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Ingrowing Hair: A Case Report

Authors:
  • First Affiliated Hospital, Sun Yat-sen University

Abstract and Figures

Cutaneous pili migrans and creeping eruption caused by parasitic diseases may present as a moving linear lesion in skin. The former, caused by a hair shaft or fragment embedded in the superficial skin or middle dermis, is a rare condition characterized by creeping eruption with a black line observed at the advancing end. In exceptionally rare instance, the hair grows inside the skin and burrows in the uppermost dermis, such a condition has been called “ingrown hair.” We report a 30-year-old Chinese man, who was accustomed to pull or extrude the beard hairs, with 1-year history of slowly extending black linear eruption on his right chin. Cutaneous examination revealed a 4-cm long black linear lesion beneath the skin associated with edematous erythema around and folliculitis on both ends of the lesion. After treatment with topical mupirocin ointment, the erythema and folliculitis improved and 2 hairs of the beard with hair follicles were pulled out from the skin. Two weeks later, another similar black line about 1 cm in length in the skin presented on the prior lesional area, which was pulled out by a shallow incision of the skin and was also demonstrated as a beard hair with hair follicle. The patient was diagnosed as “ingrowing hair” with multiple recurrences. The lesions recovered after the beard hairs were pulled out. No recurrence occurred in a year of follow-up. We suggest that “ingrowing hair” is better than “ingrown hair” to describe such a condition. Pulling out the involved hair and correcting the bad practice are its optimal management strategies.
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Ingrowing Hair
A Case Report
Di-Qing Luo, MMS, Yu-Hua Liang, MMS, Xi-Qing Li, PhD, Yu-Kun Zhao, MMS,
Fang Wang, MMS, and Rashmi Sarkar, MD
Abstract: Cutaneous pili migrans and creeping eruption caused
by parasitic diseases may present as a moving linear lesion in skin.
The former, caused by a hair shaft or fragment embedded in the
superficial skin or middle dermis, is a rare condition characterized
by creeping eruption with a black line observed at the advancing end.
In exceptionally rare instance, the hair grows inside the skin and
burrows in the uppermost dermis, such a condition has been called
‘‘ingrown hair.’’
We report a 30-year-old Chinese man, who was accustomed to
pull or extrude the beard hairs, with 1-year history of slowly
extending black linear eruption on his right chin. Cutaneous exam-
ination revealed a 4-cm long black linear lesion beneath the skin
associated with edematous erythema around and folliculitis on both
ends of the lesion. After treatment with topical mupirocin ointment,
the erythema and folliculitis improved and 2 hairs of the beard with
hair follicles were pulled out from the skin. Two weeks later,
another similar black line about 1 cm in length in the skin presented
on the prior lesional area, which was pulled out by a shallow incision
of the skin and was also demonstrated as a beard hair with hair
follicle.
The patient was diagnosed as ‘‘ingrowing hair’’ with multiple
recurrences. The lesions recovered after the beard hairs were pulled
out. No recurrence occurred in a year of follow-up.
We suggest that ‘‘ingrowing hair’’ is better than ‘‘ingrown hair’’
to describe such a condition. Pulling out the involved hair and
correcting the bad practice are its optimal management strategies.
(Medicine 95(19):e3660)
INTRODUCTION
Cutaneous pili migrans is a rare condition characterized by a
hair fragment or hair shaft moving in the shallow epidermis
or dermis, forming an eruption resembling larva migrans.
1–6
Up
to date, no more than 30 cases of cutaneous pili migrans have
been reported since its first description by Yaffee
7
in 1957, and
it has Asian predilection.
1–4
However, we considered that
cutaneous pili migrans has been underestimated, because even
the present corresponding author and the colleagues had met 4
cases since 2009. Among them, 2 had been previously
reported,
1,2
and another 2 whom were diagnosed recently
had not been reported yet. Interestingly, there is an exception-
ally rare condition previously called ‘‘ingrown hair’’ mimick-
ing the presentations of cutaneous pili migrans, in which the
causative factor is a hair growing inside the skin and burrowing
in the uppermost dermis rather than a hair shaft moving inside.
