Creeping Hair in the Beard Area.

Abstract

Dear Editor: Creeping disease is a skin disease caused by a parasite that tunnels its way through the skin, leaving a visible red, itchy, linear eruption. The most representative example of creeping disease is cutaneous larva migrans. In rare cases, a creeping in the skin may mimic creeping disease. A 31-year-old Korean man presented with a single linear, thin, and wavy black line embedded within the superficial skin on the right submandibular region (Fig. 1, black arrows). The skin lesion was detected incidentally 1 month previously. The black line, 7 cm long when stretched, extended horizontally and laterally along Langer's line. The wavy black line was easily moved and stretched by pressure, and restored quickly. The lateral tip was exposed out of the skin when pushed laterally. The black line was easily and completely removed by pulling its exposed tip with a steady pressure by using forceps (Fig. 2A). Interestingly, a light and scanning electron microscopic examination confirmed the black line to be (Fig. 2B). Creeping hair, also known as migrating hair, embedded hair, pili cuniculati (burrowing hair), or cutaneous pili migrans, was diagnosed. Fig. 1 A single linear, thin, and wavy black line was embedded within the superficial skin on the right chin (black arrows). It showed lateral extension along the direction of Langer's line and the same growing direction with surrounding (inset, red arrows). ... Fig. 2 (A) The creeping was easily and completely removed. (B) Hair shaft viewed under a light microscope (×400) and a scanning electron microscope (inset: ×2,000). Creeping is often initially misdiagnosed as cutaneous parasitic infections such as cutaneous larva migrans. Some characteristics that can differentiate between creeping and cutaneous larva migrans, to achieve an accurate diagnosis, are as follows1. First, although there is no pruritus in patients with creeping hair, patients with cutaneous larva migrans have intense itch symptoms and secondary dermatitis. Second, in creeping hair, the penetrating can move in only one direction. However, cutaneous larva migrans can move in any direction and generally leaves more tortuous tracts. Third, creeping is easily and completely removed by slight pulling at the other side of the root. Fourth, the growth direction of creeping is identical to that of the normal surrounding hairs (Fig. 1, red arrows). Finally, once removed, it can be easily confirmed to be by using light microscopy. In this case, the creeping was not considered to have an external source, but was believed to have grown inside the skin, burrowing in the uppermost dermis2. This ingrowing beard may be associated with minor trauma due to shaving with a safety razor and a lateral oblique growth on the lateral chin (Fig. 1, red arrows). However, some reported cases showed eruptions on the plantar region due to the penetration of a fragment from the outside, which could be termed hair as a foreign body2,3. Previous reports of creeping hair, including the present case, involve penetration by thick, dark hair, and the individuals are most likely of Asian origin4. This may be associated with the fact that among all ethnic groups, in Asians has the largest cross-sectional area with the highest tensile strength5. Cases of creeping are extremely rare, and we believe that this is the first Korean case. In conclusion, dermatologists should always consider the possibility of creeping hair, although rare, in patients showing creeping eruptions.