Ingrown Hair: How to Identify and Causes

An ingrown hair occurs when hair that has been shaved, tweezed, or waxed curls back into the skin as it regrows. It is a common skin condition that can affect the beard area of the face (including the neck, cheeks, and chin) as well as the legs, armpits, and pubic area.

Ingrown hairs can affect anyone but are more common in Black people with curly hair who shave. Though ingrown hairs are generally not serious, they can cause small, pus-filled bumps that become infected if the skin is irritated, as with constant rubbing or friction.

This article describes the symptoms and causes of ingrown hair as well as how they are treated at home or by a healthcare provider. It also looks at ways to prevent ingrown hairs and who is most at risk.

What Are the Symptoms of an Ingrown Hair?

Ingrown hairs are sometimes confused for pimples but are relatively easy to distinguish based on their location and other signs and symptoms.

Symptoms of an ingrown hair include:

• Tiny, swollen bumps on places where you shave, tweeze, or wax
• A pimple-like appearance, sometimes with a tiny head of pus
• Bumps that are redder or darker than the surrounding skin, depending on your skin tone
  
• A visible curved hair just beneath the surface of the skin
• Itching, burning, or stinging
  

What Are the Causes of an Ingrown Hair?

Ingrown hairs are otherwise known as pseudofolliculitis barbae. Although the term is typically applied to ingrown hairs of the beard area, it can refer to any part of the body in which shaving or plucking has caused an ingrown hair.

Because the hair of the beard and pubic area tends to be coarse, these areas are particularly vulnerable to penetration by ingrown hairs. An ingrown hair occurs in about one in four cases of people who experience a complication when removing pubic hair.

As an ingrown hair tip penetrates the skin, it sets off an inflammatory reaction that causes itching and swelling along with post-inflammatory hyperpigmentation (darkening of the skin).

Risk Factors

Ingrown hairs affect some people more than others, including people who are Black or Asian and those who have tight, curly hair. Risk factors also include behaviors like:

• Pulling the skin while shaving (which allows the hair to retract into the follicle)
• Shaving too aggressively against the direction of the hair growth
• Shaving, plucking, or waxing areas of skin that are already tender or inflamed

How Is an Ingrown Hair Treated?

Some ingrown hairs can heal themselves with time. The most practical approach is to stop shaving, plucking, or waxing and allow the hair to grow back naturally until the skin is fully healed.

Other treatment options for ingrown hairs include:

• Topical tretinoin: Available by prescription, this topical ointment can gently exfoliate dead skin cells, helping release trapped hairs and decrease hyperpigmentation.
• Topical antibiotics: Available by prescription, this ointment helps treat skin infections or prevent infection on damaged skin.
• Steroid facial creams: Available by prescription, these creams are designed specifically for the face to help ease inflammation.
• Glycolic acid lotion: Available over-the-counter or by prescription, these topical lotions help soften curved hairs. A lack of moisture can make ingrown hairs more likely.
• Topical benzoyl peroxide: Available over-the-counter, these popular pimple creams help dry pus-filled lesions.
• Vaniqa (eflornithine): This prescription topical cream decreases hair regrowth.
• Laser hair removal or electrolysis: These hair removal techniques may be useful in areas where ingrown hairs are recurrent or severe.

How to Release an Ingrown Hair

If you have the occasional ingrown hair, it is not unreasonable to release it yourself with the right tools and precautions.

First and foremost, you should only release ingrown hairs that you can visibly see beneath the surface of the skin. More importantly, you should never pop a pus-filled bump or try to dig out an ingrown hair.

To safely release an ingrown hair:

1. Apply a warm, moist cloth to the skin for several minutes to help soften the skin.
2. Sterilize the skin with an alcohol swab and sterilize a needle with some alcohol.
3. Gently insert the needle under the visible hair loop and lift the tip to release the end. There should be no bleeding.
4. Do not pluck the hair. Instead, snip the hair close to the skin and allow the skin to heal for a couple of days.
5. Rinse your skin and apply a cool, wet cloth for a few minutes.
6. Apply a soothing after-shave product or astringent.
   

Complications if Ingrown Hairs Are Left Untreated

If left untreated, an ingrown hair can cause a keloid. A keloid is an abnormally hard and smooth scar that can spread beyond the original borders of the skin injury. With pseudofolliculitis barbae, the formation of a keloid can often cause permanent scarring.

If ingrown hairs cause tiny pus-filled bumps (pustules), you may be at risk of a secondary infection if you try to pop the pustule.

A secondary skin infection occurs when a break in the skin from a primary infection allows bacteria entry into deeper tissues. This can lead to widespread inflammation and pain as well as possible scarring and tissue damage.

Popping a pustule also forces pus into deeper tissues where it can form a pus-filled cyst or nodule.

How to Prevent Ingrown Hairs

Ingrown hairs may be hard to prevent in some people. However, it is important to note that improper shaving techniques and skin care practices can also contribute.

Here are some ways to prevent ingrown hairs:

• Limit shaving, waxing, and tweezing.
  
• Use shaving cream with plenty of water. Never dry shave with a razor.
• Do not use old razor blades.
• Use single-blade razors which often work better than double- or triple-blade razors.
• Shave in the direction of your hair growth. This is especially true when you first start shaving in the morning or whenever there is heavy beard growth.
• Do not pull the skin while shaving.
• Rinse the razor blade after each stroke to remove debris and prevent the spread of bacteria.
• Use a gentle face or body scrub to prevent hairs from becoming trapped.
• Get an electric razor designed to give you a 5 o'clock shadow. These don't shave as closely as other manual or electric razors.

When to See a Healthcare Provider

See a healthcare provider if ingrown hairs are recurrent and cannot be curbed with at-home treatments. In some cases, you may be referred to a skin specialist called a dermatologist for treatment.

While most ingrown hairs do not require urgent care, see a healthcare provider immediately if you develop signs of serious skin infection, including:

• Fever and/or chills
• Increasing redness, swelling, pain, and heat
• Tenderness to the touch
• A cloudy or creamy discharge from the skin
• A foul smell
• Expanding redness or red streaks from the wound

Summary 

An ingrown hair is one that curls back into the skin after shaving or plucking, causing an inflamed bump. Ingrown hairs are common in the beard area as well as the armpits, legs, and pubic area. Black people who shave are especially vulnerable.

An ingrown hair will often resolve on its own if you allow the hair to grow back naturally. For recurrent or severe cases, your healthcare provider may prescribe topical tretinoin, topical steroids, or electrolysis to manage your symptoms or prevent a recurrence. Proper shaving techniques can go a long way toward preventing ingrown hairs.