3
To our knowledge, only 4 cases published in Japanese literature
have been reported (Table 1),
3
and none in English literature
have been described. Herein, we report a case and suggest to
rename it as ‘‘ingrowing hair.’’
CASE PRESENTATION
A 30-year-old Chinese man without any relevant medical
histories was referred because of 1-year history of slowly
extending black linear eruption on his right chin, which gradu-
ally protracted toward the back of neck without any associ-
ations. No treatments were administered. A week prior to
presentation, the lesion presented with painful erythema around
it. The patient usually shaved his beard by blade, and was
accustomed to pull or extrude the beard hairs when he had spare
time. He denied acne history on his neck. No other family
members were similarly affected. Cutaneous examination
showed that a 4.3-cm-long black linear eruption beneath the
skin located on the right chin, associated with edematous
erythema around it and 2 inflammatory papules on both ends
of the lesion (Figure 1A). After 1-week treatment of topical
mupirocin ointment, the edematous erythema and papules
improved excellently, and a hair shaft with its distal end
protruding out of the skin was observed which was pulled
out with ease (Figure 1B and C). The hair, measured 4 cm in
length, was demonstrated a hair shaft with follicles under
microscope (Figure 1D). Meanwhile, another hair, about
0.3 cm far from the follicle of the priorly pulled beard hair,
was also found which showed a short section protruding out of
the skin near the root. By pulling the hair near the root with
forceps, a 2.2-cm-long, slippery, straight, black hair was easily
removed from the skin (Figure 1C, the white arrow). Then the
patient continued with topical mupirocin ointment. Two weeks
later, the patient returned and the erythema improved markedly.
However, a new black linear lesion about 1 cm in length
appeared in the skin in the region of prior erythema
(Figure 1E). After a shallow incision of the skin, a 1-cm-long
Editor: Ismael Maatouk.
Received: September 15, 2015; revised: April 3, 2016; accepted: April 19,
2016.
From the Department of Dermatology (D-QL, Y-KZ, FW), The Eastern
Hospital of The First Affiliated Hospital, Sun Yat-sen University,
Guangzhou; Department of Dermatology (Y-HL), The Fifth People’s
Hospital of Foshan, Foshan; Department of Dermatology (X-QL), Sun Yat-
sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; and
Department of Dermatology (RS), Maulana Azad Medical College and
LNJP Hospital, New Delhi, India.
Correspondence: Di-Qing Luo, Department of Dermatology, The Eastern
Hospital of The First Affiliated Hospital, 183 Huangpu Rd E., Sun
Yat-sen University, Guangzhou 510700, P. R. China
(e-mail: luodq@mail.sysu.edu.cn; diqing.luo@medmail.com.cn).
Written informed consent was obtained from the patient for publication of
this case report and any accompanying images.
D-QL, Y-HL, and X-QL are equal contributors.
The authors have no conflicts of interest to disclose.
Copyright #2016 Wolters Kluwer Health, Inc. All rights reserved.
This is an open access article distributed under the Creative Commons
Attribution-NoDerivatives License 4.0, which allows for redistribution,
commercial and non-commercial, as long as it is passed along unchanged
and in whole, with credit to the author.
ISSN: 0025-7974
DOI: 10.1097/MD.0000000000003660
Medicine®
CLINICAL CASE REPORT
Medicine Volume 95, Number 19, May 2016 www.md-journal.com |1
hair with follicles was extracted from the epidermal burrow
(Figure 1F). The patient was given topical mupirocin ointment
for a week, and was asked to stop pulling or extruding the beard
hairs. Three months later, only mild erythema left behind
(Figure 1G). No relapse occurred during 1 year of following-up.
DISCUSSION
Based on the entities that the black lines were beard hairs
with follicles extending gradually rather than hair shafts moving
alone, we considered that the present conditions resulted from
the hairs growing inside the skin, and we diagnosed them as
‘‘ingrown hair’’ rather than ‘‘cutaneous pili migrans.’’ Con-
sidering the hairs had been growing inside the skin until they
were pulled out, we prefer to term the present instance as
‘‘ingrowing hair’’ rather than ‘‘ingrown hair,’’ which may
be a more appropriate way to describe the disease, and can
be distinguished from the condition in pseudofolliculitis barbae
in which the hair also grows inside the skin and causes pseu-
dofolliculitis.
