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Hypertrichosis may be congenital or acquired. Congenital generalized types are very rare and have been described as being inherited and occurring sporadically. Some of the "dog-faced" or "monkey-faced" persons in circus sideshows probably had this condition. A host of rare syndromes may have congenital hypertrichosis as a feature. Congenital localized hypertrichosis has been noted on the margin of the pinna in infants of diabetic mothers. Localized congenital hypertrichosis over the base of the spine ("faun tail") may be a marker of underlying spinal abnormalities.

Acquired hypertrichosis may be generalized or localized also. Acquired hypertrichosis lanuginosa ("malignant down") is a rare but striking cutaneous manifestation of internal malignancy. Fairly generalized hypertrichosis may occur in patients with diverse diseases such as porphyrias, dermatomyositis, anorexia nervosa, mercury intoxication, insulin-resistant diabetes, Cushing's disease, hypothyroidism, postencephalitis, multiple sclerosis, head injuries, and POEMS syndrome [polyneuropathy (sensorimotor), organomegaly (heart, spleen, kidneys), endocrinopathy, skin changes (hyperpigmentation, hypertrichosis, hyperhidrosis, thick skin, clubbed nails, leukorychia, angiomas)]. Drugs can induce hypertrichosis (see T.a.bie 2Z-1). Localized acquired hypertrichosis may occur over areas of inflammatory dermatoses such as venous stasis or areas occluded by a plaster cast or may be a feature of a benign nevus. Acquired hypertrichosis of ears and eyebrows as well as long eyelashes may be seen in patients with acquired immunodeficiency syndrome (AIDS). Hairy pinnae may be an ethnic variant seen in men from India, or it may be a feature of

XYY syndrome. Hairy elbows may be familial and unassociated with other problems. TREATMENT

Treatment of excessive hair growth may include shaving, depilatories, bleaching, plucking, waxing (really a sort of plucking), laser, and electrolysis. Electrolysis is the only permanent method of hair removal and usually requires more than one treatment of each hair follicle that one wishes to ablate. It should be done by someone trained in the technique. Inquiry should be made whether the operator uses sterile needles to deliver the electrical current to the hair follicle to prevent any possibility of accidental transmission of blood-borne disease.

Shaving, contrary to popular belief, does not increase the amount of hair that regrows. Chemical depilatories and bleaching agents are available over the counter and frequently prove effective but may be irritating to the skin of some persons. Waxing and plucking have the advantage of removing the unwanted hair for longer periods without retreatment than does shaving. Plucking, waxing, and electrolysis may cause a folliculitis. Electrolysis also can cause scarring when done incorrectly, and is expensive. Laser treatment may offer some help.

1. Shaving the hair does not increase growth.

2. Frequent shampooing does not damage normal scalp hair.

3. Dandruff does not cause hair loss unless the scalp becomes severely secondarily infected.

4. Excessive brushing of the hair can cause hair breakage and hair loss.

5. Hair length is genetically predetermined by the duration of the anagen phase.

alopecia (hair loss)

(see Fig 27-1, Fig 27-2, Fig 27-3, Fig 27-4, Fig 27-5 and Fig 27-6)

Hypertrichosis Lanuginosa

Figure 27-1. Hair loss (alopecia) due to alopecia areata. (Neutrogena Skin Care Institute)

Shaving Someone With Hypertrichosis

Figure 27-2. Hair loss (alopecia) due to alopecia areata totalis. (Neutrogena Skin Care Institute)

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