The authors have indicated no significant interest with commercial supporters.T hreading is an epilatory technique that is gaining popularity in Western countries, especially in the United States. It is claimed that threading is a more cost-effective, affordable, less-invasive, and safer alternative to shaving, chemical depilation, waxing, plucking, and laser hair removal. 1 Despite being considered a less traumatic method of effective hair removal, skin abrasion, follicular trauma, and erythema are not uncommon occurrences. Physical damage from this technique may compromise the skin's barrier, allowing for the invasion of pathogens such as human papilloma virus (HPV) and staphylococcus. 2-6 We present two such cases of warts in the periocular region that developed after eyebrow threading was performed. We also review the literature on other reported complications of threading techniques.
Case 1A 20-year-old Asian woman presented to our clinic complaining of progressive spreading of skin-colored lesions along the lower part of her brows and on the upper eyelids. The lesions had started appearing in the past 6 months. The patient revealed that she had been continuously having her brow threaded at the local beauty parlor over the preceding 12 months.On examination, there were densely packed, 2-to 4-mm, white to skin-colored papules over both inferior eyebrows and upper eyelids ( Figure 1A). Biopsy of one papule from the right side revealed epidermal hyperplasia with perinuclear vacuolization in the superficial epidermis and focal hypergranulosis, consistent with verruca plana ( Figure 1B). A full skin examination failed to reveal any other lesions suspicious for verruca. The patient was otherwise healthy and did not have any history of immunosuppression. She was treated with topical 5% imiquimod cream with complete resolution of the lesions in 8 weeks. She chose to forgo any further threading sessions.
Case 2A 21-year-old Caucasian woman presented with warty lesions on the left side of the face that were increasing in size and number over the 3 months before presentation. She had been having her eyebrows threaded frequently in a local cosmetic parlor for 1 year. On physical examination, she demonstrated small and large warty papules on the inferior margin of the left brow and upper eyelid and on the forehead, with adjacent hyperpigmentation (Figure 2). The patient was otherwise in good health, without warts on any other area of the skin and with