8
Although the exact mechanisms for ingrowing hair remain
unknown, we considered that the actions of pulling or extruding
the beard might play important roles for the present patient,
because the actions might result in possibility of localized
inflammation and edema around the follicle, and/or changing
the growing direction of the beard hair, that made the hair grow
inside the skin possible. While the hair was growing slowly
inside the skin, the black lesion was extending gradually, and
the length of lesion may be equal to the length of the ingrowing
hair (excluding the follicle section). But when the hair follicle is
deceased, the hair might move inside the skin as cutaneous pili
migans does. When the hair is growing inside the skin, it may
also cause physical stimulation causing possible erythema
around. In the present case, a hair shaft extruded out of the
skin after the inflammation improved, we thought that the
erythema may be a possibly inflammatory reaction stimulated
by the hair, and the hair was excluded from the skin as a foreign
body finally. Of course, we cannot exclude the possibility that
localized infection played a role in some extent for the
erythema.
Based on the literature, only 5 cases, including the present
patient, have been reported and all were men with an age range
of 30- to 58-year old (Table 1).
3
The involved locations
included the neck,
3
cheek,
3
and chin. Three occurred on the
neck. The results suggested that ingrowing hair always occurs
on the area where the beard hairs are distributed, and beard hairs
may be the causative hair. All the prior cases were from Japan
3
and the present case is from China. To our knowledge, no
similar cases were described in other areas, mimicking
cutaneous pili migrans with Asian predominance.
1–4
The
reasons of Asian predominance for cutaneous pili migrans
are because that Asian hair, especially the Japanese, has larger
diameter with circular geometry, and is harder and straighter
than African or Caucasian hair,
9
which may make the Asian hair
extend and grow inside the skin easier than that of other
population.
1,2
We speculated that the mechanisms for the
Asians’ predilection of ingrowing hair are the same as they
are in cutaneous pili migrans. However, we lack the data of any
possible difference of the beard hairs between Asia and
other countries.
The differential diagnoses included cutaneous pili
migrans, interdigital pilonidal sinus, creeping eruption caused
by parasitic diseases, and pseudofolliculitis barbae. Cutaneous
pili migrans is caused by hair shaft or fragment, or the pubic
hair, and always without hair follicles, showing a painful linear
lesion with a moving black line at the advancing end.
1–6
The
length of the black line is stable while the lesional length
extended gradually. A hair can be pulled out by a shallow
incision of the skin.
1–6
But we speculated that, when the follicle
is deceased, ‘‘ingrowing hair’’ may became ‘‘cutaneous pili
migrans.’’ Interdigital pilonidal sinus, commonly occurring in
the barber, is caused by the naked hair shaft or fragment
penetrating the follicle and entering the dermis without extend-
ing the lesion.
1,5,6,10
The creeping eruption caused by parasitic
disease is always caused by nematode larva, in rare condition,
subcutaneous migration of a fly’s maggot (migratory myiasis),
an adult nematode (Loa loa, Dracunculus medinensis), a tre-
matode larva (F. gigantica), or Sarcoptes scabiei may be the
provoking factors.
1,4,11– 13
Its lesion is mobile and tracks sinu-
ously, commonly associated with severe itching without pre-
sence of black line.
4
A parasite is always found at the advancing
end of the lesion. Pseudofolliculitis barbae is an inflammatory
disorder that occurs most frequently in men with a dense and
curly beard, presenting as the curly hair tending to curl into the
skin instead of straight out the follicle.
8
Persistent irritation
caused by shaving or depilation may be the triggering factor.
8
But in rare instance, the hairs come out of and again re-enter the
skin causing solid papules with bent hairs inside.
8
Based on
clinical features, it is not difficult to make a correct diagnosis for
such disorders.
As ingrowing hair is caused by a hair growing inside the
skin, extracting the hair and correcting the bad habit may be its
optimal management strategies. The present case is notable
because of multiple ingrowing hairs and recurrent lesions. To
the best of our knowledge, no similar case had been reported
previously.
