Razor bumps: their causes and cures

razor bumps
Photo courtesy of Dr. Crutchfield

A 9-step program for improving skin condition

Razor bumps look and feel like pimples, but they are actually the result of ingrown hairs. The medical term for this condition is “pseudofolliculitis barbae” (PFB), where the word “pseudo” means “not genuine.”

What causes razor bumps?
Hair grows inside tubes in the skin called “follicles.” When shaved, the tip of the hair is left with a sharp point. As a curly hair grows, this sharp tip may curve back and pierce the surface of the skin. The medical term for this cause of PFB is “extrafollicular penetration” (see diagram).

The body treats all ingrown hairs just as it would a splinter or any other foreign object by producing an inflammatory (tender, red, pus-filled) pimple-like bump. Often, if the condition occurs over an extended period of time, the skin will respond by producing unsightly dark spots and skin thickness at the sites of the PFB bumps.

Unfortunately, these dark spots can take many months to fade. Since most African American men have curly, coarse hair and curved follicles, they frequently suffer from razor bumps. This is also true for people of Mediterranean descent. It should be noted that razor bumps can affect anyone who has curly hair or who has hair follicles oriented at oblique angles to the skin surface, making it easier for the sharp hair tips to re-enter the skin.

The key to controlling PFB is to minimize hair re-entry back into the skin (and subsequent inflammation) by reducing the sharpness of the hair tip and by leaving hair at the appropriate length after shaving.

What to do about razor bumps
The best therapy is to avoid shaving and let the beard grow. However, this is not always a practical solution.

It should be noted that if your doctor feels that your condition is extreme, you should let your beard grow out for several weeks before proceeding. As the hair lengthens, the shafts will act like miniature “springs” and eventually “pop free.” Your doctor will tell you when to begin the anti-PFB shaving program and may even prescribe a short course of antibiotic pills.

If you do shave, the following step-by-step program is recommended:

Step 1
Wet your beard with warm water to soften the hair. The best way to accomplish this is to take a shower before shaving. Make sure that your beard hair is in contact with the water for at least two minutes.

This will fully hydrate your hair. Hydrated hair cuts more easily and leaves a hair tip that is not as sharp. This will decrease the chance for it re-entering the skin.

Step 2
Use a soft-bristled toothbrush in a circular motion on the beard area to dislodge any hair tips that are beginning to pierce the skin. This should be done twice per day before shaving and at bedtime.

If approved by your doctor, you may even use a sterile needle cleaned with rubbing alcohol or a toothpick to dislodge any particularly stubborn tips. Failure to dislodge any tips attempting to re-enter the skin will cause “extrafollicular” razor bumps.

Step 3
Use an adjustable electric razor or barber-like clippers (that are designed to shave close).Make sure to get one that has adjustable blade settings. Shave at the setting that leaves hair the longest to prevent “transfollicular” razor bumps.

If using a non-electric razor, use one that has a protective guard like “Gillette Skinguard” or the “Bumpfighter Razor.” With these, before shaving apply shaving oil followed by Aveeno Therapeutic oatmeal shave gel.


Step 4
Use Vaniqa ™ lotion twice daily. Vaniqa is a product that requires a prescription from your doctor. Vaniqa will make the hair grow very slowly, so less grooming is required, which means less overall irritation. This is optional.

Step 5
After shaving, apply Cerave Cream (an over-the-counter moisturizing cream) followed directly with an over-the-counter hydrocortisone 1% cream on top of the Cerave Cream. The pharmacist can help recommend the over-the-counter hydrocortisone 1% cream. These two creams will minimize inflammation and irritation and increase soothing hydration. 

Step 6
Always use a “collar extender” whenever wearing neckties to prevent excess friction and pressure from worsening the PFB condition on the neck and collar area. These are easily found on Amazon.com.

Step 7
For cleansing purposes, you should always use a mild soap such as Vanicream cleansing bar, Dove unscented, Olay, Purpose, Basis, or Cetaphil.

Step 8
If dark spots are a problem, apply a hydroquinone-containing skin-lightening lotion. A pharmacist can help you select an appropriate product. Be sure to use it only three months at a time with a one-month break.

Step 9
Additionally, if one is using a lightening cream, a good sunscreen must be applied twice daily, once in the morning, and one other time. Using a lightening cream without sunscreen is like walking up an escalator that is moving down—it’s tough to make any progress.

It may take a few days to several weeks for your condition to improve. Sometimes it can even take a couple of months to see improvement. Stay with the program and don’t give up.

The goal is not necessarily to have” perfect” skin but to significantly improve the current condition of your skin. Don’t let Perfection be the enemy of Very Good. Many patients do experience extremely satisfying results when using this system.
In extreme, severe cases, laser hair removal may be considered, but talk carefully with your dermatologist before doing this. Using the wrong hair laser can cause significant damage.

It is also important to note that whenever you have inflammation of the skin, your skin can react by producing dark spots. If the inflammation is removed, the dark spots will fade away with time. This may take several weeks or even months.

The best way to treat dark spots is to prevent them from appearing in the first place. Hopefully, that is what this skin program will do for you.