Ingrowing Hair

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 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.

Intradermal Growing Hair: Two Case Reports

“…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.…”

“…However, histopathology for the entity was still absent at present. Patient 2 had repeated recurrence, and the previous case (Luo et al, 2016) relapsed even after stopping the habit of plucking or extruding the beads for a year (the current corresponding authors’ unpublished data), suggesting that some other unknown mechanisms may also play important roles for IGH, that may be the reason why Patient 2 needed to destroy the follicle to ultimately cure the disorder. As few people like to pluck or extrude the scalp hairs while it is more common to do so for the beards, which may be one of the reasons why IGH always involves the beard areas including chin and neck.…”

“…The pathogenesis for IGH remains unknown. However, it has been suggested that the action of plucking or extruding the beards might have played important roles for its pathogenesis by causing localized inflammation and/or changing the growing direction of hairs, resulting in the possibility of the hair growing and extending beneath the skin (Luo et al, 2016). As no bleeding presented after the distal end was pulled out, the authors speculated that the hairs might be growing in the superficial layer of the epidermis, even just in the stratum corneum.…”

“…In 2006, Sakai et al (2006) mentioned four Japanese patients who presented as hairs growing inside the skin and burrowing in the uppermost dermis, and considered the entity as “ingrown hair.” In 2016, Luo et al (2016) reported a similar case, and renamed it as “ingrowing hair,” that was considered to be better than “ingrown hair” to describe the condition. To the current authors’ knowledge, only five cases including four Japanese (Sakai et al, 2006) and a Chinese (Luo et al, 2016) with such a rare condition have been reported up to July 31, 2018. All these patients were male with involvement of the face or neck alone (Luo et al, 2016; Sakai et al, 2006).…”

“…To the current authors’ knowledge, only five cases including four Japanese (Sakai et al, 2006) and a Chinese (Luo et al, 2016) with such a rare condition have been reported up to July 31, 2018. All these patients were male with involvement of the face or neck alone (Luo et al, 2016; Sakai et al, 2006). The authors herein added another two new cases.…”