An ingrown hair can lead to a localized foreign-body inflammatory reaction, which causes the pinpoint red or pink bumps on the skin. 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 pus bumps 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.
Individuals who have ingrown hairs may experience a painful acne-like eruption after shaving. The upper skin layers may have some dilation of the small superficial blood vessels, which gives the skin a red or flushed appearance. Pustules and rare abscesses may form on the ingrown hair sites due to the infection with common skin bacteria such as Staphylococcus and Pseudomonas.
Are ingrown hairs the same as razor bumps or pseudofolliculitis?
One type of ingrown hairs is pseudofolliculitis barbae, also called “razor bumps,” in which 5-40 small red bumps appear on the beard area (lower face and neck) and may flare with repeat shaving. It is 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 improperly treated cases, 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.
Are there any home remedies for ingrown hairs?
Although no cure exists, you can help 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 re-enter the skin.
- · Use a moistened wash cloth, a wet sponge, or a soft-bristled toothbrush with a 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 the ingrown hair.
- · Do not shave against the direction or grain of the hair growth.
- · Avoid shaving too closely 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 1-2 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 into the skin by leaving slightly longer stubble.
- · Another way to prevent ingrown hairs is by avoiding shaving and allowing hair to grow naturally.
- · Carefully use a sterile needle and alcohol wipe to dislodge stubborn ingrown hairs or use tweezers to gently tease the hair out of the skin. However, this is usually not recommended in that these procedures may be too aggressive and cause further damage to the skin.
What is the treatment for an ingrown hair?
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
- · topical creams
- · topical antibiotics
- · 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 specialized in dermatology for the best treatment may be necessary for more severe cases.
Chemical depilatories like Neet or Nair can break the disulfide bonds in 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 due to the possible chemical irritation on the skin. Hydrocortisone cream can be applied to alleviate the irritation caused by chemical depilatories.
Tretinoin or 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 with a mild strength can be 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 and clindamycin, topical anti-bacterial agents such as benzoyl peroxide, and the combinations of topical antibiotics and anti-bacterial agent can help reduce the growth of skin bacteria and treat secondary infection. Oral antibiotics such as tetracycline or cephalexin are used to control infected pustules or abscess formation. Anti-bacterial washes such as benzoyl peroxide (Clearasil, Proactiv) or chlorhexidine (Hibiclens) can be used once or twice a day to control the infection.
Topical eflornithin 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 1-2 months. Hence, it can be useful as long term therapy in individuals with excessive facial hair or patients who have pseudofolliculitis barbae.
Prescribed fading creams such as hydroquinone 4%, kojic acid, azelaic acid 15-20%, or over-the-counter fading creams with 2% hydroquinone can help improve any residual or persistent skin discoloration. Prescription of higher concentration of hydroquinone may also be formulated by compounding pharmacists to help particularly resistant skin 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 hairs. 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.
Do ingrown hairs affect the entire body?
Ingrown hairs most characteristically involve the beard, bikini, and legs. Other common locations include the face, neck, thighs and buttocks. Although possible, it is rare to have it all over the body. It does not affect the mouth, palms, vagina, or soles where there are no hair follicles.
What do ingrown hairs look like?
Photos of ingrown hairs show very small, red or pink bumps at each hair follicle. These small pus bumps or dry red bumps are often scattered over an area. Pictures show some of the bumps may be slightly red or have an accompanying light-red halo indicating inflammation.
Sometimes, scratching off the top reveals a small trapped or coiled hair beneath the bump. Acne white heads called milia may also be in the same areas as ingrown hairs.
What causes the small bumps in ingrown hairs?
The bumps seem to arise from skin plugging and inflammation at the small hair follicles. Sometimes there are common skin bacteria like staphylococcus or pseudomonas in the follicles. The upper skin layers may have some dilation of the small superficial blood vessels, thereby giving the skin a red or flushed appearance.
How is ingrown hair diagnosed?
The diagnosis of ingrown hair is typically very straightforward and based on the skin 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.
Does diet have anything to do with ingrown hairs?
Overall, diet does not seem to affect ingrown hairs.
What else could ingrown hair look like?
Other medical conditions can mimic ingrown hairs. Some possible look-alike skin conditions include folliculitis, keratosis pilaris, acne, cyst, abscess (furuncle), milia (whiteheads), eczema, impetigo, atopic dermatitis, contact dermatitis, heat rash (miliaria), or dry skin (xerosis).
Less common mimickers include chicken pox, herpes, pustular psoriasis, molluscum contagiosum, viral warts, Fox-Fordyce Disease, Graham-Little-Piccardi-Lasseur Syndrome, pruritic papular eruption of HIV disease, and erythema toxicum neonatorum. Folliculitis may also resemble uncommon skin conditions like lichen spinulosus, pityriasis rubra pilaris, phrynoderma (vitamin A deficiency), ulerythema oophryogenes, ichthyosis vulgaris, eruptive vellus hair cysts, ethromelanosis follicularis faciei et colli, keratosis follicularis (Darier Disease), Kyrle Disease, lichen nitidus, lichen spinulosus, perforating folliculitis, and trichostasis spinulosa.
Can ingrown hairs be prevented?
The simplest way to prevent ingrown hair is to allow hair to grow. Shaving and waxing can cause or exacerbate ingrown hairs. The shaving techniques mentioned above can be applied to prevent or decrease the occurrence of ingrown hairs. Topical hair growth inhibitor cream (Vaniqa), electrolysis, or hair removal lasers can also effectively help decrease ingrown hairs.
Ingrown Hair at a Glance
- · A benign skin disorder commonly seen in teenagers and adults.
- · Typically seen in adult men with darker skin or Africa American skin.
- · Commonly occurs on shaved areas, such as face, neck, armpit, legs, and pubic region.
- · Looks like scattered, pinpoint tan or red bumps
- · Can be cosmetically disfiguring
- · Often caused by improper shaving
- · May clear on its own without treatment
- · Infection of skin can occur if leave unattended or exposed to bacteria
- · Avoid close shaves to prevent ingrown hair
- · May require ongoing maintenance therapy
- · Many topical creams are available to help control the condition
- · Combination therapy may be needed to achieve the best result
- · Laser hair removal can be a good option to prevent ingrown hairs
For more information, please call (949) 582-7699 or visit the practice website at www.lagunaskincenter.com.
Information in this publication and site is not intended to serve as medical advice. Individuals may use the information as a guide to discuss their treatments with their own physicians. This site does not promote nor endorse the unauthorized practice of medicine by non-physicians or state licensed health care providers.
Medicine is a constantly changing science and not all therapies are clearly established. New research changes drug and treatment therapies daily. The authors, editors, and publisher of these artciles have used their best efforts to provide information that is up-to-date and accurate and is generally accepted within medical standards at the time of publication. However, as medical science is constantly changing and human error is always possible, the authors, editors, and publisher or any other party involved with the publication of this article do not warrant the information in this article is accurate or complete, nor are they responsible for omissions or errors in the article or for the results of using this information. The reader should confirm the information in this article from other sources prior to use. In particular, all drug doses, indications, and contraindications should be confirmed in the package insert.