Cutaneous Mycobacterium massiliense Infection Caused by Skin Coining ‘Gua Sha’ in Korean Healthy Female

• Published in: Annals of dermatology 2021-12, Vol.33 (6), p.572
• Main Authors: Sang-woo Park, Hyun-bin Kwak, Sang-kyung Lee, Eui-sung Jung, Su-kyung Park, Jaehyeon Lee, Hye-soo Lee, Seok-kweon Yun, Han-uk Kim, Jin Park
• Format: Article
• Language: Korean
• Subjects: East Asian traditional medicine; Mycobacterium infections; Nontuberculous
• ISSN: 1013-9087; 2005-3894

Nontuberculous mycobacteria are ubiquitous environmental organisms that are rare pathogens in immunocompetent individuals. However, cutaneous nontuberculous mycobacteria infections have been increasingly associated with invasive procedures, including surgery, liposuction, filler injection, intramuscular injection, mesotherapy, piercing, acupuncture, and cupping therapy. Herein, we report the first case of cutaneous nontuberculous mycobacteria infection caused by the East-Asian traditional treatment ‘Gua Sha’, also known as scraping, coining or spooning in English. A 35-year-old healthy female presented with widespread, painful skin nodules and pustules on her upper and lower extremities that had developed after Gua Sha treatment for body contouring. Histopathologic examination of the lesions revealed granulomatous inflammation in the dermis and the culture isolates were identified as Mycobacterium massiliense with molecular identification. The patient was successfully treated with intermittent incision and drainage of persistent nodules and oral clarithromycin based on antimicrobial susceptibility testing. We recommend implementation of a standard safety protocol for Gua Sha practitioners to minimize the risk of infection transmission.