Ugly Risks of Beauty Routines

, University of Medicine & Dentistry of New Jersey


Medscape General Medicine. 1996;1(1) 

In This Article

Skin Infections

The skin is the largest organ of the body and is subjected to daily assaults and frequent minor breaks that can result in infection. As with the eye, the most common skin infections are the result of the gram-positive bacteria staphylococci and streptococci. Occasionally, cosmetics will cause an allergic pruritic skin rash that becomes secondarily infected with one of these organisms. The crusted superficial infection with streptococci (often group A) is called impetigo and is characterized by its golden color. This infection usually responds to a 7- to 10-day course of the twice-daily application of a topical antibiotic preparation like bacitracin or mupirocin ointment (Table III). If necessary, 500mg PO qid erythromycin for 7-10 days may be prescribed.

Occasionally, these bacteria can cause more severe infection if a woman is not careful with her beauty routine. In New York City, a woman nicked her leg while shaving and, within hours, developed a group A streptococcal infection resulting in a necrotizing fasciitis that caused her death a few days later.

Careful cleaning and local care of wounds and meticulous cleaning of beauty-care instruments are mandatory. In women with edema or lymphedema (eg, women with mastectomy and arm edema, varicose vein stripping, or saphenous vein removal for grafting), infections can be particularly worrisome. Women with cardiac, renal, or hepatic disease and peripheral edema or vascular insufficiency from these causes are also at high risk of serious complications from staphylococcal or streptococcal infections.

Folliculitis. Women with infections of the hair follicles of the scalp, legs, or underarms will often arrive in the clinician's office complaining of superficial skin inflammation or pruritus. Inspection may reveal pustules, with or without erythema, at the site of central hair follicles.

Scalp infections caused by gram-positive bacteria can result when the skin integrity of the scalp is broken by burns to the scalp with hot combs or curling irons. In the days before proper cleansing of hair-salon equipment, scalp infection was so commonly associated with contaminated combs that it was called sycosis barbae, or barber's itch. The same attention to equipment handling should be paid during professional salon care and home care of the hair and scalp as was described for nail care.

In most cases, folliculitis requires no more than antiseptic soap washes. Treatment of severe scalp infections, however, such as those associated with implanted hair extensions, requires the use of systemic antibiotics, such as dicloxacillin or erythromycin, 500mg qid for 7 to 10 days. In some cases, hospitalization may even be necessary. Complications of folliculitis can include cellulitis, furunculosis, and alopecia.

Women who go to spas and use hot tubs, pools, or whirlpools may get folliculitis if the water in the facility has become contaminated and is not properly cleaned.[16] One of the more common organisms in this setting is Pseudomonas aeruginosa.

Leg and underarm depilatories and loofah sponges used by some women for exfoliation can cause a similar folliculitis.[17] Fortunately, this particular infection is usually self-limiting and requires no treatment. Women who use loofah sponges, however, must be taught to allow them to dry completely between uses and to decontaminate the sponges with hypochlorite (10%) bleach at regular intervals. In one study, sterile loofah fragments were found to support the growth of numerous gram-negative (Pseudomonas, Xanthomonas, and Klebsiella) and gram-positive (enterococcus and group B Streptococcus) species. When desquamated epithelial cells are trapped in the fibrous matrix, loofah sponges can become a rich breeding ground for pathogens.[18]

Tattoos and body piercing. Cosmetic procedures involving body piercing and tattoos can also cause local infection. As with most superficial skin infections, local culture for bacteria to identify the organism and its sensitivity, followed by topical antibiotics, may be all that is needed. But if the area is painful, red, swollen, and warm or if the woman has a fever, systemic antibiotic treatment and drainage of an abscess may be needed along with a septic workup including blood cultures. The current fashion of piercing the ear through the cartilage high on the pinna rather than through the fatty tissue of the earlobe has been reported to increase the risk of potentially disfiguring infection. In one case, severe Pseudomonas perichondritis was associated with high-ear piercing.[19]

Tattoo and body-piercing practitioners often are not licensed and may be inexperienced. Blood-borne pathogens, including hepatitis B and C, are of particular concern. Women who have recently had tattoos or piercing should be tested for hepatitis B and C. If the procedure was performed recently (in the past 72 hours) by a nonlicensed practitioner, hepatitis B immune globulin may be administered.[11] Vaccination for hepatitis B may be warranted in women who are planning to undergo tattooing or piercing.