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EYEBROW THREADING: A BOON OR A BANE
Sanjeev GuptaMridu ChaudhryAneet Mahendra, and Sarabjit Kaur

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.

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. 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.

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.
Figure 1.
Multiple skin-colored and pearly white papular lesions over eyebrow, upper and lower eyelid (male)
Figure 2.
Multiple pearly white popular lesions with central umbilication inside eyebrows, on upper eyelid and lid margin (female)

References

1. Abdel-Gawad MM, Abdel-Hamid IA, Wagner RF. Khite: A non-western technique for temporary hair removal. Int J Dermatol. 1997;36:217. [PubMed]
2. Verma SB. Eyebrow threading: A popular hair-removal procedure and its seldom-discussed complications. Clin Exp Dermatol. 2008;34:363–5. [PubMed]
3. Ramos-e-Siva M, de Castro MC, Carneiro LV. Hair removal. Clin Dermatol. 2001;19:437–44.[PubMed]
4. Bloom MW, Carter EL. Bullous impetigo of the face after epilation by threading. Arch Dermatol.2005;141:1174–5. [PubMed]
5. Odom RB, James WD, Berger TG. Andrew’s diseases of the skin. 9th ed. Philadelphia: W.B. Saunders; 2000. pp. 473–525.
6. Kumar R, Zawar V. Threading warts: A beauty parlor dermatosis. J Cosmet Dermatol. 2007;6:279–82.[PubMed]
7. Verma SB. Vitiligo koebnerised by eyebrow plucking by threading. J Cosmetic Dermatol. 2002;1:214–5. [PubMed]
8. Ghosh SK, Bandyopadhyay D. Molluscum contagiosum after eyebrow shaping: A beauty salon hazard.Clin Exp Dermatol. 2009;34:e339–40. [PubMed]

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