Facial Folliculitis Induced by Threading

Terri Nutt, Major, USAF, MC, FS
Derrick Adams, Captain, USAF, MC

A young woman presented to the dermatology clinic with a cutaneous eruption following a faddish eye brow removal treatment known as “threading.” This case report discusses her clinical presentation, treatment, and briefly investigates the growing movement of threading for the cosmetic removal of facial hair.

A 22-year old white female presented with a 7 day history of a bilateral erythematous eruption of papules and pustules superior to each eyebrow. The lesions were mildly painful and non-pruritic. She had reported having her eyebrows “threaded” at a local health spa prior to the appearance of the lesions. A review of systems was negative for any systemic involvement. The lesions were isolated to the area manipulated by the threading and diagnosed as folliculitis. She experienced complete resolution with a short course of topical clindamycin and hydrocortisone 1% cream twice daily.

Threading is a rapidly-growing alternative technique for the cosmetic removal of unwarranted vellus facial hair. Widely advertised in fashion magazines and promoted by boutiques, the process is attracting a considerable following in the United States. Threading involves knotting and twisting a fine cotton thread around each hair shaft to essentially “pluck” it from the scalp. Supporters claim that threading allows for a more painless, precise, less irritating, and lasting hair removal experience compared with waxing. It is also heavily promoted as a more “natural” method of hair removal than waxing.

The practice of threading is also called khite in Arabic and fatlah in Egyptian. Its origins are unclear but the practice is common throughout the Middle East and India, where it has been accepted as the standard method of facial hair removal for centuries.

Both men and women readily utilize this technique as its practice appears to be free of gender bias.2 Some websites claim it is endorsed by dermatologists for individuals using topical retinoids to minimize acneiform eruptions that commonly occur with waxing. A literature search utilizing OVID, MEDSCAPE and the American Academy of Dermatology failed to produce any support for this claim.

Dermatologists in the United States should become familiar with the practice of threading, or khite, as international travel, overseas immigration, and its commercial promotion is on the rise.


1. Abdel-Gawad, MM, Abdel_Hamid IA, Wagner RF. Khite:a non-Western technique for temporary hair removal. Int J Dermatol. 1997 Mar; 36: 217.
2. Ramos-e-Siva M, de Castro MC, Carneiro LV. Hair Removal. Clinics in Dermatology. 2001 Jul-Aug;19(4):437-444.

Click on these buttons to visit our journalsSearch for Papers and Articles
Return to Psychiatry On-LineReturn to Dentistry On-LineReturn to Vet On-LineReturn to GP On-LineLink to Pharmacy on-LineReturn to Anaesthesia On-LineReturn to Medicine On-LineReturn to Family Medical Practice On-Line
Chest Medicine
Family Medical
Practice On-Line

All pages copyright ©Priory Lodge Education Ltd 1994-2005.

Published October 1st 2005

Authors’ affiliation: Both authors are from David Grant Medical Center, Travis Air Force Base, California. The opinions expressed are those of the authors and should not be construed as official or as representing those of the US Air Force or the US Department of Defense.
Reprints: Derrick Adams, Captain, USAF, MC.
362 Chestnut St
Vacaville, California 95688
(707) 451-9430