By Helen Branswell

TORONTO (CP) - It's the story of a Brazilian wax that went south, a drive to get rid of the hair down under that nearly cost a young Australian woman her life.

Her doctors say it's also a cautionary tale for other aficionados of the minimalist look - a warning that maximum depilation can potentially lead to debilitation, especially when it's being performed on someone with a weakened immune system.

"I think the message . . . of this case is just to say: 'Hey guys, you know, we need a bit of a reality check here," says Dr. Lindsay Grayson, an infectious diseases specialist with Austin Health and the University of Melbourne.

"This might be fine and mostly pretty innocuous and fun, but for some people it's not that. It can be quite serious."

The "some people" Grayson refers to are people whose immune systems are weakened - or compromised, in the language of the medical community. That typically encompasses people with HIV-AIDS, those on immune-suppressing drugs because they've undergone an organ transplant or people receiving cancer therapy. And in this case, it also refers to someone with poorly controlled diabetes.

The person in question is an unidentified 20-year-old Australian woman with Type 1 diabetes - the kind that requires regular insulin shots - who underwent a disastrous Brazilian bikini wax. Her physicians report on her startling case in an upcoming issue of the journal Clinical Infectious Diseases.

During the waxing procedure, which was performed by a trainee, the woman experienced some vulval bleeding, suggesting tearing of the skin. And in the two weeks after, she developed symptoms of a worsening infection - pain, swelling, redness and discharge.

By the time she sought medical help she was reporting excruciating pain, fever, a rash that extended up to the chest and neck and severe difficulty urinating. Examination showed her external genitalia were "grossly swollen." Doctors couldn't do an internal examination because the woman was in too much pain; one was eventually performed after she'd been put under general anesthesia.
Her condition was so severe treating doctors thought she had necrotizing fasciitis - flesh-eating disease - and they urgently put her on a regime of heavy-duty antibiotics.

The woman didn't have that rapidly progressing infection, caused by some strains of Streptococcus bacteria. But she did have a life-threatening Streptococcus pyogenes infection with what looked like a flare-up of a pre-existing herpes infection.

"If she had not received appropriate therapy, she would have died," Grayson said in an interview from Melbourne.

The antibiotics did the trick, though, and the woman recovered. She was released from hospital after 10 days and was able to return to work after 21.

But this tale of hair scares doesn't end there.

Six months later, the woman again tried to denude her nether regions, this time eschewing wax and turning to the razor. Razors often make small tears in the skin and a few days later she was back in hospital with a second infection and herpes recurrence.

The second bout was less severe than the first, possibly because she sought care more quickly, Grayson says. "She was scared stiff."

While Grayson and his colleagues acknowledge that this case is probably at the severe end of the spectrum of hair-removal complications, they nonetheless think it sounds a crucial cautionary note.

"The importance of it is that it highlights a potential new phenomenon and that is the impact of the beauty industry on patients such as this," Grayson says.

Dr. Michael Libman, director of infectious diseases for Montreal's McGill University Health Centre, admits he's never seen a case as bad as the one this woman had.

But Libman says skin infections are common among people who remove hair - whether it's men shaving too close to a herpes cold sore and spreading it about their face, or infected lesions that develop on legs nicked in shaving.

"For her, it was a constellation of unfortunate events. She managed to have herpes at the time. She managed to also get an infection at the time and perhaps also to be a little immune suppressed. And all of those three things happening together, that is probably only going to happen in one in a million (cases)," Libman says from Montreal.

"But minor variants of that - either spreading the herpes around or spreading the infection around - would not be nearly that uncommon."

And the risk, of course, is greater in the groin.

"One of the problems with shaving pubic hair, as opposed to shaving your face or shaving your legs, is that it's an area that just has more bacteria in the neighbourhood," Libman says, adding that waxing also causes microscopic tears in the skin that can allow bacteria which normally sit harmlessly on the surface of the skin to slip into tiny cuts and cause infections.

While he says many doctors will have seen infections resulting from hair removal efforts, he doesn't anticipate anyone would issue general guidance against it.

"I think the rate of complications is too low that people are going to say 'This is too dangerous,"' Libman says. "But the recommendation would be to be careful."