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Table of Contents
Year : 2020  |  Volume : 38  |  Issue : 1  |  Page : 61-62

Incidental extraction of susuk: The unspoken talisman and a literature review

Department of Dermatology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan

Date of Web Publication27-Feb-2020

Correspondence Address:
Hsin-Yi Lin
Department of Dermatology, Taipei Medical University-Shuang Ho Hospital, No. 291, Zhongzheng Road, New Taipei City 23561
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ds.ds_32_19

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How to cite this article:
Liu D, Weng TY, Lee WR, Chin SY, Lin HY. Incidental extraction of susuk: The unspoken talisman and a literature review. Dermatol Sin 2020;38:61-2

How to cite this URL:
Liu D, Weng TY, Lee WR, Chin SY, Lin HY. Incidental extraction of susuk: The unspoken talisman and a literature review. Dermatol Sin [serial online] 2020 [cited 2022 Dec 6];38:61-2. Available from: https://www.dermsinica.org/text.asp?2020/38/1/61/279602

Dear Editor,

Susuks, also known as charm needles, are talismans made by precious metals such as gold and silver into pin/needle shape. These talismans are placed by shaman into the receiver's subcutaneous tissue, mainly over the facial area.

The patient is a 45-year-old Indonesian female who came to our outpatient department with a chief complaint of a pruritic forehead lesion for years. There are no history of trauma and no medical history relevant to the current medical condition. Physical examination reveals a firm nodular-plaque over the central forehead above the glabella region. The lesion is one by one centimeter in size with bluish-gray discoloration and some dotted pigmentation within the lesion [Figure 1]a. Initial clinical differential diagnosis includes prurigo nodularis, irritated dermatofibroma, irritated button osteoma, giant sebaceous hyperplasia, granulomatous lesions, and seborrheic keratosis.
Figure 1: (a) Clinical image of the lesion. (b) Foreign body is approximately 7 mm in length. Excised lesion is adjacent to the foreign body. (c) Histopathology finding under hematoxylin and eosin stain showing features of prurigo nodularis (H and E, ×4)

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Surgical excision of the lesion was performed, and during the procedure, we incidentally discovered a metal object buried in the subcutaneous fat at the lateral border of the lesion. The foreign-body was removed and identified as a gold pin-like metal, measuring approximately 7 mm in length [Figure 1]b. The patient was reassured during the operation that no trauma of any sort could have resulted in this foreign body to penetrate her forehead. Both the lesion and foreign body were sent for pathology, the histopathology finding includes marked hyperparakeratosis, hypergranulosis, psoriasiform hyperplasia, solar elastosis, and superficial perivascular infiltrates of mononuclear cells. There is one well-circumscribed hyalinized fibrotic area in the mid dermis surrounded by hypertrophic nerve bundles and dense lymphoid cells [Figure 1]c. Pathology finding is compatible with prurigo nodularis. The investigation was performed to identify the metal object, search of the literature using keywords, including “gold needle,” “Indonesia,” and “forehead,” was used. This metal object was later identified as a susuk needle.

The mystic practice of susuk is commonly performed among Southeast Asian, especially Malayan, Thai, Singaporeans, Indonesians, Bruneian, and Muslim females.[1] Most susuk receivers do not speak about their hidden talismans, that being said, these talismans are being discovered with increasing frequency due to common image study used in nowadays medical practice.[2] This behavior was in consistent with our patient, who refuses to discuss further about this talisman.

A recent study that looked into the constituents of susuk found that >80% were composed of gold and have included considerable amounts of copper, silver, aluminum, iron, and silicon.[3] Copper is necessary to maintain the stiffness of the talisman, and the high percentage of gold explains its high biocompatibility in human tissue.

Susuk has various supposed purposes; it is believed to have the power to improve the strength, health and physical appearance of the receiver. It can also cure ailments, protect the receiver from harm, cast a spell on another person to achieve a more loving relationship, and achieve a successful career.[4]

The practice of susuk in strictly forbidden in Islamic society.[5] Although restricted by Islamic religion, this ritual is still widely performed, probably due to the affordable cost of susuk and its believed mysterious power. Previously published studies suggest the range of one to fifteen United States dollar (USD) per needle implantation.[3] Depending on the performer, there will be different restrictions that the receiver needs to keep in mind in order for susuk to retain its effect. Most of the restrictions were prohibition from certain foods such as drumsticks (Moringa oleifera) and lady finger banana (Musa acuminata).[3],[6]

Perhaps, due to the embarrassment of relying on rituals or banned by certain religion, these talismans remain hidden until the receiver past away. Controversies exist regarding the removal of susuk before death, some believe that the talisman should be removed before death in order for the receiver to leave the world peacefully,[4],[7] some believe the vice versa.[1]

Data provided by the Ministry of Labor suggests approximately 700,000 migrant workers in Taiwan with the majority originating from Southeast Asia. Along with the need of migrant workers, different culture, and religion was also introduced into Taiwan. It is important to keep in mind that during the practice of dermatology, we look at not only the clinical presentation of the lesion but also evaluate the cultural and religious background of our patient.

Susuk is usually inserted deep into the subcutaneous tissue;[8] the anatomical location of susuk implantation is closely related to procedures carried out by dermatologists. We were amazingly surprised by the fact that during the literature review, no articles related to susuk were published in a dermatology journal and we think it is of importance for dermatologists to recognize the existence of this cultural practice.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understand that her names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Nambiar P, Ibrahim N, Tandjung YR, Shanmuhasuntharam P. Susuks (charm needles) in the craniofacial region. Oral Radiol 2008;24:10-5.  Back to cited text no. 1
Arishiya Thapasum F, Mohammed F. Susuk – Black magic exposed “white” by dental radiographs. J Clin Diagn Res 2014;8:ZD03-4.  Back to cited text no. 2
Balasundram S, Yee SC, Shanmuhasuntharam P. Susuk: Charm needles in orofacial soft tissues. Open J Stomatol 2013;3:155.  Back to cited text no. 3
Teo SK. A woman with hidden charm needles. J R Coll Phys Edinb 2006;36:211-2.  Back to cited text no. 4
Nor MM, Yushar A, Razali M, Rahman RA, Ramli R. Incidental radiological findings of susuk in the orofacial region. Dentomaxillofac Radiol 2006;35:473-4.  Back to cited text no. 5
Sharif MO, Horner K, Chadwick S, West C. Susuk charms? A case report. Br Dent J 2013;215:13-5.  Back to cited text no. 6
Pothiawala S. Incidental radiological finding of charm needles. Hong Kong J Emerg Med 2012;19:141-3.  Back to cited text no. 7
Varghese E, Samson RS, Nagraj SK, Chandrappa PR. Susuk or charm needle: A strange object detected on orthodontic diagnostic radiographs. BMJ Case Rep 2017;2017. pii: bcr-2017-222497.  Back to cited text no. 8


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