Abstract
Dear Editor,
In the period from April 2014 to April 2015, 14 Caucasian women, ranging from 21 to 53 years of age, were admitted to our department because of the slow appearance of papular, non-inflammatory lesions on the pubis. Two women also had lesions on the abdomen and one on the right thigh. A clinical diagnosis of molluscum contagiosum (MC) was made. All patients were immunocompetent and in good general health. Furthermore, all of them had performed pubic hair removal (according to clinical history, ten patients by shaving and four by waxing). In the same period, no women with pubic hair were observed with MC on the pubis. As far as men are concerned, no cases of pubic hair removal and MC were recorded in our clinic in the same period.
The practice of pubic hair removal is undertaken for cultural and religious reasons and, in recent years, as a fashion phenomenon.1–4 In a recent British study, it has been stated that 70 to 80% of adults remove pubic hair, in part or entirety, by means of different methods. 4 However, it was also observed that pubic hair removal is associated with an increased risk of infections and sexually transmitted infections (STIs).5–11
A 20-year-old Australian woman with type I diabetes presented with life-threatening group A Streptococcus pyogenes toxic shock syndrome and Herpes simplex (HSV) infection of her external genitalia following a wax for pubic hair removal. 5 In a group of 61 patients with viral infections of the pubis, MC was identified in 44 (71%), human papillomavirus (HPV) infection in seven (11%), concomitant MC and HPV in seven (11%) and HSV in three patients (4.8%). 6 To our knowledge, the co-infection MC–HPV was not reported in other studies. No concomitant MC–HPV infection was observed in our patients. According to the same authors, shaving was a risk factor for a high number of lesions. 6 A prospective 20-year (1988–2007) Spanish study investigating trends of MC showed that there was a three-fold increase from an incidence of 1.3% in the first decade (1988–1997) to 4% in the second (1998–2007) (P < 0.001). 7 In a group of 30 patients with MC, 93% had removed pubic hair (70% by shaving, 13% by clipping and 10% by waxing). 8 These authors concluded that pubic hair removal (especially by shaving) could be a risk factor for MC and other STIs, such as HPV infection. 8 Other authors stated that waxing of the pubis causes abnormalities of the skin barrier that allows the penetration of MC and HPV virus. 9 Conversely, a significant correlation between increase in pubic hair removal and the decreasing incidence of pubic lice infestation was observed. It was hypothesised that the removal of pubic hair may lead to eradication of pubic lice as the natural habitat of this parasite is destroyed. 4 On the basis of our experience, female pubic hair removal, by waxing or shaving, is a practice that could facilitate the local dissemination of MC virus. As previously mentioned, it is possible that waxing and shaving of the pubis causes abnormalities of the epidermis that allows the penetration and dissemination of MC.