CONCLUSION
Ingrowing hair is a rare cutaneous disease caused by hair
growing inside the skin and characterized by slowly extending
black linear lesion beneath the skin, the length of the lesion is
TABLE 1. Summaries of Reported Cases of Ingrowing Hair
Case No Sex Age, y
Lesional
Location
Length of the
Eruption, cm
Length of the
Hair, cm Reference
1 Male 42 Right cheek 6 4.5 3
2 Male 34 Neck 2.5 2.5 3
3 Male 58 Right frontal neck 5 5 3
4 Male 52 Right frontal neck 3 3 3
5 Male 30 Right chin Multiple (4.0/2.2/1.0) Multiple (4.0/2.2/1.0) Present
Luo et al Medicine Volume 95, Number 19, May 2016
2|www.md-journal.com Copyright #2016 Wolters Kluwer Health, Inc. All rights reserved.
FIGURE 1. The presentations of ingrowing hair. A 4.3-cm-long black linear lesion beneath the skin located on the right chin associated
with edematous erythema around and 2 inflammatory papules on both ends of the lesion (A). The folliculitis improved excellently after
treatment with topical mupirocin ointment for a week, and a hair shaft with its distal end protruding out of the skin presented on the lesion
(B). A hair (grasped by the forceps) (C) with hair follicle (D, the white arrow; the inset showing a closer view of the hair, 100) is easy pulled
out; the second hair shaft (C, the white arrow) with its follicle in skin is pulled out from the skin. A new black linear lesion about 1 cm in
length appeared in the skin in the region of prior erythema 2 weeks later after pulling out of the prior beards (E), showing hair shaft with
hair follicle (F). Mild erythema left behind in 3 months of follow-up (G).
Medicine Volume 95, Number 19, May 2016 Ingrowing Hair
Copyright #2016 Wolters Kluwer Health, Inc. All rights reserved. www.md-journal.com |3
always equal to the length of the hair except that inflammatory
reaction occurs. It may involve the cheek, chin, and neck, and
may be multiple or recurrent. Pulling out the hair and correcting
the bad habit are its optimal treatments.
ACKNOWLEDGMENT
The authors thank the patient participating in the
present study.
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report and review of the literature. Int J Dermatol. 2009;48:947–950.
3. Sakai R, Higashi K, Ohta M, et al. Creeping hair: an isolated hair
burrowing in the uppermost dermis resembling larva migrans.
Dermatology. 2006;213:242–244.
4. Ishida Y, Matsubara K, Takai M, et al. A case of ’creeping hair’
resembling cutaneous larva migrans. Clin Exp Dermatol.
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3-year-old child. Pediatr Dermatol. 2004;21:612–613.
7. Yaffee HS. Imbedded hair resembling larva migrans. Arch Dermatol.
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8. Nguyen TA, Patel PS, Viol KV, et al. Pseudofolliculitis barbae in
women: a clinical perspective. Br J Dermatol. 2015;173:279–281.
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ethnic hair. J Am Acad Dermatol. 2003;48:S115–S119.
10. Uysal AC¸ , Alago¨z MS,U
¨nlu
¨RE, et al. Hair dresser’s syndrome: a
case report of an interdigital pilonidal sinus and review of the
literature. Dermatol Surg. 2003;29:288–290.
11. Caumes E. It’s time to distinguish the sign ’creeping eruption’ from
the syndrome ’lutaneous larva migrans’. Dermatology.
2006;213:179–181.
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cutaneous larva migrans. Lancet Infect Dis. 2004;4:659–660.
Luo et al Medicine Volume 95, Number 19, May 2016
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... Cutaneous pili migrans (CPM) is a rare condition caused by the movement of a hair shaft or fragment within the shallow epidermis or dermis, causing an eruption resembling cutaneous larva migrans. 1 To date, no more than 30 cases have been reported, with a high prevalence in Asian men. 2 However, in 2006, Sakai et al reported four Japanese cases classified as ingrown hair, in which the causative hair shaft grew inside the skin and burrowed into the uppermost dermis rather than exiting the skin. 3 In 2016, Luo et al 2 renamed this condition "ingrowing hair" because they believed it to be better than "ingrown hair" to describe the condition. ...
