Razor bumps on the back of the head

Are they actually razor bumps?

Appearance alone is not enough to choose a treatment. AKN is not ordinary acne, despite its name, and some people have AKN alongside ingrown hairs or acne. Folliculitis is also a broad term rather than one infection: bacteria, other organisms and irritation can produce different types that need different treatment.26

When should you suspect AKN?

AKN often begins as small, itchy bumps at the back of the scalp or neck. Crusting, pus, pain, skin thickening or patches of hair loss can develop. Bumps that enlarge or merge into raised scars deserve assessment rather than another attempt at a closer haircut. AKN is most common in Black males and often starts between ages 14 and 25, but anyone can develop it. Coarse or curly hair also increases the likelihood of ordinary ingrown hairs. Redness can be harder to see on black or brown skin, so a change from the surrounding skin colour matters too.2457

What can you do now?

1. 1Pause shaving over the affected area. Avoid razor haircuts and very short clipping at the back of the scalp while you arrange assessment.
2. 2Reduce rubbing from high collars, hats and headgear against the affected skin.
3. 3Keep the area clean, and use clean clothing and washcloths. An antimicrobial cleanser or shampoo is an option to discuss when folliculitis or secondary infection is a concern.
4. 4For mild folliculitis, apply a warm, moist cloth to ease discomfort and help affected follicles drain.
5. 5Leave the bumps alone. Picking, squeezing and scratching can damage the skin and lead to infection.

Tell your barber that the back of your scalp needs a longer cut without a razor finish. A haircut can leave some hair behind and still be a haircut, despite the pursuit of a perfectly bare neckline.5

How should you shave if they are ingrown hairs?

Not shaving is the best way to prevent ingrown hairs. If you resume shaving, the following is general ingrown hair guidance, not a treatment for AKN. An electric razor is an alternative to wet shaving. Leave at least 1 mm of stubble rather than shaving flush with the skin, and avoid shaving every day if possible.4

1. 1Wet the skin with warm water and apply shaving gel.
2. 2Use a clean, sharp blade and shave in the direction the hair grows.
3. 3Use as few strokes as possible, rinsing the razor after every stroke.
4. 4Hold a cool, wet cloth against the skin afterwards to reduce irritation.

Should you use an exfoliant or bump cream?

For ordinary ingrown hairs, a pharmacist can help choose products for itching, shaving irritation or exfoliation to help prevent trapped hairs. Persistent bumps on the back of the scalp need a diagnosis before you treat them as a routine exfoliation problem. AKN needs medical treatment; self care alone cannot treat it effectively. Avoid home remedies involving acids, engine oil or antibiotics. Acids sold for rubbing onto scalp bumps can cause chemical burns and scarring.24

Products sold as home remedies can promise to remove scalp bumps for good, which is a generous amount of certainty to fit on a bottle.2

What happens at the appointment?

A clinician examines the scalp and neck and asks when the bumps started, whether they have changed, what irritates them and which treatments you have tried. Mention your usual haircut, collar or headgear, itching and pain. Bring a list of products already tried, rather than giving another bottle an audition for the same job. If infection is suspected, a sample for a culture can help identify the organism and guide treatment. A small skin sample, called a biopsy, is sometimes needed when the diagnosis is unclear, but it is not routinely necessary for AKN.57

Which treatments can help?

For infected folliculitis, treatment can include antibiotics applied to the skin or taken by mouth, or an antifungal medicine when fungus is responsible. A clinician can also release an ingrown hair using a sterile needle or blade and prescribe treatment for inflammation or infection. Do not dig out the hair yourself.34

For AKN, treatment depends on severity. Milder disease can be treated with prescription corticosteroid creams to reduce inflammation, often alongside a retinoid, a medicine related to vitamin A. Pustules sometimes require an added antimicrobial. More extensive disease can require oral antibiotics or steroid injections. Laser procedures or surgery are options for disease that responds poorly or is extensive. There is no single agreed treatment plan for everyone; early treatment helps limit progression, scars and hair loss.57

How long does clearing take?

Mild bacterial folliculitis often improves within a few days. AKN takes longer: topical treatment is commonly reassessed every 4 to 6 weeks, with a good response often taking 6 to 12 weeks. AKN is a chronic condition without a cure, so treatment focuses on controlling symptoms, preventing infection and limiting progression rather than permanently eliminating the condition.567

When should you get medical help?

• Seek medical attention for fever, feeling shivery or very unwell, or skin that is very painful, hot or swollen.
• Get assessed if pus drains from the area or swelling or pain worsens over several days.
• Contact a clinician if suspected folliculitis worsens, keeps returning or lasts longer than 2 to 3 days.
• Arrange a dermatologist appointment for persistent scalp or neck bumps, raised scars or hair loss. Do not wait for scarring before getting possible AKN checked.