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This story is currently sitting at #13 on Reddit:

TIL that in rare cases, popping a pimple in the so-called "danger triangle" can lead to facial paralysis, brain infections/meningitis, and even death.

It links through to this Wikipedia article http://en.wikipedia.org/wiki/Danger_triangle_of_the_face

The Reddit title and what has caused it to receive so many upvotes is the claim that squeezing something like a pimple on the surface of the face could cause sever infection, brain damage or death.

There are many other similar claims if you search Google.

Has this ever happened? Are there any documented cases of someone having brain damage or death as a result of popping a pimple or boil on their face due to infection that transmitted to the brain?

  • The talk page for that article suggests that it's an urban legend (but with no proof unfortunately). – Brendan Long Aug 31 '12 at 19:55
  • An interesting story about the danger triangle. Unfortunately, I don't understand it all due to the specialized english vocabulary: informahealthcare.com/doi/abs/10.1080/01676830802009754 – Zonata Sep 13 '12 at 1:11
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    A literature check shows no cases of patient deaths, due to brain infection, arising from popping pimples. Citations from the early 20th Century are dubious at best. Today's medicine is evidence based. This triangle of death myth has been talked about for years, but there is no credible evidence to support it. The fact is that the nasal area is teeming with staph and strep in many people. And with the number of micro and macroscopic tears that occur from people picking their nose, or blowing their noses, or popping pimples, this phenomenon should be well documented in the literature. It is not – user19387 May 21 '14 at 0:46
  • There's an incident in the Philippines recently that might support this: gmanetwork.com/news/video/220318/24oras/… (a link from a local tv station here which roughly translates to: guy who developed a tumor in the brain due to irritating one's pimple better already). Might prove as solid evidence if you understand Filipino language, though. :) – user22334 Oct 3 '14 at 23:08
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+50

I was skeptical myself about the existence of the danger triangle; I just asked my father, who is a physician, today, and he told me that this indeed is true, describing an area that covers the eyes (and brows), the nose and the upper lip. (Actually more like a square). He further told me that it leads to cerebral sinus venous trombosis.

If you want to know what this cavernous sinus is, Wikipedia is detailed on that (and does mention the facial area, too).

Cavernous sinus thrombosis (CST) is the formation of a blood clot within the cavernous sinus, a cavity at the base of the brain which drains deoxygenated blood from the brain back to the heart. The cause is usually from a spreading infection in the nose, sinuses, ears, or teeth. Staphylococcus aureus and Streptococcus are often the associated bacteria.

Anyway I'd still count this is just as anecdotal evidence and he never had a case of this to happen.

But with the help of the correct term I was able to dig up some results and there actually seem to be some cases, first were described even around 1852 (I assume that the facial cosmetics industry wasn't as powerful back then, but what do I know?)

Infections of the "dangerous area" of the face were first mentioned in the literature in 1852, when Ludlow described six cases, three of them fatal. The first patient, a moderately stout man of 20, scratched the head off a pimple on his lip six days before admission to the hospital and died 36 hours after admission, in spite of the use of compresses, sedatives and leeches. […] In the first case autopsy revealed a purulent exudate in the lungs and kidneys […] In neither case was the head examined.

Another paper cites the same work but goes further:

From 1922, eighteen cases of primary infection of the nose, lips and face were admitted to the wards of Lebanon Hospital […] Of the six patient with severe symptoms who dies, four were males and six females, varying from twenty-four to fifty years of age. [...] In all six there was a positive staphylococcus aureaus blood culture, with the subsequent cultures becoming progressively worse, with thrombosis of the cavernous sinus terminating in death.

So I think I would say: Yes, popping pimples in the face can be deadly. Although cases are not very common and while reading across the lines treatment has improved, it might still be dangerous.

