Eyebrow threading: a boon or a bane.

Eyebrow threading is a practice of shaping the eyebrows. Many dermatological complications have been briefly mentioned in various publications. There are scant data regarding the appearance of molluscum in the line of eyebrows after a session of threading. We report a series of eight patients both males (3) and females (5) who had lesions of molluscum in the eyebrow region after threading. The earlier reported cases are only among the females. The present study is highlighting the appearance of molluscum in the region of eyebrow after a session of threading from beauty salon. So, to the best of our knowledge, this is the first report of its kind describing same pathology in males. The rational of reporting this case series is to create awareness among the dermatologists as well as in general population about potential hazards of threading.

Introduction

There are various ways of removing unwanted hair from eyebrow region to give a good aesthetic hair line. These include threading, tweezing or plucking, waxing, and laser. Of these, threading is the most common and widely acceptable technique because of its convenience, low cost, and negligible complications.

Before a threading session, the skin is prepared by wiping the area with a cotton ball soaked in astringent. This produces a cooling effect which numbs the skin and hence causing less pain. Threading technique involves usage of cotton thread. The cotton thread is twisted and rolled along the surface of the skin entwining the hairs in the thread, which are then lifted quickly from the follicle. Eyebrow threading is a preferred hair removal technique for a number of reasons. Unlike tweezing or plucking, eyebrow threading removes one clean line of hair all at once, making it much quicker and easier to shape the brows. As opposed to waxing, the top layers of skin are not peeled or traumatized in the process. It is important to find an aesthetician who is experienced at eyebrow threading. Inexperienced aesthetician/beautician can result in uneven brows, hair breakage, ingrown hairs, or unnecessary pain and other complications. After a threading session, a soothing lotion/antibiotic cream is applied to the threaded area. Hair threading usually lasts 2 to 3 weeks.

Though this technique looks quite benign in nature, it is associated with some dermatological complications, especially near the eyebrows. This is so because the skin in this region is very delicate. Many dermatological complications briefly mentioned in various articles include acute erythema during and after the procedure, folliculitis, pseudofolliculitis, bullous impetigo, verruca plana, molluscum contagiosum (MC), hyperpigmentation, and hypopigmentation.[1-7]

Report

We report a series of eight patients between November 2006 and April 2010 who developed molluscum lesions over eyebrows after a session of eyebrows threading from beauty salons. All patients were young males and females in the age range of 17 to 35 years, with mean age of 23.6 years. Lesions appeared within in 2 to 4 weeks after visiting to salon. None of the patients had any lesion suggestive of molluscum on any part of body prior to threading. Brief profile of the patients is given in Table 1. Routine investigations in all patients were normal including serology for Human immune deficiency virus.

Table 1

Clinical details of patients presenting with Molluscum on eyebrows

All patients presented with classical appearance of molluscum lesions as painless, flesh-colored, dome-shaped, pearly white lesions with central umbilication 2 to 4 mm in diameter. These lesions initially were confined to eyebrows region and later by koebnerization spread to nearby areas. The classical clinical appearance of the lesions in all the patients was sufficient for diagnosis. Therefore, biopsy was not done to establish the diagnosis in any of the patient. However, histopathological examination of extracted contents revealed molluscum bodies. Extraction of molluscum bodies followed by light electric desiccation/chemical cauterization was done in all patients with good cosmetic results. None of the patient had any lesion suggestive of molluscum on any other part including face prior to threading. All patients were asked to avoid threading in future but most of them continued because of being more convenient and economical.

