Most anyone who knows me irl associates me with my skincare hobby and having glowing skin. However one thing that I never talk about is my (minor) struggles and self consciousness with ingrown hair (pseudofolliculitis barbae).
What is pseudofolliculities barbae (ingrown hair) and how does it affect darker skinned individuals?
As described by Dr. Bridgeman-Shah in Dermatologic Therapy, Vol. 17, 2004, :
“Pseudofolliculitis barbae (PFB) [ingrown hair] is a chronic inflammatory and potentially disfiguring condition most often seen in men and women of African American and Hispanic origin who have tightly curled hair and who shave or tweeze hairs frequently…The shape of the hair follicle, hair cuticle, and the direction of hair growth each play a role in the inflammatory response once the hair is shaven or plucked and left to grow. This reaction often produces painful, pruritic, and sometimes hyperpigmented papules in the beard distribution. The result is an unappealing cosmetic appearance, often with emotionally distressing consequences for affected individuals. The diagnosis is made clinically. Currently, prevention and early intervention are the mainstays of therapy. Many treatment options are available; however, none has been completely curative.”
In layperson terms this basically means ingrown hairs are commonplace for men and women with tightly coiled hair –like those of Black/African American and Hispanic descent. The study also highlighted that the direction (curved, towards the skin) of hair growth and the coiled (helical or spiral-shaped hair shafts) nature of these ethnic groups, paired with shaving at an oblique angle often yielded issues with PFB (Perry et al, S114).
Now, you may be wondering how do you get ingrown hairs if you don’t shave and that this was an issue only plaguing African American men in the military (Alexander,Delph 459). However ingrown hair affects Black/African American women as well due to often frequent shaving, tweezing, or use other methods of hair removal in the upper lip, neck, arm pit pubic, and leg areas (Perry et al, S114).
Understanding the condition from a clinical perspective
The NY-based Skin of Color Center, Department of Dermatology conducted a study in 2001 to understand the condition and management thereof in 30 male and 41 female participants. In addition to the medical challenges described below, “90.1% of patients reported hyperpigmentation, suggesting that postinflammatory hyperpigmentation is a major clinical finding in PFB.” (Perry et al, S116)
The diagnosis of PFB is made on clinical grounds, based on the location and type of lesions. Papules and pustules that appear in the beard distribution are the most common presentation. The anterior neckline, mandibular areas, cheeks, and chin are the most commonly involved sites. The typical lesion site for women in our survey was the chin, whereas the neck was the most common site for men.
How do you treat ingrown hair when you have dark skin?
- Let it grow
The optimal method to resolving the issue is letting the hair grow naturally with subsequent chemical hair removal.
With mild cases discontinue shaving for 1 month, moderate cases for 2 to 3 months, and severe cases for 3 to 6 months. PFB tends to worsen during the first week because of regrowth of previously shaved hairs (Perry et al, S117).
2. Chemical depilatories
Due to the breaking down and “loosening” of the disulfide bonds in the hair, chemical depilatories (powder, lotion, cream, or paste) make the hair softer and less likely to repenetrate (Perry et al, S117-118).
Examples of products include: Nair, Veet and similar products in market. Look for the active ingredients barium sulfide or calcium thioglycolate.
Other treatments for hair removal that are more optimal darker skin types include: diode (810nm, longer wavelength) and Neyodmium:yttrium-aluminium-garnet lasera (longer pulse duration, optimal cooling and FDA approved) which both noted as the safest options (Grimes, 307). Other laser systems–ones using intense pulsed light– are not safe for darker skin types; this can lead to adverse reactions and post inflammatory hyperpigmentation (PIH) which is a common skin concern amongst darker skinned individuals (Bridgemand-Shah, 167).
4. Topical agents
Recommended topical agents: What’s a good skincare routine or products to manage ingrown hair?
