Ingrown Hair

  • Medical Author:
    Gary W. Cole, MD, FAAD

    Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Ingrown hair facts

  • Ingrown hairs are a benign skin disorder commonly seen in teenagers and adults.
  • Ingrown hairs more frequently occur in adult men with darker skin.
  • Ingrown hairs commonly occur on shaved areas, such as the face, neck, armpit, legs, and pubic region.
  • Ingrown hairs look like scattered, pinpoint tan or red bumps.
  • Ingrown hairs can be cosmetically disfiguring.
  • Ingrown hairs are often caused by shaving too closely.
  • Ingrown hairs may resolve on their own without treatment.
  • Infection of skin can occur.
  • Avoid close shaves to prevent ingrown hair.
  • Ingrown hairs may require ongoing maintenance therapy.
  • Many topical creams are available to help control ingrown hairs.
  • A combination of treatments may be needed to achieve the best result.
  • Laser hair removal can be a good option to prevent ingrown hairs.

What is an ingrown hair?

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 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 the face, neck, armpits, legs, and pubic region.

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, curled hairs, such as African Americans, 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, 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.

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Ingrown Hair Symptoms & Signs

Since the most common cause of ingrown hairs is cutting or removal of the hair below the level of the follicular orifice (commonly called a pore by patients), it typically tends to occur on your face, neck, armpits, groin, and legs. The usual sign of this condition are multiple red to flesh-colored bumps, which can be tender or itchy and can become pustular. Sometimes it is possible to see the imbedded coiled hair on magnification.

What causes an ingrown hair?

Hair that is cut short and close to the skin creates a sharp tip that can more easily 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 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 develops ingrown hairs?

Nearly everyone will have an 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.

What are symptoms and signs of an ingrown hair?

Symptoms include itch and tenderness. 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 papular 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 may form on the ingrown hair sites due to the infection with common skin bacteria, such as Staphylococcus.

Are ingrown hairs the same as razor bumps or pseudofolliculitis?

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.

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, and
  • 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 agent, can help reduce the growth of skin bacteria and treat 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 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.

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Are there any home remedies for an ingrown hair?

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 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 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 hairs is by avoiding shaving and allowing hair to grow naturally.

Do ingrown hairs affect the entire body?

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.

How do health-care professionals diagnose an ingrown hair?

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 an 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 chickenpox, 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 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, and trichostasis spinulosa.

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Is it possible to prevent ingrown hairs?

The simplest way to prevent ingrown hairs is to allow hair to grow without cutting it too short. 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 (Vaniqa), electrolysis, or hair-removal lasers can also effectively help decrease ingrown hairs.

REFERENCES:

Demaria, Andrea L., et al. "Complications Related to Pubic Hair Removal." Am J Obstet Gynecol 210.6 June 2014: 528.e1-528.e5.

Draelos, Zoe Diana. "Shaving for Success." Cosmetic Dermatology 22.11 Nov. 2009: 554-557.

Freedberg, Irwin M., et al. Fitzpatrick's Dermatology in General Medicine. 5th ed. United States: McGraw-Hill Professional, 1999.

Jasterzbski, T.J. and R.A. Schwartz. "Pseudofolliculitis Cutis: A Vexing Disorder of Hair Growth." British Journal of Dermatology 172 (2015): 878-884.

Luelmo-Aguilar, Jesús, and Mireia Sàbat Santandreu. "Folliculitis: Recognition and Management." Am J Clin Dermatol 5.5 (2004): 301-310.

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Reviewed on 6/23/2016
References
REFERENCES:

Demaria, Andrea L., et al. "Complications Related to Pubic Hair Removal." Am J Obstet Gynecol 210.6 June 2014: 528.e1-528.e5.

Draelos, Zoe Diana. "Shaving for Success." Cosmetic Dermatology 22.11 Nov. 2009: 554-557.

Freedberg, Irwin M., et al. Fitzpatrick's Dermatology in General Medicine. 5th ed. United States: McGraw-Hill Professional, 1999.

Jasterzbski, T.J. and R.A. Schwartz. "Pseudofolliculitis Cutis: A Vexing Disorder of Hair Growth." British Journal of Dermatology 172 (2015): 878-884.

Luelmo-Aguilar, Jesús, and Mireia Sàbat Santandreu. "Folliculitis: Recognition and Management." Am J Clin Dermatol 5.5 (2004): 301-310.

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