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    I am sorry, but how do these reports substantiate the claim? You are just saying that a staphylococcus infection can cause death. No problems there. Now, you need to prove that scratching a pimple in a particular region of the face, and only there, can cause a fatal Staphylococcus infection. The 1852 report just proves that someone who died of an infection has scratched a pimple six days before. How many other things did he do? Did he have other conditions? And, moreover, how many other times people had scratched pimples and did not die? – nico Sep 16 '12 at 13:47
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    @Informaficker: no, it's not the same thing. You cite the report of 1 person. That is at best anecdotal, while the link between cigarette and cancer is well established. Of course not all the smokers get cancer and not everyone that has cancer is a smoker, but there are stats out there for that. So, let me rephrase the question in a better way: is the number of people that had such infection after scratching a pimple statistically higher than those who had the same infection for other reasons? – nico Sep 16 '12 at 17:39
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    I agree with the user @nico. We have to sepparate these two claims before answering: 1st: Is the so-called "Danger zone" real? 2nd: Does the popping of a pimple guarantees a deep infection, so much that it will spread to the venous sinuses and cause an embolism (and death)? What you've managed so far, Informaficker, is to somehow validate the 1st part, but I think there's still some work to do on 2nd part. – luisgonzalez Sep 30 '12 at 12:29
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    The question asks if this can happen. I answered the theory why this could happen and I gave references to some documented cases where it happened. – Baarn Sep 30 '12 at 12:49
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    What you are addressing as the 2nd part of the question can easily be disproved by popping a pimple and surviving it. I think most of us are living examples that it isn't really dangerous to do so. – Baarn Sep 30 '12 at 12:50
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Yes. It's unlikely to happen in the same way that most wounds don't lead to devastating infections. However, places where it might be more dangerous to get an infection include the 'danger triangle' of the face and the area around the eyes, simply because of more direct venous connections to the brain. I'm a physician, and we didn't call this the 'dangerous triangle' in med school. It was simply part of the many things one learns in anatomy class. And yes, it is mentioned in textbooks. Yes, I've known a dermatologist whose patient developed meningitis, and where the most likely source of infection was presumed by everybody on the team to have come from the popped pimple on the bridge of her nose, right between her eyes. However, yes, it is pretty rare, and one is NOT likely to develop meningitis from just popping a pimple.

A example of such a textbook is Gray's Anatomy for Students (2010), by Drake, Vogl and Mitchell.

All these venous channels have interconnections with the intracranial cavernous sinus through emissary veins that connect intracranial with extracranial veins. There are no valves in the facial vein or any other venous channels in the head, so blood can move in any direction. Because of the interconnections between the veins, infections of the face, primarily above the mouth (i.e., the “danger area”) should be handled with great care to prevent the dissemination of infectious material in an intracranial direction.

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    I have to add to my comment above, though, that no, they couldn't be definitively sure it had come from the pimple. It was simply the most logical conclusion at that time given that a) Staph can live on the skin, and b) the anatomy was favorable, so this was the most likely route of entry. – K.k. Apr 15 '13 at 5:39
  • There are valves in the head veins: ncbi.nlm.nih.gov/pubmed/21287973 – Duckisaduckisaduck May 23 '14 at 19:51
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Here's a link to the National Institutes of Health's Library of Medicine, and a paper from The Annals of Surgery, July 1937, which briefly recounts three deaths attributed to disturbing a facial pimple or boil within the "deadly triangle". Discussion is had regarding the mechanism of infection, but the author states, on page three, "To this important physiologic factor is added an external factor, trauma, which is present in at least 90 percent of all such cases."

Maes U. INFECTIONS OF THE DANGEROUS AREAS OF THE FACE: THEIR PATHOLOGY AND TREATMENT. Annals of Surgery. 1937;106(1):1-10.

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    Anything more recent? I'd think we know a bit more about microbiology, epidemiology and infections now than we did 80 years ago. – PoloHoleSet Sep 21 '16 at 16:01
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Not sure about brain infection, but, popping pimples can result in death. S. aureus is a common skin bacteria that produces a variety of ailments from rashes, pimples, and boils to more serious bouts of food poisoning. It is responsible for a variety of diseases, and about 20 percent of the general population carries S. aureus on the skin and many more carry it in the nose. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3238331/

Popping the lesions can introduce the bacteria into the body and result in death from Toxic Shock Syndrome (I personally gave care to a patient with TSS from a pimple) http://www.sciencedirect.com/science/article/pii/S1027811715001457

or the infamous flesh eating bacterial condition called necrotizing fasciitis: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4841958/ http://www2.isu.edu/radsci/papers13/12_2013.pdf

Or the now all too common MRSA may be introduced into your blood stream: http://loyce2008.free.fr/Microbiologie/Skin%20soft%20tissue%20infection%20MRSA%20NEJM.pdf

Concerning the 'triangle of death' yes it can occur according to Wikipedia but the article doesn't give the incidence related to acne. https://en.wikipedia.org/wiki/Cavernous_sinus_thrombosis

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