Background

• Trichomycosis pubis, also known as “trichobacteriosis,” is a superficial bacterial infection that affects the hair shafts in the pubic region. It is a relatively uncommon condition that primarily affects the hair follicles, leading to the formation of colored nodules or concretions along the hair shafts. While trichomycosis pubis primarily affects the pubic hair, it can also occur in other regions with coarse hair, such as the axilla (armpit), facial hair, and even the scalp. 
• Various bacteria, including Corynebacterium tenuis, Corynebacterium flavescens, and Corynebacterium pubicola cause trichomycosis pubis. These bacteria are typically part of the normal skin flora and thrive in warm, moist environments. Factors such as excessive sweating, poor hygiene, and crowded living conditions can contribute to the development of this condition. 
• The characteristic sign of trichomycosis pubis is the formation of yellow, red, or blackish concretions surrounding the hair shafts. These concretions, also known as “trichobacteriosis nodosa,” are composed of bacteria and bacterial metabolic byproducts. They can cause the affected hair to appear matted, sticky, or discolored.  

Epidemiology

• Prevalence: Trichomycosis pubis is considered to be a relatively common condition, particularly among individuals who have reached puberty. The exact prevalence rates are not well-documented in the medical literature, and studies specifically focusing on its epidemiology are limited. 
• Age and Gender: Trichomycosis pubis can affect individuals of any age who have pubic hair. However, it is more commonly observed in sexually active individuals during their reproductive years. 
• Sexual Transmission: The primary mode of transmission of trichomycosis pubis is not sexual. It is believed to occur through direct contact with contaminated objects or by sharing personal items such as towels or clothing. However, sexual contact may contribute to the spread of the infection in some cases.

Anatomy

Pathophysiology

• Bacterial colonization: The primary causative agent of trichomycosis pubis is Corynebacterium minutissimum, a gram-positive bacterium. It colonizes the hair shafts in the pubic region and other areas of the body with hair, such as the axilla (armpits) or the beard region. 
• Proliferation and biofilm formation: Once the bacteria colonize the hair shaft, they multiply and form biofilms. Biofilms are complex communities of bacteria encased in a protective matrix. The biofilm formation provides protection and enhances the ability of bacteria to adhere to the hair shaft. 
• Metabolism and concretion formation: Corynebacterium minutissimum produces a substance called trichomycin, which is a complex mixture of lipids and proteins. Trichomycin accumulates around the bacterial colonies, forming the characteristic yellow, black, or red concretions on the hair shafts. These concretions are often mistaken for lice or other parasitic infestations. 
• Clinical presentation: Trichomycosis pubis is usually asymptomatic, and many individuals may not be aware of the condition. However, the presence of concretions on the pubic hair may cause cosmetic concerns or mild itching in some cases. Secondary bacterial infections or inflammation of the hair follicles may occur in rare cases. 

Etiology

• Poor hygiene: Inadequate personal hygiene, such as infrequent washing or inadequate cleansing of the pubic area, can create an environment favorable for bacterial overgrowth. 
• Excessive sweating: Increased sweating in the pubic region provides moisture that supports bacterial growth. People who perspire heavily or engage in activities that promote sweating, such as sports or physical exertion, may be more prone to trichomycosis pubis. 
• Thick hair: Individuals with dense or coarse pubic hair may be more susceptible to trichomycosis pubis. The tightly packed hairs create an environment where bacteria can easily adhere to the hair shafts. 
• Close contact: Trichomycosis pubis is considered a sexually transmitted infection (STI). Close contact with an infected individual, such as during sexual activity, increases the risk of transmission. 

Genetics

Prognostic Factors

• Apart from the potential for reoccurrence, the outlook for recovery is promising, and the prescribed treatment has proven to be efficacious.  
• The occurrence of adverse health effects is minimal, as most individuals remain unaware of the presence of the pathogen. The predominant symptom reported by patients is an unpleasant smell, which can persist and contribute to ongoing complications, given the tendency for trichomycosis to reoccur frequently. 

Clinical History

• Age Group:  
• Trichomycosis pubis is a condition that affects the pubic hair. It is characterized by the presence of bacterial overgrowth and the formation of yellow or white nodules on the hair shafts. Trichomycosis pubis can occur in individuals of any age group, if they have pubic hair.  
• However, it is more commonly observed in adults, particularly those who have reached puberty. It is less commonly seen in children, as they typically have less developed pubic hair at that stage. It is important to note that trichomycosis pubis is not related to age specifically, but rather to the presence of pubic hair. 

