Ingrown, Malformed Hairs in the Neck and Face Area

[mpkim]

I am a Caucasian, 38-year old male with mostly dark and some light facial hair.  My skin is somewhat sensitive.  My facial hair, and especially the hair on the front of my neck, tends to grow close to the skin rather than protruding straight out of the skin.  Therefore, I have never been able to get a decent looking shave using an electric shaver.



Aside from “normal” ingrown hairs, I have what appears to be a similar, yet much worse condition.  Typically the condition presents as a mild to moderate elevation of the skin – primarily in the chin or neck area but also seen as high as the side of my nose.  There may be some discoloration with the elevated skin, but the discoloration is usually not too bad.  Typically I can see what appears to be a hair (or multiple hairs) under the skin, but it does not look like a fully developed hair that has turned back into the skin.



I have read and been told by a dermatologist never to pick at the skin; however, this condition continues to worsen over time and the pressure continues to build with no apparent way of resolving itself.  The only way I’ve found to resolve the issue is by piercing the skin with a needle, and this is painless to do as the skin in this area has no feeling to it.



After doing this, what I typically find is a collection of small, malformed short hairs that have no apparent way to ever grow normally and protrude through the skin.  The hairs are very short, embedded in the skin, and typically have a significant mucous coating to them.  The only way I’ve been able to clean out the area is to work each hair free from the underlying skin with the needle, and pull it completely out with a tweezers.  This would not be possible on any other area of my face due to the intervening nerves, but it is easy for this condition as almost all the skin in the immediate area is insensitive.



The area is typically about 1/8 of an inch in diameter, but can expand to as much as 1/4 inch by the time all the problem hairs are cleaned out.  Usually I will remove 6-10 hairs from an area this size, all of them short, malformed, and coated in mucous.  The area always looks awful after I am finished, resulting in a very deep wound.  Although it looks so bad, I see no way in which the underlying, malformed hairs would ever clean up on their own – I have waited this out as long as 4 weeks in one case in order to avoid the inevitable wound associated with removing the hairs.  Of course, the lingering problem is then the scar that forms from the wound.



I am at a loss as to what should be done when this condition arises, and even more important, if and how the condition can be prevented.  I am not sure if the underlying problem is mechanical (from the shaving), an infection that could result from the shaving and/or personal hygiene, physiological, dietary, or other.  Any advice on how to treat, and more importantly prevent this issue would be appreciated.



Thank you.

[Alan Rockoff, MD]

Sir:



You have obsessive-compulsive disorder and are mutilating yourself.  You seem convinced that you "have to," but you don't.  Unless you stop, nothing will make you better.  The help you need is psychiatric and pharmacologic.  The sooner you get this care, the better off you'll be.  If you reject this suggestion and keep looking for skin-related causes that aren't there, then you're dooming yourself to years of disfigurement and needless suffering.



Good luck.



Dr. Rockoff