Hypertrichosis

Hypertrichosis Definition

Hypertrichosis is a condition wherein there is excessive hair growth and thickness that is not considered normal for a person’s age, sex, body area, and ethnicity.

Hypertrichosis Vs. Hirsutism

Hypertrichosis and hirsutism both exhibit excessive hair growth. However, in hypertrichosis, excessive hair growth is not confined on androgenic areas or bodily surfaces that rely on androgen for hair to grow. Basically, hirsutism involves overproduction of androgen [1]. The term hirsutism therefore is only applicable to women who have hair distribution like that of the men [2]. Hypertrichosis, on the other hand, involves a whole lot of factors which will be discussed further in the next sections of this article.

Causes of Hypertrichosis

Congenital/hereditary Generalized Hypertrichosis

1. Coffin-Sirls syndrome
2. Lawrence-Selp syndrome
3. Donahue syndrome (leprechaunism)
4. Hyperkinetic circulatory disorder
5. Wiedermann syndrome
6. Reticular ichthyosiform erythroderma
7. Congenital hypertrichosis lanuginose
8. Brachmann-de Lange syndrome
9. Gorlin syndrome
10. Hurler syndrome
11. Hemihypertrophy
12. Schinzel-Gledion syndrome
13. Jalili syndrome
14. Generalized smooth muscle hamartoma
15. Gingival fibromatosis
16. Barbar-Say syndrome
17. Buntinex syndrome
18. Cantu generalized hypertrichosis
19. Pivnick syndrome

Acquired Generalized Hypertrichosis

1. Juvenile dermatomyositis
2. CNS-related problems or traumas
3. Drugs: minoxidil, diazoxide, phenytoin, cyclosporine, psoralen, UVA light, steroids, streptomycin, acetazolamide, oxadiazolopyrimidine, fenoterol
4. POEMS (polyneuropathy, organomegaly, endocrinopathy, M protein, skin changes)
5. Hypothyroidism
6. Porphyria
7. Acrodynia
8. Malabsorption syndrome
9. Acquired hypertrichosis lanuginosa

Congenital Localized Hypertrichosis

1. Hemimaxillofacial dysplasia
2. Congenital smooth muscle hamartoma
3. Hairy pinna
4. Hairy elbows
5. Becker nevus
6. Nevoid hypertrichosis
7. Trichomegaly
8. Congenital pigmented nevus
9. Familial cervical hypertrichosis
10. Stiff skin syndrome
11. Anterior cervical hypertrichosis
12. Winchester syndrome
13. Neuroectodermal abnormality

Acquired Localized Hypertrichosis

1. Osteosclerotic myeloma
2. Undercasts
3. Kala-azar (eyelashes) [3]
4. Melorheostotic scleroderma
5. Post morphea
6. Chicken pox
7. Periphery of burnt area
8. Reflex sympathetic dystrophy
9. Drugs: interferon, sodium tetradecyl sulphate, topical latanoprost, topical minoxidil
10. Immunization sites
11. Chronic osteomyelitis
12. Denervated area
13. Repeated trauma
14. Human immunodeficiency virus (HIV)
15. Lymphedema
16. Congenital arteriovenous fistula
17. Topical irritants

 Causes Source: Fitzpatrick’s Dermatology in General Medicine 7th edition

 

Types and Pictures of Hypertrichosis

I.    Generalized Hypertrichosis

A. Congenital Hypertrichosis Lanuginosa

 

Picture 1:  Congenital Hypertrichosis Lanuginosa
Photo Courtesy of Brooke Army Medical Teaching File.
Image Source: Andrews’ Diseases of the Skin: Clinical Dermatology 10th edition

This is a rare condition involving a fully penetrant X-linked dominant trait. The whole body, except the palms of the hand and soles of the feet, is covered with excessive hair 2-10 cm long. Many cases of congenital hypertrichosis lanuginosa involve the mother taking various substances during pregnancy. These substances that may have contributed to the child’s condition include alcohol, hydantoin, minoxidil, and valproate [3].

The unfortunate patients are the ones who are being featured in circus shows as “monkey men” or “dog-faced men” [1]. Old folks may believe that they are cursed but no, they’re not. They have hypertrichosis.