Physical Examination

• Medical History: The healthcare provider will start by asking you questions about your symptoms, duration, and any previous treatments you may have undergone. They may also inquire about your sexual history and any other relevant medical conditions. 
• Visual Inspection: The provider will visually examine the affected area. They will look for characteristic yellowish masses on the pubic hair shafts. These masses may appear as small, sticky, and adherent nodules along the hair. 
• Dermoscopy: In some cases, the healthcare provider may use a dermoscope, which is a handheld device with magnification and light, to examine the affected hair more closely. This can help confirm the diagnosis by visualizing the bacterial masses. 

Age group

Associated comorbidity

• Obesity: Excess body weight and increased adiposity can lead to increased sweating in the pubic region, creating a favorable environment for bacterial growth. 
• Diabetes: Poorly controlled diabetes, especially with elevated blood sugar levels, can compromise the immune system and increase the risk of infections, including trichomycosis pubis. 
• Immunocompromised conditions: Individuals with compromised immune systems, such as those with HIV/AIDS, undergoing chemotherapy, or taking immunosuppressive medications, may be more prone to developing infections, including trichomycosis pubis. 
• Activities and habits: Certain activities and habits may contribute to the development or exacerbation of trichomycosis pubis.

These include: 

• Poor personal hygiene: Inadequate washing or cleaning of the pubic region can allow bacteria to proliferate, leading to the development of trichomycosis pubis. 
• Excessive sweating: Excessive sweating in the pubic area, often due to physical activities or hot climates, can create a favorable environment for bacterial growth and increase the likelihood of trichomycosis pubis. 

Associated activity

Acuity of presentation

• In terms of acuity of presentation, trichomycosis pubis typically has a chronic course, meaning that it tends to persist over a long period of time if left untreated. However, the severity and visibility of the symptoms can vary among individuals. Some people may have mild cases with minimal symptoms, while others may experience more pronounced symptoms. 
• The characteristic appearance of trichomycosis pubis includes the presence of small, discrete, and adherent concretions surrounding the hair shafts in the pubic area. These concretions can be yellow, black, or brown in color and are typically easy to detect upon close examination. In some cases, the affected hairs may appear coated or “sleeved” with the concretions. 

Differential Diagnoses

• Pubic lice (Pthirus pubis): Pubic lice are parasitic insects that infest the pubic region. They attach to the hair shafts and feed on blood, causing intense itching and the presence of nits (lice eggs) or lice. 
• Contact dermatitis: Irritation or allergic reaction to irritants or allergens, such as soaps, detergents, lotions, or certain fabrics, can lead to contact dermatitis. It can cause redness, itching, and inflammation in the affected area. 
• Folliculitis: Folliculitis is the inflammation of hair follicles and can occur in the pubic region. It is commonly caused by bacterial or fungal infections and may present with pustules or small red bumps. 
• Scabies: Scabies is a contagious skin infestation caused by the Sarcoptes scabiei mite. It results in intense itching and the appearance of red, raised bumps or blisters. The pubic area is one of the common sites affected by scabies. 

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

• Improve personal hygiene: Wash the affected area daily with a mild soap and warm water. Gently scrub the area to remove any concretions or debris around the hair shafts. Thoroughly dry the area afterward. 
• Shave or trim the affected hair: Trimming or shaving the pubic hair can help reduce the bacterial load and facilitate the application of topical treatments. 
• Topical antimicrobial agents: Over-the-counter antibacterial creams or gels containing active ingredients such as benzoyl peroxide or clindamycin can be applied to the affected area. These agents help eliminate the bacteria causing the infection.  
• Avoid tight clothing: Wear loose-fitting underwear and clothing to promote airflow and reduce moisture in the affected area, as bacteria tend to thrive in warm and moist environments. 
• Practice good overall hygiene: Maintain good personal hygiene, including regular bathing and changing of underwear. Avoid sharing towels or personal items with others to prevent the spread of bacteria. 

