Bumps under the beard: ingrown hairs, infected follicles and barber's itch

What it is

Three different problems cause bumps in the beard. Razor bumps (pseudofolliculitis barbae) are ingrown hairs: curly hairs cut very short curl back into the skin. Folliculitis barbae is an infection of the hair follicles, usually by a common bacterium (Staphylococcus aureus), with itchy or tender bumps and small pus spots. Tinea barbae (a fungal beard infection, sometimes called barber's itch) causes inflamed, lumpy, crusted patches where hairs pull out easily; despite the name, it is often not very itchy. They can look alike, and razor bumps and folliculitis often happen together.

How it works

Razor bumps are a reaction to the hair itself, so they settle when the hair is allowed to grow a little. Folliculitis happens when bacteria get into follicles, often through tiny cuts from shaving or from equipment that carries bacteria; some people carry the bacteria in their nose, which is why it can keep coming back. Tinea barbae is usually caught from animals such as cattle, and rarely from other people; it needs antifungal treatment.

Why it matters on darker skin

Razor bumps are particularly common in Black men because tightly curled hair is more likely to grow back into the skin. On brown and black skin the bumps often look dark brown or purplish rather than red, and each one can leave a dark mark or, with repeated irritation, a raised scar. Deep, untreated infection of the follicles can scar and cause permanent bald patches in the beard.

Causes and triggers

Close shaving, especially against the direction of growth or with a multi-blade razor; pulling the skin tight while shaving; dull or dirty blades; shared or poorly cleaned clippers; picking and squeezing; sweat and friction from helmets or masks; and close contact with farm animals for tinea barbae.

What helps — and why it works

For razor bumps, the most reliable fix is to let the beard grow a few millimetres: use clippers with a guard instead of a razor. If you must shave, shave at the end of a shower, use a fragrance-free shaving cream and leave it on for a couple of minutes, shave in the direction the hair grows, do not pull the skin tight or press hard, and moisturise afterwards. If the tip of a trapped hair is visible above the skin, you can lift it out with sterilised tweezers; never dig under the skin. For mild folliculitis, wash gently twice a day; a pharmacist can suggest an antiseptic wash or antibacterial cream, and if it is not clearly better within one to two weeks, see a doctor. Use a fresh disposable blade each time, or clean clippers with an alcohol-based disinfectant. Tinea barbae needs a doctor, because it usually needs antifungal tablets.

What to avoid and why

Avoid plucking or digging out ingrown hairs, squeezing pus spots, sharing razors, towels or clippers, and putting steroid or "mixed" creams on bumps: steroids can make fungal and bacterial infections spread. Avoid hair removal creams on irritated skin.

Common mistakes

• Shaving closer to "get rid of" bumps, which makes them worse.
• Treating every bump as acne.
• Stopping antibiotics or antifungals as soon as the bumps look better.
• Using the same unwashed towel on the face every day.

Questions to ask your doctor or pharmacist

Useful questions include: What do you think is causing this? Is it likely to come back, and how can I prevent it? Which products should I stop? How long before I should expect improvement, and when should I come back if it isn't better? Are there side effects to watch for? Is this treatment safe if I am pregnant, breastfeeding or for my child? Writing your questions down, bringing your products (or photos of their labels) and taking dated photos of the problem make an appointment much more useful.