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CASE REPORT
Year : 2016  |  Volume : 17  |  Issue : 1  |  Page : 27-28

Cutaneous pili migrans over the scalp of an infant


Department of Dermatology, Venereology, and Leprosy, Mahatma Gandhi Memorial Medical College and Maharaja Yashwant Rao Hospital, Indore, Madhya Pradesh, India

Date of Web Publication4-Jan-2016

Correspondence Address:
Rahul Nagar
Department of Dermatology, Venereology, and Leprosy, Mahatma Gandhi Memorial Medical College and Maharaja Yashwant Rao Hospital, Indore, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-7250.173156

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  Abstract 

An infant was brought to our outpatient department with a large burrow over his scalp, which was present since 1-month. His father had extracted a thread like structure from the burrow. On scanning microscopic examination, the thread like structure was found to be a terminal body hair. Cutaneous pili migrans (CPM) is a rare skin condition in which a hair shaft or fragment is embedded in the superficial skin. To best of our knowledge this is first reported case of scalp involvement in CPM.

Keywords: Bristle migrans, burrowing hair, creeping hair, cutaneous pili migrans, imbedded hair, migrating hair, moving hair


How to cite this article:
Nagar R, Khare S. Cutaneous pili migrans over the scalp of an infant. Indian J Paediatr Dermatol 2016;17:27-8

How to cite this URL:
Nagar R, Khare S. Cutaneous pili migrans over the scalp of an infant. Indian J Paediatr Dermatol [serial online] 2016 [cited 2020 Jul 9];17:27-8. Available from: http://www.ijpd.in/text.asp?2016/17/1/27/173156


  Introduction Top


Cutaneous pili migrans (CPM) is a rare skin condition in which a hair shaft or fragment is embedded in the superficial skin. It is characterized by a creeping eruption with black-line like hair mimicking cutaneous larva migrans.[1] It was first reported in 1957 by Yaffee,[1] since then 27 cases have been reported including 6 cases of children affected by CPM. Various locations involved included the ankle, sole, toe, breast, cheek, neck, jaw, abdomen,[2] and leg [3] have been reported. In this report, we present a case of an 8-month-old infant whose lesion was situated on the scalp. To our knowledge, this is first reported a case of scalp involvement in CPM.


  Case Report Top


An 8-month-old infant, presented to our department for the lesion over the right retro-auricular area. His mother noted a black, linear lesion behind baby's right ear 1-month back. For baby's condition, a pediatric consultation was taken and the topical antibiotic was started. After a month of topical medication, no relief was observed. Hence, his father tried to pull out the thread like structure, which he brought to our department for examination.

A linear dusky erythematous burrow like structure was observed at the right retroauricular area; the burrow had crusted erosion at one end while the other end was closed [Figure 1]. The thread-like structure brought by baby's father was a terminal hair [Figure 2] and [Figure 3], probably a terminal body hair. On the basis of clinical findings, the diagnosis of CPM was made.
Figure 1: A burrow like linear structure, with crusted erosion at one end present over right retro-auricular area

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Figure 2: Hair shaft withdrawn from the lesion, it was brought by the baby's parent

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Figure 3: Scanning microscopic picture of hair brought by the baby's parent

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  Discussion Top


CPM has also been described as imbedded hair, bristle migrans, burrowing hair, creeping hair, migrating hair, moving hair, intradermal creeping of pubic hair, hair fragments in the skin, and cutaneous pili eruption.[3],[4]

The etiology of the condition remains unclear. It is probably an acquired condition because no hair follicles have been reported in any of the reported cases.[2],[4] Causative hair shaft are suggested to be extrinsic, which penetrates the skin owing to sharp hair tip or due to the broken epidermis at the point of entry of hair shaft.[2],[3],[4] The baby had been frequently held in his parents arm; there are many opportunities for friction between mother's body and that of baby's while feeding as well as other day to day activities. Also infants' head and body massage are the common cultural practice in India. In the present case, hair appears to have a tapering end, which has probably caused the hair to penetrate the skin. A combination of sharp ended hair shaft, forces of body surface movement, and the biomechanical force exerted while limb movement [3],[5] has been postulated to be responsible for creeping of the hair shaft into the skin.

Franbourg et al.[6] reported that the Asian hair has high tensile strength and the largest cross-sectional area compared with that of all other ethnic groups. This may explain why most of the cases were reported from the East Asian countries. In a review 14 out of 20 cases have been reported from Japan.[4] The duration between the discoveries of the lesion to the consultation was from 2 days to several years, although some were not presented.[4]

CPM and cutaneous larva migrans closely resemble each other, however CPM tends to move in a linear fashion in only one direction whereas, cutaneous larva migrans can move in any direction and generally results in more serpiginous or tortuous tracts. Furthermore, lesions in CPM are asymptomatic or painful, whereas those in cutaneous larva migrans are extremely pruritic. Therefore, it is necessary to recognize CPM from other creeping eruptions via close examination.[3],[4],[7]

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

 
  References Top

1.
Yaffee HS. Imbedded hair resembling larva migrans. AMA Arch Derm 1957;76:254.  Back to cited text no. 1
[PUBMED]    
2.
Kim YH, Kim JI, Hwang SH, Min JH, Chae SW, Lee SJ, et al. Cutaneous pili migrans. Ann Dermatol 2014;26:534-5.  Back to cited text no. 2
    
3.
Xie H, Zhang RZ, Zhu WY. A new site of cutaneous pili migrans in a 6-month-old infant. Indian J Dermatol Venereol Leprol 2012;78:498-9.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.
Luo DQ, Liu JH, Huang YB, He DY, Zhang HY. Cutaneous pili migrans: A case report and review of the literature. Int J Dermatol 2009;48:947-50.  Back to cited text no. 4
    
5.
Kim JY, Silverman RA. Migrating hair: A case confused with cutaneous larva migrans. Pediatr Dermatol 2010;27:628-30.  Back to cited text no. 5
    
6.
Franbourg A, Hallegot P, Baltenneck F, Toutain C, Leroy F. Current research on ethnic hair. J Am Acad Dermatol 2003;48:S115-9.  Back to cited text no. 6
    
7.
Sakai R, Higashi K, Ohta M, Sugimoto Y, Ikoma Y, Horiguchi Y. Creeping hair: An isolated hair burrowing in the uppermost dermis resembling larva migrans. Dermatology 2006;213:242-4.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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