Discussion

In our present day of civilization with globalization and a rapidly growing fashion industry, more and more people of all ages are very particular about their persona. Cinema and television idols cause a mass hysteria, thus causing a great impact on general population to follow their footsteps blindly. In order to look glamorized, people opt for various beauty regimens without paying attention to their adverse unforeseen consequences. Threading is one such technique which is practiced widely by all adults (from common layman to film stars) to give an aesthetic look of eyebrows by removing excess of hair. It is a centuries-old technique of hair removal practiced widely in India and other countries. Due to its easy accessibility, being inexpensive, less time consuming, not very painful, it has gained wide popularity. It is thought to originate from Turkey and was traditionally used on the entire face such as the chin, eyebrows, sideburns, and cheeks. However, it has been an ancient art for many countries such as India. In Arabic, hair threading is called “khite.” In Egypt, hair threading is called “fatla.”[12] In the procedure, the beautician removes individual or group of unwanted hair by using “thread” which is wound around the fingers like a loop, the thread is looped around hair follicles and pulled out quickly with brisk movements in rapid succession. Though threading is a safe technique, but because it is a traumatic procedure and because of improper hygienic measures, it may cause acute erythema during and after the procedure, folliculitis, pseudofolliculitis, bullous impetigo, verruca plana, MC, hyperpigmentation, and hypopigmentation.[1-7]

MC is a viral infection of the skin or occasionally of the mucous membranes caused by a DNA poxvirus. It is transmitted by direct contact, either person to person, or by shared items, such as clothing, towels, etc. The virus later may be autoinoculated from one primary site to distant site. Threading being a traumatic procedure can disturb epidermal-barriers function, rendering the eyebrow area more susceptible to inoculation and development of warts by seeding the virus. Pox virus may survive for longer time in environment. Source of getting infection can be beautician's hands, cotton puff, powder, cotton thread, towels, clothing's, scissors, adoption of poor hygienic ways, and lack of awareness.

In the present study, some patients gave history of using same towels and thread on many of customers during threading. This is largely due to poverty, illiteracy, and ignorance among the population. Even the beauticians do not understand the importance of sterilizing their instruments prior to using on their customers as well as of use of same cotton thread on many of patients. Use of same towel on many of customers is very common practice in many of haircut and beauty salons. A beautician should be given a proper awareness regarding maintenance of the local hygienic measures like washing hands prior to any procedure, using disposable gloves, not using the same clothing, cotton, cotton thread, and towels on all customers, and similarly customers should never hesitate to interrupt the beautician if they feel she/he is noncompliant. Moreover, to avoid these hazards completely, customers can carry their own items such as cotton thread, towels, powder, etc., if possible. These simple precautions might change the scenario of threading and will make it free from complications.

Appearance of MC after eyebrow threading was first reported by Verma SB in a female patient.[7] Later, Ghosh SK and Bandyopadhyay observed the same in three females.[8] The present series of eight patients which also includes three males is the largest case series till date. Nowadays, the word “Beauty” is no longer confined to females as males also are not lagging behind in getting themselves pampered. The rapidly growing male beauty salon, spa center are examples of the same. So, the appearance of MC after eyebrow threading in males in the present case series is reported for the first time.

Conclusion

To conclude, all of the case reports reported so far mentioning the appearance of warts or molluscum are only in females, but in our study, three male patients were also reported to have appearance of molluscum lesions after threading. Current series of case reports warns the young populations and also make the Dermatologists aware about the potential hazard of this widely practiced technique. At the same time, people among all sections of society need to be made aware of such incidents since the eye brow threading is a very common procedure not limited to one group, but it is commonly practiced by all, e.g., males or females, young or old, educated or uneducated, high or low socioeconomic people. Thus, it has become mandatory to raise awareness of complications not only among beauticians, but also in the general population.

There is a growing popularity of threading for shaping of the eyebrows, especially in the young population. It is very important for the beauticians and the dermatologists to be aware of the potential complications of this seemingly benevolent procedure, as this may lead to significant cosmetic blemish and mental trauma to the patient.

Multiple skin-colored and pearly white papular lesions over eyebrow, upper and lower eyelid (male)

Multiple pearly white popular lesions with central umbilication inside eyebrows, on upper eyelid and lid margin (female)