Skincare Case 110

This case involves a 33-year-old male with Fitzpatrick skin type VI and combination skin, who presents with the main concern of ingrown hair on the beard area. The patient has experienced this issue for as long as he has been growing his beard, and it appears to worsen specifically after shaving. He has tried a variety of home remedies with little improvement, including using creamy butter shave cream, soaking his razor in alcohol before shaving, using after-shave and alcohol post-shaving, and attempting to pluck ingrown hair with a pair of tweezers. Physical examination reveals some ingrown hairs on the beard area and a few pustule-like pimples with some oozing fluids.

Causes

Ingrown hairs, also known as Pseudofolliculitis barbae, occur when hair that has been shaved, waxed, or plucked grows back into the skin, causing inflammation and irritation. This condition is more common in individuals with curly or coarse hair, which is often the case for Fitzpatrick skin type VI. Shaving can exacerbate the issue by creating sharp edges on the hairs, allowing them to more easily pierce the skin and grow back into it. The pustule-like pimples are likely folliculitis, a secondary bacterial infection of the hair follicles.

What is Done Wrong

1. Improper shaving technique: Shaving too close to the skin can increase the risk of hair growing back into the skin. Shaving in the opposite direction of hair growth can also cause this problem.
2. Use of alcohol: Using alcohol on the skin can be too drying, disrupting the skin’s natural barrier, and potentially leading to more irritation and inflammation.
3. Tweezing ingrown hairs: Picking and plucking at ingrown hairs can lead to skin damage, scarring, and potentially more infection.
4. Lack of exfoliation: Regular exfoliation can help remove dead skin cells that may trap hairs under the skin.

Office and Home Treatment Options

Office treatments:

1. Laser hair removal: This treatment can reduce the amount of hair and thus the chance of hairs becoming ingrown.
2. Steroid creams: These can be prescribed to reduce inflammation if the ingrown hairs are causing significant discomfort.
3. Antibiotics: If folliculitis is present, a course of topical or oral antibiotics may be required.

Home treatments:

1. Proper shaving technique: Shaving in the direction of hair growth, using a single-blade razor, and not pulling the skin taut can reduce the risk of ingrown hairs.
2. Use a gentle exfoliating product: This can help remove dead skin cells that may trap hairs.
3. Use a moisturizing shave cream: This can help protect the skin’s barrier and reduce irritation.

Preventions

1. Correct shaving techniques: As mentioned above, these can significantly reduce the risk of developing ingrown hairs.
2. Regular exfoliation: This can help prevent hairs from becoming trapped under the skin.
3. Keep skin moisturized: This can help maintain the skin’s natural barrier and reduce irritation.
4. Consider alternative hair removal methods: If shaving continually causes problems, it may be worth considering other methods such as trimming or laser hair removal.

Home Care Daily Routine

Morning:

1. Cleanse the face with a gentle cleanser.
2. Apply a non-comedogenic moisturizer.
3. If shaving, use a moisturizing shave cream and single-blade razor. Shave in the direction of hair growth and do not pull the skin taut.
4. Apply an alcohol-free after-shave balm to soothe the skin.

Evening:

1. Cleanse the face with a gentle cleanser.
2. Two or three times a week, gently exfoliate the skin, focusing on the beard area. This could be done with a gentle facial scrub or with a product containing a chemical exfoliant like salicylic acid.
3. Apply a non-comedogenic moisturizer.

It’s crucial for the patient to avoid picking or trying to remove the ingrown hairs with tweezers as it can lead to further inflammation and potential scarring. If the ingrown hairs persist despite the above measures or if they become red, inflamed, or pustular, he should seek medical advice as he may need prescription treatments.

Maintaining this routine and good shaving practices should help in reducing the occurrence of ingrown hairs. However, improvements will be seen over time, not instantly, and it’s essential to be consistent with the routine.