Ingrown hair

Overview

Ingrown hair occurs when a hair that's been removed starts to grow back and curves into the skin. Shaving, tweezing or waxing can cause this to happen. An ingrown hair can cause tiny, swollen bumps on the skin that may hurt. The condition most often affects Black people with curly hair who shave.

Most instances of ingrown hair get better without treatment. You can avoid this condition by not removing hair or not shaving very close to the skin. If that's not an option, you might try other hair removal methods that lessen the risk of developing ingrown hair.

Symptoms

Signs and symptoms of ingrown hair include:

• Tiny, swollen bumps where you shave, tweeze or wax
• Small bumps that look like blisters or are filled with pus
• Small bumps that are darker than surrounding skin (hyperpigmentation)
• Burning or stinging
• Itching
• Hair in the shape of a loop because the tip of the hair curves and grows into the skin

When to see a doctor

An occasional ingrown hair isn't cause for alarm. Seek medical care if your condition doesn't clear up or if it causes problems regularly.

Causes

Ingrown hair occurs when a hair that's been removed starts to grow back and curves into the skin. This usually happens after shaving, tweezing or waxing.

Hair structure and direction of growth play a role in ingrown hair. A curved hair follicle, which produces tightly curled hair, is believed to encourage the hair to reenter the skin once the hair is cut and starts to grow back. Shaving creates a sharp edge on hair, making it easier to pierce the skin.

Ingrown hair might also be caused by:

• Pulling your skin when you shave. This action causes hair to draw back into the skin.
• Tweezing.

When a hair penetrates your skin, your skin reacts as it would to a foreign body — it becomes irritated.

Risk factors

The main risk factor for ingrown hair is having tightly curled hair.

Complications

Ingrown hair that doesn't clear up can lead to:

• Bacterial infection (from scratching)
• Patches of skin that are darker than usual (postinflammatory hyperpigmentation)
• Raised scars that are darker than surrounding skin (keloids)
• Pseudofolliculitis barbae, also known as razor bumps
• Fine depressed scars (grooves)

Prevention

To help prevent ingrown hair, avoid shaving, tweezing and waxing. If that's not an option, use these tips to make ingrown hair less likely:

• Before shaving wash your skin with warm water and a mild facial cleanser.
• Apply lubricating shaving cream or gel a few minutes before shaving to soften the hair. Or apply a warm, damp cloth.
• Apply shaving cream and use a sharp, single-blade razor. This helps avoid a too-close shave.
• Don't pull your skin while shaving.
• Shave in the direction of hair growth.
• Rinse the blade after each stroke.
• Rinse your skin and apply a cool, wet cloth for about five minutes. Then use a soothing after-shave product or a glycolic acid lotion to help remove dead skin cells (exfoliate).

The following hair removal methods also may help prevent ingrown hair:

• Electric razor or clippers. With the razor, avoid the closest shave setting. Hold the razor or clippers slightly away from your skin.
• Chemical hair remover (depilatory). The chemicals in hair removal products may irritate your skin, so test on a small patch of hair first.

Diagnosis

Your health care provider is likely to diagnose ingrown hair by looking at your skin and asking about your hair removal habits.

Treatment

To treat ingrown hair, stop shaving, tweezing or waxing until the condition improves — usually 1 to 6 months. If you wish, trim a beard with scissors or electric clippers. Don't start shaving again until all the skin has cleared and ingrown hairs have gone. These steps help control the condition. They won't make it go away permanently.

If you can't go that long without removing your hair and other self-care techniques aren't helping, your health care provider might recommend medications, laser-assisted hair removal or both.

Medications

Your health care provider may prescribe certain medications to help manage your condition. They include:

• Drugs that help remove dead skin cells. A nightly application of a retinoid cream such as tretinoin (Renova, Retin-A, others) helps to clear dead skin cells (exfoliate). You may start seeing results within two months. A retinoid may also help repair any discoloration (postinflammatory hyperpigmentation). A lotion with glycolic acid helps reduce the curvature of the hair, which lessens the chance of a hair growing into the skin.
• Creams to calm your skin. Steroid creams help reduce irritation and itching.
• Creams or pills to control infection. Antibiotic creams treat mild infections caused by scratching. Antibiotic pills might be needed for a more serious infection.
• Creams to decrease hair growth. A product called eflornithine (Vaniqa) is a prescription cream that decreases hair regrowth when combined with another hair removal method, such as laser therapy.

Laser hair removal and electrolysis

Your health care provider might recommend laser-assisted hair removal, which removes hair at a deeper level than does shaving, waxing, tweezing or electrolysis. Laser treatment slows regrowth and is a longer term solution. Possible side effects of this method are blistering, scarring and loss of skin color (dyspigmentation).

Lifestyle and home remedies

If you have razor bumps but can't stop shaving, develop a consistent skin care routine such as the following to help control this condition:

• Shave at least twice a week.
• Don't tweeze ingrown hairs.
• Before shaving wash the affected area using a warm washcloth or soft-bristled toothbrush. Use a circular motion for a few minutes.
• Apply a warm, damp cloth for a few more minutes.
• Apply shaving cream — don't let it dry out — and use a sharp, single-blade razor.
• Don't pull your skin while shaving.
• Shave in the direction of hair growth.
• Rinse the blade after each stroke.
• Release visible ingrown hairs by inserting a sterile needle under each hair loop and gently lifting the tip that has grown back into the skin.
• Rinse your skin and apply a cool, wet cloth for a few minutes. Then use a soothing after-shave product. If needed, try using a 1% hydrocortisone cream for no more than four weeks.

If you're able, avoid close shaves. Try using an electric clippers. Set it to leave stubble. If shaving worsens your condition, you might want to try a chemical hair removal product (depilatory), such as Nair, Magic, others. Test it on a small patch of hair first.

Preparing for an appointment

You're likely to start by seeing your primary care provider, who may refer you to a doctor who specializes in skin conditions (dermatologist).

To get the most from your appointment, it's good to prepare. Here's some information to help you get ready for your appointment.

What you can do

• List any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• List key personal information, including any major stresses or recent life changes.
• Make a list of all medications, vitamins and supplements you're taking.
• List questions to ask your health care provider.

For ingrown hair, some basic questions to ask your health care provider include:

• What's the most likely cause of my condition?
• What are other possible causes for my condition?
• Do I need any tests?
• Is my condition likely temporary or chronic?
• What is the best course of action?
• What are the alternatives to the primary approach you're suggesting?
• Are there restrictions I need to follow?
• Is there a generic alternative to the medicine you're prescribing?
• Do you have any relevant brochures or other printed material that I can take home with me? What websites do you recommend?

Don't hesitate to ask other questions, as well.

What to expect from your doctor

Your health care provider is likely to ask you a number of questions, such as:

• When did you begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• Does anything seem to improve your symptoms?
• Does anything make your symptoms worse?
• What type of razor do you use?
• How often do you shave?
• What shaving or other hair removal technique do you use?

What you can do in the meantime

In the days before your medical appointment, if possible, stop shaving or using any form of hair removal. Ingrown hair may worsen at first as the hair grows back. But eventually it improves.