The importance of sun protection due to photosensitivity
I have to stress the importance of sun protection, especially when you have darker skin! Some of the below recommendations will heighten photosensitivity which can lead to PIH and is not something you probably want more of! It is of the utmost importance to ALWAYS wear sunscreen on skin with direct sun exposure in general and especially when using any chemical exfoliants.
Eflornithine hydro- chloride: prevents hair growth but not removal
- Vaniqua (FDA approved; used in conjunction with other treatments such as the above laser therapy and depilatories)
Can be used to treat PIH associated with ingrown hairs.
Alpha Hydroxy Acid (including Glycolic acid, Lactic acid, azelaic acid): Reduces bonds in the hair shaft
Personally I’ve had great success with reducing the inflammation of the papules caused by PFB with a combination of the below bolded products. Of course this is in conjunction with a routine full of hydration and easing into the use of chemical exfoliants over a long period of time. LabMuffin has a great Chemical Exfoliation Basics post on her blog (Part 2 is here) and there are resources on r/SkincareAddiction’s wiki page. If you are looking for Asian Skincare recommendations, check r/AsianBeauty’s search for AHA and BHA products respectively. When searching for a product that best suits your needs, researching reviews and understanding how your skin is as essential as the slow introduction into an existing routine.
- Kate Somerville ExfoliKate® Intensive Exfoliating Treatment
- Dr. Dennis Gross Alpha Beta Peel Extra Strength (contains glycolic, mandelic, and lactic acid)
- MUAC Lactic Acid 40% Peel
- Nip & Fab Glycolic Fix Night Pads
- Cosrx AHA 7 Whitehead Power Liquid (glycolic acid, niacinamide, and hyaluronic acid are top ingredients)
- Peter Thomas Roth glycolic toner 8%
- Drunk Elephant T.L.C. Framboos Glycolic Night Serum 1 oz/ 30 mL
- The Ordinary. Azelaic Acid Suspension 10%
Paula’s Choice Clear Daily Skin Clearing Treatment with Azelaic Acid
Salicylic acid: anti-inflammatory properties
Topical retinoids: include prescription tretinoin, isotretinoin, adapalene, alitretinoin; if you have access to Curology, it is a great resource for accessing dermatological care with prescription medications
0.5% tretinoin, adapalene topical gel such as Epiduo
Disclaimer: I am not a medical professional so all practices, opinions, and otherwise are purely anecdotal and based on my personal experience and research. This post is meant to be directional. Please consult your healthcare provider if you are looking to treat any medical conditions.
Additionally–no affiliate links have been used, all bolded products I’ve purchased with my own funds.
Alexander, A. M., & Delph, W. I. (1974). Pseudofolliculitis barbae in the military. A medical, administrative and social problem. Journal of the National Medical Association, 66(6),459-64, 479
Bridgeman‐Shah, Sharon. “The medical and surgical therapy of pseudofolliculitis barbae.” Dermatologic therapy 17.2 (2004): 158-163.
Davis, Erica C., and Valerie D. Callender. “Postinflammatory hyperpigmentation: a review of the epidemiology, clinical features, and treatment options in skin of color.” The Journal of clinical and aesthetic dermatology 3.7 (2010): 20.
Grimes, Pearl E., ed. Aesthetics and cosmetic surgery for darker skin types. Lippincott Williams & Wilkins, 2008: 307-8.
Lamb, Angela, and Gregory N. Yañez. “Pseudofolliculitis Barbae.” Acneiform Eruptions in Dermatology. Springer New York, 2014. 289-294.
Nguyen, T. A., et al. “Pseudofolliculitis barbae in women: a clinical perspective.” British Journal of Dermatology 173.1 (2015): 279-281.
Nijhawan, Rajiv I., and Andrew F. Alexis. “Practical approaches to medical and cosmetic dermatology in skin of color patients.” Expert Review of Dermatology (2011).
Perry, Patricia K., et al. “Defining pseudofolliculitis barbae in 2001: a review of the literature and current trends.” Journal of the American Academy of Dermatology 46.2 (2002): S113-S119.