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Ingrown Hair
Ingrowing Hair

Ingrown hair is a condition wherein hair that was shaved grows back into the skin. Such a condition causes irritation and inflammation in the affected area.

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WIKIDATA, CC BY-SA 3.0

Presentation

In males, the most common areas favoring development of ingrown hair include the chin, cheeks and the neck region. Males who shave off their head can also develop ingrown hair on scalp part [6].
In women, the common areas of ingrown hair are the regions of armpit, legs and area where pubic hair develops. Ingrown hair presents with the following signs and symptoms [7]:

  • Development of bumps which are small, solid with a round shape – having same appearance as that of pimple
  • Development of pus filled lesions
  • The affected area undergoes darkening
  • Inflammation of the affected area accompanied by itching and pain
  • Presence of embedded hairs

Workup

Diagnosis of ingrown hair consists of thorough physical examination of the affected area. The pustules are analyzed for presence of secondary infections. In addition, a complete history of hair removal habits is gathered from the patients.
Biopsy of the affected area is not indicated in such cases unless signs of secondary skin infections are evident.

Treatment

Medications are given to effectively manage the condition. The following types of medicines are administered for treating ingrown hair [8].

  • Retinoids: Retinoids such as tretinoin are administered which would help in the process of exfoliation and also aid in prevention of skin darkening and thickening. 
  • Corticosteroids: These are administered so that inflammation can be effectively controlled.
  • Antibiotics: In case of severe infections, oral antibiotics may be administered to combat the infection. In addition, ointments containing antibiotics may also be given to relieve symptoms of itching and irritation caused due to ingrown hair.

Prognosis

The prognosis of ingrown hair is good and the accompanying bump generally fades away with proper treatment. Individuals are prone to get recurrent bouts of ingrown hair if proper care and preventive measures are not taken. In addition, several treatments may be required in order to prevent recurrence of the condition.
Untreated or chronic ingrown hair can lead to development of bacterial infections and permanent scarring of the affected area.

Etiology

Ingrown hair develops when the hair curls and grows back into the skin due to use of improper shaving or hair removal techniques. Individuals with coarse or curly hair are at an increased risk of developing this condition. Activities such as shaving, waxing, electrolysis and wearing tight fitting clothing can promote development of ingrown hair. When there is an ingrown hair, the skin reacts as it would to a foreign body and throws out various uncomfortable signs [2].

Epidemiology

The exact incidence of ingrown hair is not known. It is thought to commonly strike males between the age group of 14 – 25 years. Individuals with ingrown hair are more prone to develop pseudofolliculitis barbae. The occurrence of ingrown hair is common amongst Blacks. It has been estimated that about 45 – 83% of black and 3% of white individuals develop pseudofolliculitis barbae due to removal of facial hair [3].

Pathophysiology

The pathogenesis of ingrown hair involves two main processes, namely extrafollicular penetration and transfollicular penetration. The incidence of ingrown hair is a common phenomenon in males who have curly hair. While shaving, sharp edges are created in the hair which when grows again, gets curled and re-enters the skin. This process is known as extrafollicular penetration.

In the other process, the cut hair re-enters the skin without growing out. This phenomenon is known as the transfollicular penetration. Males who use the double blade razor also fall prey to ingrown hair. In double blade razor, the hair is pulled out by the first blade followed by cutting by the second one. Such an activity causes the hair to retract favoring development of ingrown hair [4, 5].

Prevention

Ingrown hair occur as a result of various hair removal technique that causes the improperly cut hair to re-enter the skin. Individuals are therefore advised to use those kinds of hair removal techniques that would help prevent the development of ingrown hair. The following precautionary methods can be used to avoid ingrown hair:
Always follow the practice of shaving after wetting the facial hairs. Shaving off dry hairs leads to development of ingrown hair and therefore such a practice should be discouraged.Electric razor should be preferred over other variants [9].

Individuals are advised to shave in the direction of hair growth and avoid skin taut.
The practice of using a single blade razor should be encouraged and males are also advised to apply cool compresses to the area after shaving [10].

Summary

It is a common condition amongst the males aged 14 – 25 years. However, the condition can affect any individual who practice hair removal by waxing, shaving or tweezing. Use of electrolysis to remove hair can also predispose an individual to develop ingrown hair [1]. Any activity that promotes uneven breaking of hair using sharp pointed objects can cause ingrown hair.

Patient Information

  • Definition: Ingrown hair is a condition wherein shaved hair re-enters the skin causing development of bumps and inflammation in the affected area. Such a type of condition is common amongst individuals aged 14 – 25 years. Ingrown hair can strike any individual who practice hair removal techniques to shave hair.
  • Cause: Several hair removal techniques like shaving, waxing, use of electrolysis and tweezers to remove hair predispose an individual to develop ingrown hair. Individuals with coarse or curly hair are more prone to develop this condition.
  • Symptoms: Symptoms of ingrown hair include development of small, solid, round shaped bumps in the affected area followed by inflammation and irritation. The lesions are small and filled with pus. In many cases, individuals may also experience pain and darkening of the affected area.
  • Diagnosis: The condition is diagnosed with a thorough physical examination of the affected area. In addition, the pustules may be checked for signs of secondary inflammation. Skin biopsy may seldom be required.
  • Treatment: Ingrown hair is treated with medications such as antibiotics, corticosteroids and retinoids. Antibiotics are administered to treat the bacterial infection and corticosteroids are given to reduce the inflammation. Retinoids help in darkening of the skin and also help alleviate hyperkeratosis characterized by thickening of the skin.

References

  1. Richards RN, Meharg GE. Electrolysis: observations from 13 years and 140,000 hours of experience. J. Am. Acad. Dermatol. 33(4),662–666 (1995).
  2. Kligman AM, Peters L. Histologic changes of human hair follicles after electrolysis: a comparison of two methods. Cutis. Aug 1984;34(2):169-76.
  3. Kelly AP. Pseudofolliculitis barbae and acne keloidalis nuchae. Dermatol Clin 2003; 21:645.
  4. Winter H, Schissel D, Parry DA et al. An unusual Ala12Thr polymorphism in the 1A α-helical segment of the companion layer-specific keratin k6hf: evidence for a risk factor in the etiology of the common hair disorder pseudofolliculitis barbae. J. Invest. Dermatol. 122(3),652–657 (2004).
  5. Lynfield YL, Macwilliams P. Shaving and hair growth. J Invest Dermatol 1970; 55:170.
  6. BHAKTAVIZIAM C, MESCON H, MATOLTSY AG. SHAVING. I. STUDY OF SKIN AND SHAVINGS. Arch Dermatol 1963; 88:874.
  7. McCabe J, Blades Z, McGrath EE. A spontaneous skin lesion. Can. Med. Assoc. J. 179(12),1297–1299 (2008).
  8. Cohen JL. Pain management with a topical lidocaine and tetracaine 7%/7% cream with laser dermatologic procedures. J Drugs Dermatol. Sep 1 2013;12(9):986-9.
  9. Nanni CA, Alster TS. Long-pulsed alexandrite laser-assisted hair removal at 5, 10, and 20 millisecond pulse durations. Lasers Surg Med. 1999;24(5):332-7.
  10. Vachiramon V, Brown T, McMichael AJ. Patient satisfaction and complications following laser hair removal in ethnic skin. J Drugs Dermatol. Feb 2012;11(2):191
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