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International Journal of Trichology International Journal of Trichology
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 Table of Contents  
CASE REPORT
Year : 2023  |  Volume : 15  |  Issue : 1  |  Page : 33-35  

Uncommon foot pain: A rare case of sequential migration of cutaneous pili migrans


1 Walter Cantídio University Hospital, Fortaleza, CE, Brazil
2 Center for Research and Drug Development (NPDM), Federal University of Ceara, Fortaleza, CE, Brazil
3 Post-Graduate Program of Pathology; Post-Graduate Program in Translational Medicine, Federal University of Ceara, Fortaleza, CE; Molecular Oncology Cancer Center, Barretos Cancer Hospital, Teaching and Research Institute, Barretos, SP, Brazil

Date of Submission12-Jan-2021
Date of Decision14-Nov-2021
Date of Acceptance25-Jan-2022
Date of Web Publication19-Apr-2023

Correspondence Address:
Howard Lopes Ribeiro Junior
Department of Morphology, Federal University of Ceara, R. Delmiro de Farias, S/N, Rodolfo Teófilo, CEP 60430-170, Fortaleza, CE
Brazil
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijt.ijt_4_21

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   Abstract 


Cutaneous pili migrans (CPM) is an uncommon condition in which a hair fragment penetrates the skin and produces a creeping lesion similarly of cutaneous larva migrans associated with local pain. There are few reports of CPM in the literature, and none visually describes the migration of the hair shaft in the epidermis associated with pain. Herein, we showed the first report describing a case of an in situ sequential migration of CPM in an adult patient.

Keywords: Diagnosis, emergency, pili migrans


How to cite this article:
Sales Kd, de Matos Mota AG, Gusmao CT, Ribeiro Junior HL. Uncommon foot pain: A rare case of sequential migration of cutaneous pili migrans. Int J Trichol 2023;15:33-5

How to cite this URL:
Sales Kd, de Matos Mota AG, Gusmao CT, Ribeiro Junior HL. Uncommon foot pain: A rare case of sequential migration of cutaneous pili migrans. Int J Trichol [serial online] 2023 [cited 2023 May 30];15:33-5. Available from: https://www.ijtrichology.com/text.asp?2023/15/1/33/374394




   Introduction Top


Cutaneous pili migrans (CPM), First described by Yaffee in 1957,[1] is an uncommon condition in which a hair fragment penetrates the skin and produces a creeping lesion similarly of cutaneous larva migrans associated with local pain. Kim and Silverman[2] describe that CPM differs from cutaneous larva migrans by the black staining and linear migration of the hair and also by the absence of pruritus. There are few reports of CPM in the literature, and none visually describes the migration of the hair shaft in the epidermis associated with pain. Thus, to our knowledge, this is the first reported case in Brazil.


   Case Report Top


A Brazilian 31-year-old white woman, with no previous history of disease, reported unusual pain in her left foot without associations with trauma or contiguous injuries. The patient reports that she looked at her foot several times and identified a broken epidermis similar to a hair in the plantar region of the left foot. The patient recorded the lesion [Figure 1]a. After 2 days, under pain and discomfort, the patient was admitted to the surgical emergency service. On physical examination, the patient was more sensitive to pain when her plantar region was manipulated at the level of the first metatarsal. No dermatological or infection disorders (e.g., larva migrans) were identified. Macroscopically, an intradermal capillary fragment, with approximately 2.5 cm length, was identified on the plantar face of the left hallux [Figure 1]b. This finding confirmed the diagnosis of CPM. By analyzing [Figure 1]a, the physician concluded that the hair had moved from the epidermis of the plantar region to the proximal region of the hallux of the left foot. After the diagnosis, under local anesthesia, the black line was easily extracted using a 25-gauge needle, and it was found to be a hair shaft without hair follicle [Figure 1]c and [Figure 1]d. After removing the hair, the lesion was successfully treated and no recurrence occurred since then. Thus, we reported the first case of an in situ sequential migration of CPM in an adult patient.
Figure 1: Clinical presentation of cutaneous pili migrans (CPM). (a) Image recorded by the patient. Black arrow points to CPM lesion. (b) In situ migration of CPM in the plantar region of the left foot. (c) Extraction and exposure of the hair shaft. (d) Hair shaft without hair follicle extracted

