Razor burn and ingrown hairs are common skin complaints, particularly among men who shave daily and women who shave or wax the legs, bikini area and underarms. While often dismissed as cosmetic concerns, severe or recurrent cases — clinically termed pseudofolliculitis barbae when affecting the beard area — cause genuine discomfort and can lead to post-inflammatory hyperpigmentation, scarring and secondary infection.

Community pharmacists see these complaints regularly and can offer practical advice and OTC treatment.

Understanding the conditions

Razor burn is acute irritant contact dermatitis caused by the mechanical trauma of shaving. It presents as diffuse redness, stinging and a burning sensation immediately after shaving, typically resolving within hours to a day.

Ingrown hairs (pseudofolliculitis) occur when shaved or waxed hairs curl back into the skin rather than growing outwards. The embedded hair triggers a foreign-body inflammatory response, producing firm, often painful papules and pustules. According to NHS guidance, they are most common in people with curly or coarse hair, particularly affecting men of African-Caribbean descent (where prevalence may exceed 60% in those who shave regularly).

Pharmacy treatment

For acute razor burn

• Cool compress. A clean flannel soaked in cool water applied to the area for 10 minutes reduces inflammation.
• Emollient. A fragrance-free moisturiser (e.g. Cetraben, Diprobase) applied to the shaved area soothes and restores the skin barrier. Avoid products containing alcohol, which stings and worsens drying.
• Hydrocortisone 1% cream. For persistent redness and irritation lasting more than a few hours, a thin application of OTC hydrocortisone cream twice daily for up to three days is appropriate. Not for routine use after every shave.
• Avoid re-shaving the affected area until irritation has fully resolved.

For ingrown hairs

Mild cases (a few papules, no infection):

• Warm compress. A warm, damp flannel applied for 5–10 minutes softens the skin and may help the trapped hair emerge.
• Gentle exfoliation. A mild exfoliating wash containing salicylic acid (0.5–2%) or glycolic acid helps prevent and treat ingrown hairs by softening the stratum corneum and keeping follicle openings clear.
• Do not pick or squeeze. This introduces bacteria and increases scarring risk.
• Benzoyl peroxide 5% wash. Used as a cleanser on affected areas, this reduces bacterial load in follicles and has mild keratolytic properties. Warn patients it bleaches towels and clothing.

Infected ingrown hairs (pustules, spreading redness, pain):

• Topical antiseptic. Chlorhexidine 0.05% wash or povidone-iodine applied to the area.
• If localised infection is present, a pharmacist may recommend a short course of topical fusidic acid if available OTC (Fucidin cream is POM in the UK — check local availability of pharmacy-medicine alternatives).
• Refer to GP if infection is spreading, there are multiple abscesses, the patient has fever, or lesions are on the face and worsening despite self-care.

Prevention strategies

Prevention is more effective than treatment for chronic sufferers. Pharmacists can advise:

Shaving technique

• Shave with the grain (in the direction of hair growth), not against it. Shaving against the grain gives a closer cut but increases the risk of ingrown hairs.
• Use a single-blade razor or an electric trimmer that does not cut below skin level. Multi-blade razors cut hair too short, increasing the likelihood of the cut end curling back into the follicle.
• Soften hair before shaving. Shave after a warm shower or apply a warm, damp flannel for 2–3 minutes. Use a shaving gel or cream — never shave dry skin.
• Replace blades regularly. Dull blades require more pressure and passes, increasing trauma.
• Rinse with cool water after shaving and apply an alcohol-free moisturiser.

Chemical alternatives to shaving

Depilatory creams (containing calcium thioglycolate or potassium thioglycolate) dissolve hair at the skin surface without cutting it, which eliminates the sharp tip that causes ingrown hairs. However, they can cause chemical burns if left on too long or used on sensitive skin. Advise a patch test 24 hours before first use.

For chronic pseudofolliculitis barbae

Patients with persistent, recurrent ingrown hairs despite technique changes should be referred to their GP. Treatment options beyond OTC include prescription retinoids (tretinoin cream, which promotes cell turnover and prevents follicular plugging), topical antibiotics for recurrent infection, and laser hair reduction, which is increasingly available on the NHS for severe pseudofolliculitis barbae causing scarring.

Products to avoid

• Aftershaves containing alcohol — sting, dry the skin and worsen irritation.
• Fragranced moisturisers — potential irritants on freshly shaved, compromised skin.
• Astringent toners — can tighten pores and trap emerging hairs.
• Scrubbing with rough exfoliants during active inflammation — worsens irritation.

When to refer

Refer to a GP if there are signs of spreading infection (cellulitis), recurrent abscesses requiring incision and drainage, deep cysts forming along the jawline or bikini area, significant scarring or keloid formation, or if symptoms persist despite three months of preventive measures.

Finding pharmacy skin advice

Community pharmacists can assess skin conditions and recommend treatments without a GP appointment. Use PharmSee's pharmacy finder to locate a pharmacy near you, or explore pharmacy career opportunities in community health.

Sources: NICE CKS Folliculitis, NHS Ingrown Hairs, BNF.