... Luo et al suggested that actions such as friction, pulling, or extruding the beard might play an important role in the pathogenesis of ingrowing hair by causing localized inflammation and oedema around the hair follicle or by changing the growth direction of the hair, leading to the possibility of hair growth inside the skin. 2 To date, eight cases of "ingrowing hair" have been reported, all of which were observed on the neck and face of the affected individuals. [2][3][4][5] These studies suggest that ingrowing hair always occurs in beard growth areas and is prevalent among Asian men. ...
... Luo et al suggested that actions such as friction, pulling, or extruding the beard might play an important role in the pathogenesis of ingrowing hair by causing localized inflammation and oedema around the hair follicle or by changing the growth direction of the hair, leading to the possibility of hair growth inside the skin. 2 To date, eight cases of "ingrowing hair" have been reported, all of which were observed on the neck and face of the affected individuals. [2][3][4][5] These studies suggest that ingrowing hair always occurs in beard growth areas and is prevalent among Asian men. This may be because Asian hairs have a larger diameter with a circular geometry that are harder and straighter, making it easier for hairs to grow and extend inside the skin. ...
Article
Full-text available
Cutaneous pili migrans is a rare condition caused by embedded hair shafts or fragments which presents as a mobile black linear rash and is easily confused with cutaneous larva migrans. “Ingrowing hair”, in which the hair shaft grows inside the skin and burrows into the uppermost dermis rather than exiting the skin, is much rarer, and only 8 cases have been reported thus far, all in Asian men. We report a case of a 22-year-old Chinese male with a 4 cm-long black linear rash that migrated from the anterior abdomen to the left lower abdomen. The black lines represented hair shafts with follicular structures. The lesion disappeared immediately after hair removal. No recurrence occurred in 4 weeks of follow-up. To our knowledge, this is the first description of ingrowing hair occurring in the abdomen.
... In rare cases, hair-induced creeping eruption in the skin can mimic cutaneous larva migrans. This condition was first reported by Yaffee in 1957 2 , and is described in the literature as imbedded hair, bristle migrans, pili cuniculati (burrowing hair), pseudolarva migrans, migrating hair, moving hair, intradermal creeping of pubic hair, hair fragments in the skin, cutaneous pili eruption, creeping hair, ingrown hair, and ingrowing hair [2][3][4][5] . The lesion is characterized by a creeping eruption with a black-line-like hair at the advancing end with or without erythema 3.4 . ...
... To our knowledge, a total of 52 cases of hair-induced eruption have been reported since 1957 [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] . The characteristics of these cases, including ours, are summarized in Table 1. ...
... The differential diagnoses for creeping hair include creep-ing eruption caused by parasitic diseases, interdigital pilonidal sinus, and pseudofolliculitis barbae. The lesion caused by parasitic disease is mobile and the tracks are sinuous, commonly associated with severe pruritus, and lacks a black line; furthermore, a parasite is always found at the advancing end of the lesion 5 . Interdigital pilonidal sinus is caused by short sharp hairs that penetrate the interdigital space of the hand; the causative hair fragment cannot be observed from the skin surface, and ultrasonography aids in the diagnosis of this disease 19 . ...
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Creeping hair is a rare condition characterized by creeping eruption with a black line at the advancing end, mimicking cutaneous larva migrans. The condition is also referred to as cutaneous pili migrans, migrating hair, and embedded hair. A total of 52 cases have been reported since 1957 and most cases were published in English. Herein, we report a case in which creeping hair occurred in the iliac region and review the literature from 1957 to February 2021. A 35-year-old Chinese female presented with a black moving linear eruption that had migrated from the lower abdomen to the iliac region without causing any symptoms during a 3-year period. Cutaneous examination showed a 6.5-cm-long black linear lesion beneath the skin that was revealed to be a hair shaft. After removal of the hair, the eruption diminished and no recurrence occurred in 3 months of follow-up. The creeping hair that had migrated with its lower end forward was confirmed by observation under dematoscopy and light microscopy. A review of the literature revealed that creeping hair occurs most frequently in young and middle-aged patients and the reported cases are mainly from Asia. The top locations involve the foot. The causative hair includes head hair, beard, pubic hair, body hair, and one case of dog hair. A close-up examination and dermoscopic inspection are helpful for the diagnosis of creeping hair.
