Ingrown Hair and Pseudofolliculitis

Ingrown hairs can develop when a hair curls back into the skin or becomes embedded in the follicle wall instead of growing outwards. The surrounding inflammation is called pseudofolliculitis. The form in the beard area is known as pseudofolliculitis barbae (PFB).

Pseudofolliculitis is not an infection; it is an inflammatory reaction to hair re-embedding itself into the skin. However, a secondary bacterial infection may develop. It most commonly occurs on the neck, chin, jawline, and beard area; it can also appear in the bikini area, armpits, and legs.

Curly and thick hairs are more prone to regrowth. Shaving too closely, shaving by stretching the skin, shaving against the direction of hair growth, using a blunt razor, and repeatedly going over the same area can increase the risk. An electric shaver or a technique that leaves the hairs slightly above the skin's surface may be helpful for some patients.

Removing ingrown hairs with a needle or tweezers can increase the risk of inflammation, infection, post-inflammatory hyperpigmentation, and scarring. Spots and hypertrophic scars/keloid-like marks may be particularly noticeable in darker phototypes.

Treatment includes modifying shaving technique, reducing new ingrown hairs, controlling inflammation, and addressing pigmentation/scarring as needed. Retinoids and keratolytics may be used in selected patients; excessive peeling in actively irritated skin can worsen symptoms.

In recurrent PFB, laser hair reduction is a significant long-term option. Reducing hair density and thickness can help decrease the incidence of new ingrown hairs. Laser selection should be based on skin phototype, hair color and thickness, and safety parameters. The goal is not to guarantee "never again" ingrown hairs, but to significantly reduce the ingrown hair cycle.