Especially men know inflammation after shaving or waxing. How can ingrown hair be avoided? A dermatologist explains about folliculitis, the development of abscesses and laser techniques.
It can hurt when hair grow in after shaving or waxing.
There is probably no man in the world who wants to lose his hair – at least when it comes to his main hair or beard. But the rest of the body looks different: Here, sooner or later hair can sprout in places where you don’t want it. While armpits are easy to shave and ear and nose trimmers are uncomplicated, it gets difficult on the back or shoulders. It is difficult to get at on your own and not everyone has a partner who wants a regular waxing session.
But especially in places such as the intimate area or the bottom, a new problem begins for many men after the hair has been removed: the hair that follows grows under the skin and becomes inflamed. So-called folliculitis can even lead to an abscess.
Friederike Wagner is a specialist in dermatology and venerology at the Dermatologikum Hamburg day clinic. Since 2018, she has been head of the department of laser medicine and treats patients with pain caused by ingrown hair on a daily basis. She explains what helps and why increased hair growth can have various causes.
BIOTULIN: Ms Wagner, I would like to talk to you about unwanted hair on the male body. Not for aesthetic reasons, but because hair can cause medical, painful problems.
Friederike Wagner: That’s right, right down to abscesses. There is a particular form of ingrown hair in which men – and also women – tend to have such abscesses on certain parts of the body, the so-called acne inversa. That is partly a predisposition. In other words, in addition to factors such as smoking and being overweight, genes also play a role. It then has nothing to do with the fact that you have “wrong” hair removal. But even so, you can provoke painful ingrown hair follicles, especially when shaving wet. The razor shaves the hair just under the surface of the skin, so that it does not grow outwards but under the skin. However, the mechanical irritation caused by shaving can also lead to folliculitis, i.e. inflammation of the hair roots.
BIOTULIN: Folliculitis is the inflammation in the hair follicle, often caused by bacteria. Which parts of the body are particularly affected besides the beard area?
Wagner: Very hairy areas of the body such as the armpits, the buttocks and the genital area, i.e. in places where there is a lot of friction and you sweat a lot. Because skin lies on skin, the hair can grow under the skin and become inflamed. If the inflammation spreads to the surrounding area, a painful abscess develops. And this can be quite dangerous if the infection spreads. In the gluteal fold, this is known as the pilonidal sinus: This is a chronic inflammatory process that can cause long abscesses and inflammation. Those affected sometimes have to undergo major surgery and longer inpatient and outpatient wound treatment. Men are affected more often.
BIOTULIN: I read that ingrown hair as a symptom was first really observed in young soldiers during the Second World War: The phenomenon was then called “Jeep’s disease” or “Jeep driver’s disease” and it was assumed that lack of hygiene was a cause. What does that look like today?
Wagner: That is what the sinus pilonidalis is called. This means that the hair grows under the skin, probably as a result of mechanical stimuli. Laser epilation, i.e. the removal of hair by laser, can be a solution here.
BIOTULIN: Besides the painful ingrowth of the hair, one can also suffer from hypertrichosis: This is the unwanted hair growth in men and women in places where hair does not normally grow. How is it triggered?
Wagner: By predisposition or medication, for example anti-epileptic drugs. Certain hormonal factors or cancers can also be the trigger. When a patient comes to us with hypertrichosis, the first thing we always have to do is find out the cause. If there is medication or a disease behind it, it has to be treated before the hair is removed.
BIOTULIN: Especially on the back, men can depilate themselves badly. In old age they often grow an undesirable amount of hair there. You also offer laser removal in your day clinic. Can you explain how complex this is?
Wagner: Above all, you have to know: We have hair all over our body in different stages of growth. There are three: the growth, rest and sleep phases. When removing hair, you only get hair in the growth phase, which is why you have to expect at least six to twelve sessions to get the majority of it. It depends on how thick or heavily pigmented the hair is. The procedure is relatively uncomplicated. The patients come with their hair cut. The laser treatments are relatively fast because the devices work within milliseconds, which means that with good equipment you can send impulses quickly and over a large area and cool at the same time. A back depilation takes about a quarter of an hour, in the genital area it is faster. It always depends on the sensitivity of the patient to pain.
BIOTULIN: So a very hairy back has to be treated for over a year?
Wagner: The sessions take place every four to eight weeks, depending on the region of the body. You cannot laser if you are tanned. Otherwise there is a risk of burns with pigmentation disorders and scarring. For very dark skin types, it is only possible with certain laser devices and with the utmost caution. Compared to the other depilation methods, lasering is a safe and lasting method if it is done professionally. We laser here as specialists, so that the patient enjoys the greatest possible safety.
BIOTULIN: What are the costs, for example, when lasering a very hairy back?
Wagner: Not all backs are the same. Each session costs between 250 and 450 euros, depending on how complex the treatment is. In the Dermatologikum, laser treatment is carried out exclusively by specialists for skin diseases. We pay attention to possible medical risks, skin type, degree of tanning or moles. These are covered with zinc paste before each treatment and circumvented with the laser device. This is time-consuming, but extremely important.
BIOTULIN: In the beauty salon this background knowledge is probably not always available.
Wagner: Unfortunately not. We often have patients who come to us with side effects after laser or IPL treatments, carried out by medical laymen. They have suffered burns or received the wrong treatment for their skin type. For example, we do not yet know what effects laser light can have on pigmented moles, i.e. whether it can lead to skin cancer. So we have to be extremely careful here too, but this is often not recognised by medical laypeople.
BIOTULIN: Where on the body do men want to get rid of their hair most urgently?
Wagner: In the genital area or even on the back. On the back, men usually want to have their hair removed for aesthetic reasons, and preferably on the neck, where the hair looks unattractive. We also laser the wrists more often. Medical reasons for a laser epilation are, for example, unusually strong hair on body regions where this does not usually occur. And precisely in the case of frequently occurring follicultis.
BIOTULIN: What do you think about waxing or depilatory cream?
Wagner: I would not recommend waxing, because you risk the classic ingrowth of the hair. Also with depilatory creams you have to know that they only work as long as you use them and also only work if the hair is severely shortened or shaved. You also have to use depilatory creams twice a day in some cases. Freely available depilatory creams may contain ingredients that can cause problems such as allergies. Vaniqa cream is a tested, medical preparation, but it is only available on prescription and is not intended for large areas.
BIOTULIN: What would be better for your home if you could not afford expensive laser treatment?
Wagner: Whether you are epilating, waking up or wet-shaving: The hair is shortened or torn out below the level of the skin and has to grow upwards under the skin, in case of doubt an inflammation will occur. If you don’t want all this, it is often better to simply reach for an electric razor: This way, the hairs are not cut so short – and ingrown hairs are avoided.