... "Ingrowing hair" refers to the hair with follicles growing into the skin, rather than hair shafts moving alone, which is seen even more rarely. 1 A total of seven cases, including four Japanese and three Chinese ones 1,3 have been reported till now. In this study, we report another case which, to the best of our knowledge, was the first reported case describing the dermoscopic and reflectance confocal microscopic characteristics of this condition. ...
... "Ingrowing hair" refers to the hair with follicles growing into the skin, rather than hair shafts moving alone, which is seen even more rarely. 1 A total of seven cases, including four Japanese and three Chinese ones 1,3 have been reported till now. In this study, we report another case which, to the best of our knowledge, was the first reported case describing the dermoscopic and reflectance confocal microscopic characteristics of this condition. ...
... According to epidemiological studies, approximately 50% of the inhabitants of Brazil, Venezuela, Colombia and Argentina have already been exposed to P. brasiliensis, which infects humans through inhalation. 1 However, only a small proportion develops clinical manifestations. Cases are divided into paracoccidioidomycosis infection (without signs and symptoms) and paracoccidioidomycosis disease, which is subdivided into acute, subacute, chronic and associated with immunosuppression. ...
... Based on the presentations, the diagnosis of "ingrowing hair" for the present two patients can be made. To the current authors' knowledge, all the reported cases (Luo et al., 2016;Sakai et al., 2006) including the present were from Asia, and the causative agents were beard hairs, suggesting that larger diameter with circular geometry, harder and straighter hairs of Asian play important roles for the hairs growing and extending beneath the skin (Franbourg, Hallegot, Baltenneck, Toutain, & Leroy, 2003;Luo, Liu, Huang, He, & Zhang, 2009;Luo, Zhao, & Liu, 2010;Luo et al., 2016). As both "ingrown hair" (Panchaprateep, Tanus & Tosti, 2015;Sakai et al., 2006) and "ingrowing hair" (Luo et al., 2016) are the terms that have been used to describe the disease of hairs growing inside the skin, and both can easily cause confusion, the present authors suggest that "intradermal growing hair (IGH)" may be a more appropriate term to describe the present entity. ...
... Based on the presentations, the diagnosis of "ingrowing hair" for the present two patients can be made. To the current authors' knowledge, all the reported cases (Luo et al., 2016;Sakai et al., 2006) including the present were from Asia, and the causative agents were beard hairs, suggesting that larger diameter with circular geometry, harder and straighter hairs of Asian play important roles for the hairs growing and extending beneath the skin (Franbourg, Hallegot, Baltenneck, Toutain, & Leroy, 2003;Luo, Liu, Huang, He, & Zhang, 2009;Luo, Zhao, & Liu, 2010;Luo et al., 2016). As both "ingrown hair" (Panchaprateep, Tanus & Tosti, 2015;Sakai et al., 2006) and "ingrowing hair" (Luo et al., 2016) are the terms that have been used to describe the disease of hairs growing inside the skin, and both can easily cause confusion, the present authors suggest that "intradermal growing hair (IGH)" may be a more appropriate term to describe the present entity. ...
... To the current authors' knowledge, all the reported cases (Luo et al., 2016;Sakai et al., 2006) including the present were from Asia, and the causative agents were beard hairs, suggesting that larger diameter with circular geometry, harder and straighter hairs of Asian play important roles for the hairs growing and extending beneath the skin (Franbourg, Hallegot, Baltenneck, Toutain, & Leroy, 2003;Luo, Liu, Huang, He, & Zhang, 2009;Luo, Zhao, & Liu, 2010;Luo et al., 2016). As both "ingrown hair" (Panchaprateep, Tanus & Tosti, 2015;Sakai et al., 2006) and "ingrowing hair" (Luo et al., 2016) are the terms that have been used to describe the disease of hairs growing inside the skin, and both can easily cause confusion, the present authors suggest that "intradermal growing hair (IGH)" may be a more appropriate term to describe the present entity. As the authors' team met three cases within 3 years, the authors considered that IGH may have been largely underestimated, misdiagnosed, or neglected as a diagnosis in China before. ...
