Patients are worried about the 'triangle of death.' Here’s what you should know about this area of the face
Key Takeaways
A TikTok video by Brooke Hyland of the show Dance Moms has brought attention to the dermatological term “triangle of death.”
The “triangle of death” refers to an area on the face extending from the nasal bridge to the corners of the mouth. It is extra sensitive, given its prominent retrograde vessels leading to the brain. Experts say the popping pimples in this area is risky and can lead to cavernous sinus thrombosis, meningitis, or even stroke.
Experts say patients should avoid picking bumps or pimples in this area and consult a dermatologist for care instead.
In a video posted to TikTok, Brooke Hyland of the show Dance Moms says she woke up unable to open her eye due to a hard, painful, unpoppable pimple on the top, inner corner of her eyelid. She asked her followers initially if she should apply ice or see a doctor.
In response, her followers flooded the comment section, telling her she should seek medical attention because the pimple was close to the “triangle of death,” or “death triangle.”
Like Hyland, you may not have heard of this term before. However, David Li, MD, MBA, a board-certified dermatologist at Boston Derm Advocate, says the "triangle of death" is a common term in dermatology and plastic surgery.
While the moniker may sound a bit dramatic, there’s some merit to it: “It refers to an area on the face extending from the nasal bridge to the oral commissures, or corners of the mouth, which is known for its high sensitivity due to the prominent retrograde vessels leading to the brain,” Dr. Li says.
This area of the face is prone to serious infections, Dr. Li explains: “For this reason, it’s dangerous to pop or pick acne in the triangle." Dr. Li also says unsanitary injections, piercings, or trauma could “carry a risk of spreading to the brain, potentially leading to serious conditions like cavernous sinus thrombosis, meningitis, or even strokes.”[]
According to The Journal of Emergency Medicine, the triangle of death was involved with the hospitalization of a 52-year-old man presenting with high-grade fever, chills, and cranial nerve deficits. Doctors found that the man had had a furuncle (or pus-filled boil) on the tip of his nose, which had extended into the upper lip area. The authors say complete right ophthalmoplegia due to right lateral and medial rectus palsy was found, and he was prescribed antibiotics, which healed the lesion even though a fever persisted.[][]
The Indian Journal of Otolaryngology and Head and Neck Surgery says the relationship between furuncles and health concerns was observed as early as 1852, citing a 1937 study finding that 61% of cavernous sinus thrombosis cases developed as a result of furuncles on the upper part of the face.[]
“Due to the special nature of the blood supply to the human nose and surrounding area, it is possible (although very rare) for retrograde infections from the nasal area to spread to the brain causing cavernous sinus thrombosis, meningitis or brain abscess,” the authors write. “This is possible because of venous communication (via the ophthalmic veins) between the facial vein and the cavernous sinus.”
In another case report, a previously healthy 20-month-old boy had flu-like syndrome before having suddenly developed paranasal hemolytic streptococcus gangrene in the danger triangle of the face area, which led to progressive thrombocytopenia and hepatitis. The infant developed streptococcal toxic shock syndrome (STSS) and was treated with aggressive antibiotics.[]
The authors note that prompt diagnosis and aggressive, timely treatment completely resolved the issue within a month. In this case, the authors said that hemolytic streptococcus gangrene in the danger triangle of the face is too lethal to operate.
Dr. Li says—as the case reports show—that antibiotics have significantly reduced the death rate due to infections this year, but that it’s important that physicians and patients know the risk and use caution in this area of the face.
According to Phyllis Pobee, MD, a family physician specializing in cosmetic medicine and medical director at Skinbosses and RenewRx in Shelburne, Ontario, patients should be encouraged to avoid popping any pimple in the triangle of death area. “Instead, maintain a clean skincare routine, use warm compresses to reduce inflammation, and if the pimple is particularly troublesome, consult a dermatologist. They can safely treat the area and prevent any serious complications.”