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

use-of-behavioral-modifications-for-treating-trichomycosis-pubis

Psychology 

• Maintain good personal hygiene: Cleanliness is crucial in preventing and managing trichomycosis pubis. Regularly wash the affected area with mild soap and water, ensuring that you thoroughly cleanse the hair shafts. 
• Shave or trim the pubic hair: Trimming or shaving the pubic hair can help reduce the environment suitable for bacterial growth. However, it’s essential to be cautious and use proper hygiene practices when shaving to avoid skin irritation or cuts that may increase the risk of infection. 
• Avoid excessive sweating: Bacteria thrive in warm and moist environments, so it’s important to minimize excessive sweating in the pubic area. Wear loose-fitting clothes, especially during hot and humid weather, to promote air circulation and reduce sweating. 
• Use antibacterial agents: Topical antibacterial agents, such as benzoyl peroxide or antibacterial soaps containing triclosan, can be used to cleanse the affected area. These products can help reduce bacterial colonization and prevent the recurrence of trichomycosis pubis. However, consult a healthcare professional before using any medication or antibacterial products. 
• Practice safe sex: Trichomycosis pubis can be transmitted through sexual contact. To prevent the spread of the infection its important to use condoms or dental dams. Additionally, communicating with sexual partners about the infection and seeking appropriate treatment is crucial. 
• Loose clothing: Wear loose-fitting underwear and breathable clothing to promote airflow and reduce moisture. 
• Drying: After washing, thoroughly dry the pubic area using a clean towel.  

Use of Topical Antibiotics for treating Trichomycosis pubis

• Clindamycin is an antibiotic that is effective against a wide range of bacterial infections, including those caused by Corynebacterium. 
• While clindamycin may have some activity against the bacteria associated with trichomycosis pubis, it is not commonly used as a first-line treatment for this condition.  
• Erythromycin is an antibiotic that is effective against a variety of bacteria, including Corynebacterium species. 
• Topical antibiotics have been used in some cases to treat trichomycosis pubis, they are typically reserved for severe or recurrent cases that do not respond to conservative management. In such instances, a healthcare professional may prescribe a topical antibiotic, such as clindamycin or erythromycin, to be applied to the affected area. 

Use of Antifungal agents for treating Trichomycosis pubis

• Naftifine hydrochloride cream (1%) is an antifungal medication commonly used to treat various fungal infections, including trichomycosis. Trichomycosis, also known as trichobacteriosis, is a superficial bacterial infection that affects the hair shafts in areas such as the underarms, groin, and pubic region. Although it is caused by bacteria rather than fungi, naftifine hydrochloride cream can still be effective in treating this condition. 
• When applied topically, naftifine hydrochloride acts by inhibiting the growth of fungi and certain bacteria, thereby eliminating the infection. It is a broad-spectrum antifungal agent that targets a range of fungi and some gram-positive bacteria. 
• According to the authors’ findings, this medication used in cases where patients exhibit nodules surrounding pubic or axillary hair. 

Use of benzoyl peroxide and sulfur soaps for treating Trichomycosis pubis

• Benzoyl peroxide is known for its antibacterial properties and ability to reduce inflammation. There has been support its efficacy in treating trichomycosis pubis specifically. Benzoyl peroxide may help reduce the number of bacteria present on the skin, but it may not eliminate the infection. Helps in prevention of bacterial growth. 
•  Sulfur soaps, on the other hand, have been used for many years to treat various skin conditions, including acne and fungal infections. Sulfur has antimicrobial and antifungal properties, which may contribute to its effectiveness against certain skin infections. While there is anecdotal evidence of sulfur soaps being used to manage trichomycosis pubis. 

Use of aluminum chloride or aluminum chlorohydrate for treating Trichomycosis pubis

• To effectively cure excessive sweating in the pubic region, it is advisable to explore the usage of antiperspirants that incorporate aluminum chloride or aluminum chlorohydrate as active ingredients. 

• Good hygiene practices: Practicing good personal hygiene is crucial in managing trichomycosis pubis. Regularly wash the affected area with mild soap and water, and gently scrub the hair shafts to remove the concretions. 
• Trimming or shaving: Trimming or shaving the pubic hair can help to improve hygiene and facilitate the application of topical treatments. However, this is a personal preference, and individuals should choose a method that they are comfortable with. 
• Topical antimicrobial agents: Over-the-counter topical antimicrobial agents, such as benzoyl peroxide or erythromycin, may be recommended to treat trichomycosis pubis.  
• Antibiotics: Antibiotics like clindamycin or erythromycin are commonly used for the treatment of trichomycosis pubis. Take the prescribed antibiotics as directed by your healthcare provider. 

Medication

Future Trends

Media Gallary

References

• Trichomycosis pubis – PubMed (nih.gov) 
• Trichobacteriosis – an overview | ScienceDirect Topics