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Hair growing inside the skin and burrowing in the uppermost dermis, previously termed as “ingrowing hair,” is a rarely reported cutaneous disorder. Up to July 31, 2018, only five cases have been reported, all were male. The authors report two Chinese Han men, 26-year-old and 31-year-old respectively, presenting with progressive extending black lines inside the skin on the right mandibular angle and the neck respectively. The black lines were finally demonstrated as growing beard hairs. The 26-year-old man was cured after the hair was pulled out, whereas the 31-year-old patient had re-occurrence after the initial hair was extracted and was cured finally by destroying the individual beard follicle. The authors would prefer the term of “intradermal growing hair” to “ingrowing hair” when describing the condition of hair growing inside the skin and extending in the uppermost dermis. Pulling out the growing hair, and sometimes destroying the beard follicle, may be of choice for its treatment.
... However, granulomatous inflammation was not observed in the current case. Some authors suggested that CPM develops from ingrown hair burrowing in the superficial skin (3,14). However, the current case had a hair shaft without a follicle, suggesting an extrinsic origin. ...
... A combination of the sharppointed hair shaft, body surface movement forces, and the biomechanical force exerted during limb movement is a postulated mechanism (15). Known risk factors are also mainly extrinsic; including shaving, habitual pulling, and walking barefoot (2,9,14). Based on the hair thickness of the patient's family, measured by SEM, the father's moustache was the most likely origin, and application of local anaesthetic cream probably induced swelling of the embedded hair shaft. ...
... An ingrown hair inciting repeated irritation of the skin thereby causing its intrusion was excluded as a differential diagnosis because of the presence of many hairs deep inside the excised cyst. Moreover, there were no black lines and patient refused the history of habitual hair pulling [30]. Usually, an ingrown hair is also more common in people who have very curly or coarse hair, which appears because the hairs have curled around and grown back into the skin, instead of rising up from it [2]. ...
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Background Pilonidal sinus is commonly seen at the sacrococcygeal region and few other sites, usually located at the midline, at areas where hairs collect or near protuberances or some adjacent rubbing surfaces. Its presence elsewhere is uncommon. We share an interesting case of a recurrent discharging sinus from the cheek bulge of a male which turned out to be a pilonidal sinus containing tuft of hairs on exploration and wide excision. Case presentation A 37 years old hirsute male presents to us with a non-healing discharging sinus at the bulge of the cheek. Exploration after a course of antibiotics showed 2 subcutaneous cavities with tuft of hairs. The area was excised along with a margin, thorough irrigation and curettage was done and the wound was closed primarily; a Z-plasty was incorporated in the central part to break the resultant suture line. Histopathological examination was done to confirm the diagnosis and rule out an off-midline dermoid cyst or an underlying/coexisting malignancy. Post-operative course was uneventful. The patient has been recurrence free for 1.5 years and is satisfied with the nature of the scar. Conclusions Pilonidal sinus of the cheek bulge is an extremely rare entity. Complete excision and clinical suspicion are important for cure of this nagging ailment, especially at unexpected areas.
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Cutaneous pili migrans (CPM) is an uncommon condition in which a hair fragment penetrates the skin and produces a creeping lesion similarly of cutaneous larva migrans associated with local pain. There are few reports of CPM in the literature, and none visually describes the migration of the hair shaft in the epidermis associated with pain. Herein, we showed the first report describing a case of an in situ sequential migration of CPM in an adult patient.
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Pseudofolliculitis barbae (PFB) also known as “razor bumps” is a chronic, inflammatory reaction characterized by papules and pustules secondary to ingrown hairs. PFB represents a multi-factorial disease process promoted by genetic predisposition and traumatic hair removal practices 1. The basic pathophysiology involves sharp pointed hair shafts curving directly back into the adjacent epidermis causing invagination, inflammation, and intraepidermal microabscess formation 2. Curly hair is a major risk factor due to the acute angle created with the plane of the skin, and a mutation in KRT75, a type II keratin, may also be involved in the etiology of PFB1,3.This article is protected by copyright. All rights reserved.
