Cosmetic Warts: Pseudo-Koebnerization of Warts after Cosmetic Procedures for Hair Removal

To sensitize patients, physicians, and aestheticians about the possibility of spread of cutaneous warts during cosmetic procedures, especially following temporary hair removal methods, such as shaving, waxing, threading, and using depilatory creams, so they practice the requisite safety measures. Cutaneous warts caused by human papilloma virus are highly contagious. They tend to spread locally with even the trivial trauma of scratching, resulting in autoinoculation or "pseudo-Koebnerization." Other than isolated case reports, there is a paucity of literature on pseudo-Koebnerization of warts by temporary hair removal methods.

The authors present their observations from five patients-two men and three women (Cases 1 to 5)-in whom, after a single or a few episodes of a specific temporary hair removal method, either pre-existent warts spread locally at a rapid pace or surfaced clinically for the first time and then started spreading locally. An attempt was made to study the temporal relationship between the cosmetic procedure and the eruption or exacerbation of warts.

All five cases showed warts in a linear or local distribution, suggesting pseudo-Koebnerization and the possible use of unclean material used for temporary hair removal methods. One male (Case 1) and two female (Cases 3 and 4) patients already had pre-existent warts, which spread locally following the temporary hair removal procedures. The clinically naive other two patients may have acquired human papilloma virus due to cross-infection from unsterilized razor blades (possibly in Case 2) or from a spouse's infected towel pressing against freshly waxed skin (Case 5). Treatment with radiofrequency ablation or topical tretinoin was successful in all patients.

Despite the widely prevalent practice of temporary hair removal cosmetic procedures around the globe, such pseudo-Koebnerization-induced "cosmetic warts" remain under-reported. Through this case series, the authors wish to inculcate the practice of more hygienic measures by patients, barbers, aestheticians, and beauticians to prevent such cosmetic mishaps.