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Bullous Impetigo of the Face After Epilation by Threading

Bullous Impetigo of the Face After Epilation by Threading Threading is an ancient method of manually removing unwanted hair using a loop of thread that is passed over the skin. We describe what is to our knowledge a previously unreported complication of this aesthetic procedure. Report of a Case An otherwise-healthy 33-year-old woman complained of an asymptomatic eruption of erosions and bullae on the face (Figure). Three weeks earlier she had undergone a threading procedure performed by a local aesthetician for removal of hairs on the forehead and cheeks. The eruption had appeared 4 days after the threading. She was treated with a 10-day course of cefadroxil for suspected impetigo. She was also prescribed prednisone for possible autoimmune blistering disease and to try to minimize the postinflammatory dyspigmentation that was anticipated. Cultures from several erosions grew Staphylococcus aureus, confirming a diagnosis of impetigo. Within 1 week of beginning the treatment, all of the active lesions had resolved, leaving severe postinflammatory hyperpigmentation. Figure. View LargeDownload Bullous impetigo after threading. Comment Known as khite in Arabic (fatlah in Egypt), threading has been practiced for centuries in countries of the Middle and Near East such as Egypt, Iran, Turkey, and India,1-3 and in recent years it has become increasingly popular in the United States.3,4 Threading is typically performed on several areas of the face, including at the eyebrows, upper lip, chin, and cheeks.3 Using a cotton thread, the operator holds one free end firmly with his or her hand and grasps the other in the teeth. An open loop is formed between 2 fingers, pressed firmly on the skin, and made smaller by moving the fingers closer together. This action causes the row of involved hairs to be trapped and pulled out of the skin. The entire hair shaft is extracted in this process.1,3 Purported advantages of threading over other epilation methods such as waxing and tweezing include less cutaneous irritation, lower cost, and shorter operating time.3,4 Mild pain is common during threading.1-3 Complications may include folliculitis and transient local reactions such as pruritus, erythema, edema, and dyspigmentation.1-3 However, to our knowledge no serious complication has been reported. That impetigo and other staphylococcal infections might be spread by threading is not surprising since folliculitis is a known complication. Our case underscores the need for aestheticians who perform threading to be properly trained in the use of techniques that minimize the risk of transmission of infections,4 particularly in view of the increasing prevalence of community-acquired methicillin-resistant staphylococcal infections.5 Correspondence: Dr Carter, Columbia University College of Physicians and Surgeons, 161 Ft Washington Ave, 12th Floor, New York, NY 10032. Financial Disclosure: None. References 1. Abdel-Gawad MMAbdel-Hamid IAWagner RF Jr Khite: a non-Western technique for temporary hair removal Int J Dermatol 1997;36217PubMedGoogle ScholarCrossref 2. Scott MJ JrScott MJ IIIScott AM Epilation Cutis 1990;46216- 217PubMedGoogle Scholar 3. Tran G Ancient technique raising—and shaping—area eyebrows Chicago Tribune September9 2001;2Google Scholar 4. Bickmore HR Milady’s Hair Removal Techniques: A Comprehensive Manual Clifton Park, NY Thomson–Delmar Learning2004; 5. Cohen PRGrossman ME Management of cutaneous lesions associated with an emerging epidemic: community-acquired methicillin-resistant Staphylococcus aureus skin infections J Am Acad Dermatol 2004;51132- 135PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Bullous Impetigo of the Face After Epilation by Threading

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Publisher
American Medical Association
Copyright
Copyright © 2005 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.141.9.1174
Publisher site
See Article on Publisher Site

Abstract

Threading is an ancient method of manually removing unwanted hair using a loop of thread that is passed over the skin. We describe what is to our knowledge a previously unreported complication of this aesthetic procedure. Report of a Case An otherwise-healthy 33-year-old woman complained of an asymptomatic eruption of erosions and bullae on the face (Figure). Three weeks earlier she had undergone a threading procedure performed by a local aesthetician for removal of hairs on the forehead and cheeks. The eruption had appeared 4 days after the threading. She was treated with a 10-day course of cefadroxil for suspected impetigo. She was also prescribed prednisone for possible autoimmune blistering disease and to try to minimize the postinflammatory dyspigmentation that was anticipated. Cultures from several erosions grew Staphylococcus aureus, confirming a diagnosis of impetigo. Within 1 week of beginning the treatment, all of the active lesions had resolved, leaving severe postinflammatory hyperpigmentation. Figure. View LargeDownload Bullous impetigo after threading. Comment Known as khite in Arabic (fatlah in Egypt), threading has been practiced for centuries in countries of the Middle and Near East such as Egypt, Iran, Turkey, and India,1-3 and in recent years it has become increasingly popular in the United States.3,4 Threading is typically performed on several areas of the face, including at the eyebrows, upper lip, chin, and cheeks.3 Using a cotton thread, the operator holds one free end firmly with his or her hand and grasps the other in the teeth. An open loop is formed between 2 fingers, pressed firmly on the skin, and made smaller by moving the fingers closer together. This action causes the row of involved hairs to be trapped and pulled out of the skin. The entire hair shaft is extracted in this process.1,3 Purported advantages of threading over other epilation methods such as waxing and tweezing include less cutaneous irritation, lower cost, and shorter operating time.3,4 Mild pain is common during threading.1-3 Complications may include folliculitis and transient local reactions such as pruritus, erythema, edema, and dyspigmentation.1-3 However, to our knowledge no serious complication has been reported. That impetigo and other staphylococcal infections might be spread by threading is not surprising since folliculitis is a known complication. Our case underscores the need for aestheticians who perform threading to be properly trained in the use of techniques that minimize the risk of transmission of infections,4 particularly in view of the increasing prevalence of community-acquired methicillin-resistant staphylococcal infections.5 Correspondence: Dr Carter, Columbia University College of Physicians and Surgeons, 161 Ft Washington Ave, 12th Floor, New York, NY 10032. Financial Disclosure: None. References 1. Abdel-Gawad MMAbdel-Hamid IAWagner RF Jr Khite: a non-Western technique for temporary hair removal Int J Dermatol 1997;36217PubMedGoogle ScholarCrossref 2. Scott MJ JrScott MJ IIIScott AM Epilation Cutis 1990;46216- 217PubMedGoogle Scholar 3. Tran G Ancient technique raising—and shaping—area eyebrows Chicago Tribune September9 2001;2Google Scholar 4. Bickmore HR Milady’s Hair Removal Techniques: A Comprehensive Manual Clifton Park, NY Thomson–Delmar Learning2004; 5. Cohen PRGrossman ME Management of cutaneous lesions associated with an emerging epidemic: community-acquired methicillin-resistant Staphylococcus aureus skin infections J Am Acad Dermatol 2004;51132- 135PubMedGoogle ScholarCrossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Sep 1, 2005

Keywords: general hair removal - epilation,bullous impetigo

References