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   Discussion Top


CPM is a rare condition in which a hair shaft or fragment burrows in the superficial skin. CPM can clinically present as a black line forming an eruption resembling larva migrans, which is recognized as embedded hair, burrowing hair, and creeping hair.[3],[4],[5] We reviewed the described cases so far. It was founded 26 reported cases of cutaneous pili by using various terms such as burrowing hair, creeping hair, migrating hair, embedded hair, and bristle migrans. Surprisingly, most of the cases reported were from Asian and Indian countries. It can be explained by influence of ethnicity on hair structure.[4],[6],[7] In Brazil, Bernardes-Filho et al.[7] described the first adult CPM report with a previous history of pain on the right heel that worsened while walking. At diagnosis, the authors reported that a 10-mm capillary fragment penetrating the skin was identified.[7] However, to the best of our knowledge, this is the first report that visually describes the skin migration of a CPM associated with pain.

The etiology of CPM remains still unclear. Commonly, the diagnosis of CPM can be confused with cutaneous larva migrans. Nonetheless, cutaneous larva migrans can move in any direction and usually results in more serpiginous or tortuous tracts.[4],[5] Luo et al.[8] stated that CPM may occur when an intradermal growing hair is excluded from the follicle. In addition, Bernardes-Filho et al.[7] describes that CPM can occur when the hair shaft is trampled on the bare feet of the patient and becomes embedded obliquely in the superficial layer of the stratum corneum, stimulating the free nerve endings in the superficial dermis. This hypothesis best explains the case presented in this study.

Clinically, CPM can appear in toes, sole, ankles, breast, cheeks, neck, and abdomen.[4],[6],[9] Dermoscopy may be useful in the diagnosis of these disorders. Furthermore, CPM can move in only linear direction and may be asymptomatic or associated with mild pain.[5],[6],[9],[10] In conclusion, the present report shows that it is necessary to differentiate CPM from other disorders and physicians should be attentive to achieve an accurate diagnosis for this foreign body, especially in emergency medical services.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.

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
    
2.
Kim JY, Silverman RA. Migrating hair: A case confused with cutaneous larva migrans. Pediatr Dermatol 2010;27:628-30.  Back to cited text no. 2
    
3.
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. 3
    
4.
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. 4
    
5.
Jang YH, Kim MJ, Kim SL, Chi SG, Lee WJ, Lee SJ, et al. Creeping hair in the beard area. Ann Dermatol 2015;27:635-6.  Back to cited text no. 5
    
6.
Ingkapairoj K, Triwongwaranat D, Jiamton S, Varothai S. Cutaneous pili migrans: A case report. Skin Appendage Disord 2020;6:52-4.  Back to cited text no. 6
    
7.
Bernardes Filho F, Bernardes A, Towersey L, Hay R. A man with an unusual foreign body. J Emerg Med 2019;57:e59-60.  Back to cited text no. 7
    
8.
Luo DQ, Liang YH, Li XQ, Zhao YK, Wang F, Sarkar R. Ingrowing hair: A case report. Medicine (Baltimore) 2016;95:e3660.  Back to cited text no. 8
    
9.
Ishida Y, Matsubara K, Takai M, Horiguchi Y, Yoshikawa Y. A case of 'creeping hair' resembling cutaneous larva migrans. Clin Exp Dermatol 2009;34:256-7.  Back to cited text no. 9
    
10.
Liu JH, Zhao YK, Wu HH, Wang F, Luo DQ, Huang YB. Intradermal growing hair: Two case reports. Am J Mens Health 2019;13:1557988319825774.  Back to cited text no. 10
    


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