Ingrown hairs are a common problem that can result in permanent ingrown hair scars. An ingrown hair occurs when one or more hairs fails to emerge from the hair follicle or if its end makes a “u-turn” after emerging from the follicle and buries itself in the skin itself. The growing hair continues to grow and elongate below the skin’s surface which can create a number of problems.
Who Gets Ingrown Hair Scars?
Risk factors for ingrown hair scars include:
- coarser, more wirey hair (often seen in African, African Americans)
- hair removal – shaving, waxing, tweezing
- tight clothing – restricts hairs ability to emerge from the follicle
- using dull razors – irritate skin causing swelling that can block new hairs from emerging properly
- not exfoliating and moisturizing enough – leaves dry skin that can clog follicles causing ingrown hair scars
Ingrown Hair Scars Or Something Else?
Often the term “scar” is used loosely. When a mark develops from an ingrown hair, it may or may not be an actual scar. Other possibilities from ingrown hairs are:
Pseudofolliculitis Barbae
Pseudofolliculitis barbae can apear similar to folliculitis barbae but is not an infection. Pseudofolliculitis barbae is due occurs when the growing ends of hairs that been shaved grow into the skin causing a foreign body reaction similar to having a splinter stuck in the skin. It is more common with wiry, coarse, and curly hairs. This condition is often referred to as “razor bumps” or “razor rash”. Pseudofolliculitis barbae can become infected and lead to true folliculitis barbae so prevention and treatment is important. Pseudofolliculitis barbae prevention strategies include:
- premanent hair removal such as laser hair removal
- shaving in the direction of hair growth
- moisturizing the skin well using high quality shaving creams or gels
- use single-blade disposable razors that shave less closely than multi-blade razors
- use disposable razors once only
- use of electric razors instead of blade razors
- shave less frequently
Treatment of Pseudofolliculitis barbae once it occurs include:
- hydrocortisone ointments to reduce inflammation
- topical acne ointments (such as bezoyl peroxide)
- oral antibiotics (tetracycline)
Folliculitis Barbae
Folliculitis occurs when skin bacteria (often Staphylococcus Aureus) invade the hair follicle cause an infection. Pseudofolliculitis barbae that becomes infected can become true folliculitis. The bump that forms will usually be warm, tender, and can drain pus. This type of bump around a hair follicle will usually need medical attention including antibiotics or even surgical drainage. It is possible that with, or without, proper medical care a folliculitis will leave a scar. This is particularly likely if the folliculitis needed surgical treatment, such as drainage.
Epidermal Cysts
What’s perceived as ingrown hair scars may actually be an epidermal cyst. Epidermal cysts can arise from blockages in hair follicles, oil glands, and sweat glands. The skin’s structures continue to form cells, keratin, oils, hair, and other substances that get trapped within the skin and accumulate. Over time, a structure called an epidermal cyst (sometimes called sebaceous cyst) forms and grows in size. Early on, epidermal cysts may be managed by simple measures such as cortisone injections. Surgical excision is often needed/requested for larger cysts that become visible and of esthetic concern. These types of cysts can become spontaneously infected requiring antibiotics and/or drainage.
Conclusion:
Ingrown hair scars can result from pseudofolliculitis barbae, folliculitis barbae, or an epidermal cyst. It is important to understand the differences between these conditions so as to prevent and treat them properly and avoid permanent scarring. Prevention is the best medicine because not only can these conditions themselves lead to scarring but so can their medical management if surgery is necessary.