Article
Introduction Cutaneous pili migrans, caused by a hair shaft or fragment embedded in the superficial skin, and occasionally in the middle dermis, is a rare condition characterized by creeping eruption with a black line at the advancing end, which resembles the lesion associated with cutaneous larva migrans. Case Report We present the case of a 38-year-old Chinese housewife with a 30-day history of painfully and slowly moving black linear eruption on the dorsal aspect of her left foot. The more she walked, the further the line extended and the more pain she felt, particularly on walking rapidly. A black hair shaft was removed from the lesion, which healed completely. Discussion Pili migrans is an extremely rare condition with only 22 cases being reported to date. The hair shaft penetrates into the superficial layers of the epidermis following injury or occasionally for no known reason. The spectacular clinical picture is similar to that seen in the interdigital spaces of hairdressers in whom there are only small hair fragments on occasion, with no movement of the lesion.
Article
Cutaneous pili migrans is a rare condition in which the hair shaft penetrates the superficial layer of the skin and produces a creeping eruption mimicking the lesion of cutaneous larva migrans. We report a 28-year-old Chinese man who presented with a painful and slow-moving black, linear eruption on the left sole after walking on a waterlogged street wearing slippers without socks. The lesion started at the anterior part of the foot near the external border, extending linearly along Langer's line towards the lateral side. It then turned in a U-shaped direction and moved across the foot to the other side, where it made a right angle and moved along the internal side of the foot. The lesion was reminiscent of cutaneous larva migrans. Walking made the line move more quickly. Physical examination showed that there was a broken epidermis at the probable entrance and a black thin line at the advancing end of the lesion. The black line was demonstrated to be a hair shaft with a sharp head by a shallow incision of the skin and examination under a microscope. After removal of the hair, the pain disappeared and the lesion diminished immediately, leaving slight pigmentation. The broken epidermis may be one of the main reasons for the hair shaft entering the skin. The force of body motion caused movement, which was made easier by the sharp head of the hair shaft. Hair can produce an eruption reminiscent of cutaneous larva migrans.
Article
Hair dresser's disease is produced by short hairs that penetrate the interdigital spaces of the hand. A case and review of the literature of pilonidal sinus in the interdigital web are reported. Surgical excision and secondary healing are the preferred methods of treatment to prevent recurrence. We have performed a rotation flap for the defect formed after excision. The patient was not hospitalized, and postoperative patient comfort prevention of the recurrences was achieved. This acquired occupational disease is rare and preventable. The personal hygiene and use of protective barrier creams or gloves could prevent the formation of the disease.
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This study collected qualitative and quantitative data about the morphology, structure, geometry, water swelling, and mechanical properties of hair fibers from subjects of different ethnic origins. X-ray analysis, cross-sectional measurements, tensile testing, and water swelling were performed on samples of hair collected from Caucasian, Asian, and African subjects. No differences in the intimate structures of fibers were observed among these 3 types of hairs, whereas geometry, mechanical properties, and water swelling differed according to ethnic origin. In addition, the behavior of hair fiber under mechanical stress was visualized with environmental scanning electron microscopy.
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A recent publication by Dr. Arthur Pratt1 reported an instance of hyperkeratosis of the heel caused by an imbedded hair. This woman patient, suffering from a neuropathy, may have had her lesion as long as seven years. The presumption was that the patient had contacted the cut hairs of her husband's beard while dragging her paralyzed leg across the floor. Joseph and Gifford2 reported interdigital pilonidal sinuses, attributed to imbedded hair, occurring in 15 barbers in the San Francisco area. In pathologic studies they showed the earliest change to be imbedding of hair in the epidermis with reactive thickening of this tissue around it. The severest changes revealed the hair lying free in the dermis, causing a foreign-body type of reaction. In the latter they noted epithelialized tracts forming around the hair, which with resultant secondary infection became inflamed and converted into branching sinuses. The