Hypertrichosis: Description, Causes and Risk Factors:Growth of hair in excess of the normal.Hypertrichosis refers to the excessive hair growth that occurs beyond the accepted limits of normal for a particular age, race, and sex. In contrast, hirsutism refers to the excessive hair in women in anatomic sites that would be characteristic of male secondary sexual distribution.HypertrichosisCauses and Risk Factors:Certain systemic diseases like porphyria can manifest hypertrichosis in 63% of patients, involving primarily the temples, cheeks, eyebrows, and hairline but may involve the trunk and arms/legs. Porphyria cutanea tarda is the most common type of porphyria that shows as a bullous skin eruption in sun-exposed areas that arises due to a deficiency in the enzyme uroporphyrinogen decarboxylase. Another illness, POEMS syndrome, has also been associated with it. Children with hypothyroidism have been found in several case reports to manifest it over the back and arms/legs that resolved with therapy. Children with intestinal malabsorption like celiac disease and a woman with anorexia nervosa have been found to have diffuse lanugo-like hypertrichosis.
  • Various types of physical trauma may cause a temporary it in the affected area. Repeat trauma or irritation may cause localized change from vellus to terminal hairs. In addition, prolonged occlusion of a limb by a cast can also generate hypertrichosis in the limb. Reflex sympathetic dystrophy has also been associated with localized it.
  • Congenital hypertrichosis lanuginosa refers to a condition in which hypertrichosis occurs as a generalized and confluent presentation of hair across the body except in regions where hair is not normally found at all (glans penis, labia minora, lips, tips of fingers, palms and soles). The hair is usually silvery gray to blond in color and grows away from the midline. The condition may be associated with dental problems, infantile genatalia, and growth and mental retardation but in most cases does not carry these associations. A subtype of congenital hypertrichosis lanuginosa include Ambras syndrome (or it universalis congenita) in which there is persistent, confluent long hair (4 to 10 inches in length) especially over the shoulders and face. Unusual facial features may be present under the long hair, and accessory nipples may also be found. Another type of congenital hypertrichosis lanuginosa is found in a Mexican family (congenital generalized hypertrichosis) in which the abnormal hair is much shorter than in Ambras syndrome and curly versus straight. Females tend to show a patchy hypertrichosis compared with men who have a more confluent presentation.
  • Acquired generalized hypertrichosis may rarely be derived from lanugo hair but more commonly vellus hair. In 1865, Turner first noted the association between lanugo hypertrichosis and malignancy (acquired hypertrichosis lanuginosa or “malignant down”), which can be a late manifestation of widely disseminated cancer. Occasionally, the abnormal lanugo hair may be the presenting sign of cancer and predate the diagnosis of cancer even by several years. Many cases of acquired hypertrichosis lanuginosa have been associated with tongue abnormalities like a burning or painful tongue, thickened papillae, abnormal pigmentation, and deep furrows. When tongue findings are seen to accompany generalized lanugo hair, an active investigation into the possibility of cancer should be undertaken. Unlike in many congenital syndromes, the hair is pale or colorless without significant length (in most cases). Regression of this abnormal lanugo hair has been seen in patients following surgical removal of cancer.
  • Drugs have also been associated with hypertrichosis.
  • Anterior cervical hypertrichosis describes excessive hair that occurs over the adam's apple of the neck usually between birth to 3 years of age and can be associated with Turner's syndrome.
Congenital forms of hypertrichosis are rare. Only 50 cases of congenital hypertrichosis lanuginosa have been recorded since the Middle Ages, and fewer than 100 cases of congenital generalized hypertrichosis have been documented in scientific publications and by the media. Acquired hypertrichosis and hirsutism are more common.Symptoms:The primary characteristic of all forms of hypertrichosis is excess hair. Hair in it is usually longer than expected and may consist of any hair type (lanugo, vellus, or terminal).Patterned forms of hypertrichosis cause hair growth in patterns. Generalized forms of hypertrichosis result in hair growth over the entire body. Circumscribed and localized forms lead to hair growth restricted to a certain area.Diagnosis:Hypertrichosis is diagnosed clinically via the occurrence of hair in excess of what is expected for age, sex, and ethnicity in areas that are not androgen-sensitive.The excess can be in the form of excessive length or density and may consist of any hair type (lanugo, vellus, or terminal).The doctor will usually do a history and physical on an individual who has hypertrichosis to determine if the condition is congenital or was acquired in some way. Since acquired hypertrichosis may have different causes, the doctor would try to get to the source of the symptoms of the acquired version of this condition. The doctor may order certain lab tests to rule out any underlying conditions that could be causing the excess hairiness.Treatment:There is no cure for any congenital forms of hypertrichosis. The treatment for acquired hypertrichosis is based on attempting to address the underlying cause. Acquired forms of hypertrichosis have a variety of sources, and are usually treated by removing the factor causing hypertrichosis, e.g. a medication with undesired side-effects. All hypertrichosis, congenital or acquired, can be reduced through hair removal. The treatment options may include:Shaving and plucking may help correct it. However, shaving provides only a temporary solution and may be negatively associated with a male ritual. Plucking is impractical for a large area and can also change telogen to anagen hairs making the area grow even more actively not to mention local irritation and discomfort associated with plucking.
  • Depilation involves a painless chemical dissolution of hair by leaving a chemical depilatory on the skin for 3 to 15 minutes and wiping the jelly-like mass of dissolved hair off with a spatula. The main drawback is the potential for an irritant dermatitis, which can be particularly acute in the area around the mouth. Depilatories should not be used more often than every other day owing to the potential for irritation, and the area should be thoroughly rinsed and topical emollients or 1% hydrocortisone cream applied to minimize irritation further.
  • Electrolysis can offer a permanent form of epilation. Use of galvanic current directed at the hair follicle produces NaOH and H2 gas with the NaOH causing destruction to the hair follicle. The damaged hair is then easily extracted from the follicular tract with forceps. Regrowth has been noted to be between 15 to 50% depending on the quality of the technician and equipment.
  • Laser hair removal is undertaken using a wavelength that targets the pigment in the hair shaft while minimizing damage to the surrounding skin pigment. The ideal laser should have a pulse duration that can be between the thermal relaxation time (TRT) of the skin and the TRT of the hair follicle. The ruby laser (694 nm), the alexandrite laser (755 nm), and the semiconductor diode laser (800 nm) are used to target the melanin, whereas the Nd:YAG laser targets a topically applied preparation.
  • The FDA has approved laser hair removal devices to provide “permanent hair reduction,” meaning the lasting reduction of treated hairs for a period greater than one complete hair cycle. With the ruby and diode lasers, most of the damage occurs at the level of the bulge and less at the bulb/dermal papilla of the hair follicle. The laser hair removal device provides hair reduction via both reductions in the number of terminal hairs and the conversion of terminal hairs into vellus hairs.
NOTE: The above information is for processing purposes. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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