B. Acquired Hypertrichosis Lanuginosa

Acquired Hypertrichosis Lanuginosa Photos

Picture 2:  Acquired Generalized Hypertrichosis Lanuginosa
Image Source: Fitzpatrick’s Dermatology of General Medicine 7th edition

Picture 3:  Acquired Generalized Hypertrichosis indicating internal malignancy.
Photo Courtesy of Brooke Army Medical Teaching File.
Image Source: Andrews’ Diseases of the Skin: Clinical Dermatology 10th edition

Acquired hypertrichosis lanuginosa is a paraneoplastic dermatosis [2].  The appearance of hair overgrowth all over the body that has not been there before must not be overlooked. This may be a sign of having a malignancy in the present or in the future.
It could also be a lot of things. Acquired generalized hypertrichosis could be associated with hepatitis or porphyria. It can also be adverse effects of some drugs listed on the Causes section of this article [4].

Picture 4:  Cyclosporine-Related Hypertrichosis

Image Source: Fitzpatrick’s Dermatology of General Medicine 7th edition

C. Universal Hypertrichosis

Picture 5:  Universal Hypertrichosis in the back of a man
Image Source: Hair Growth and Disorders

Universal hypertrichosis is seen in areas which normally have hairs on them. However, in this case, hair growth and thickness are exaggerated. There is no pathological concern regarding this condition [2].

D. Prepubertal Hypertrichosis

This is the normal hair distribution found in infants and children. This is outgrown with puberty [2].

II.    Localized Hypertrichosis

A. Congenital Localized Hypertrichosis

Hypertrichosis cubiti is a condition wherein an infant has excessive lanugo (fine downy hair) on his elbows. This measures up to 10 cm. Some cases show that short stature and developmental abnormalities are associated with it [3].

Congenital Localized Hypertrichosis Photos

Picture 6:  Fawn Tail in Spina Bifida

Photo Source: Hair Growth and Disorders

“Fawn tail” is usually seen in patients with spina bifida occulta, neurofibroma, meningioma, diastematomelia, myelomeningocele, or lipomyelomeningocele. These happen because of the failure of vertebral raphe to close [2].

Picture 7: Hypertrichosis over the sacral midline is a sign of spinal dysraphism.
Photo Courtesy of Brooke Army Medical Teaching File.
Photo Source: Andrews’ Diseases of the Skin: Clinical Dermatology 10th edition

B. Acquired Localized Hypertrichosis

Anything that causes irritation or trauma can develop hypertrichosis on the area of the body which is being overused, abused, or exhausted. Examples were enumerated in the Causes section of this article.

Acquired Localized Hypertrichosis Photos

Picture 8: This is an example of hypertrichosis acquired when a plastic splint was placed on the forearm for a month.
Photo Source: Hair Growth and Disorders

Picture 9:  An example of a “bufaloid neck” of Spanish “costaleros” that bear “pasos” on their backs every Holy Week.
Photo Source: Hair Growth and Disorders

Treatment for Hypertrichosis

Temporary Hair Removal

• Trimming
• Bleaching
• Shaving
• Plucking
• Depilatory creams
• Eflornithine: It is an ornithine carboxylase inhibitor that is proven to remove facial hair growth in women. This is often applied over the affected area after laser therapy to make it more effective [4].
• Potentially Permanent Hair Removal
• Electroepilation or electrolysis: This involves the insertion of needles into the hair follicles and then current travels through these needles in order to reach the dermal papillae [5].
• Laser hair removal: The types of lasers to be used depend on the skin type of the patient. For dark complexion, long pulse Nd:YAG laser is proven to be the best [3]. 694-1064 nm wavelengths are also recommended for patients who have fair complexion with dark-colored hairs [6].

References

1. Otto Braun-Falco, Dermatology, Springer 2000, pp 1112
2. Peytavi UB et al, Hair Growth and Disorders, Springer 2008
3. James WD et al, Andrews’ Diseases of the Skin: Clinical Dermatology 10th edition, Elsevier 2006, pp 769-770
4. Wolff K et al, Fitzpatrick’s Dermatology in General Medicine 7th edition, McGraw-Hill 2008, pp 775-777
5. Electrolysis For The Treatment Of Hypertrichosis And Hirsutism accessed on http://www.skintherapyletter.com/1999/4.6/2.html
6. Hall BJ & Hall JC, Sauer’s Manual of Skin Diseases, Lippincott Williams & Wilkins 2010, p 339