American Journal of Clinical Dermatology

, Volume 3, Issue 9, pp 617–627 | Cite as

Causes and Management of Hypertrichosis

  • Ralph M. Trüeb
Therapy in Practice


Hypertrichosis is the term used for the growth of hair on any part of the body in excess of the amount usually present in persons of the same age, race, and sex, excluding androgen-induced hair growth. In its generalized and circumscribed forms, hypertrichosis may either be an isolated finding, or be associated with other abnormalities. Therefore, accurate classification of hypertrichosis is mandatory. Excessive hair may cause cosmetic embarrassment, resulting in a significant emotional burden, particularly if extensive. Treatment options are limited, and the results of therapy not always satisfactory. Patients should, therefore, be adequately advised of the available treatment modalities for temporary or permanent hair removal. No single method of hair removal is appropriate for all body locations or patients, and the one adopted will depend on the character, area, and amount of hair growth, as well as on the age of the patient, and their personal preference. The currently available treatment methods include cosmetic procedures (bleaching, trimming, shaving, plucking, waxing, chemical depilatories, and electrosurgical epilation), and hair removal using light sources and lasers. Laser-assisted hair removal is the most efficient method of long-term hair removal currently available. The lack of comparative data make it difficult to choose the most effective system, however, although the color contrast between epidermis and the hair shaft will determine the type of laser to favor. A novel treatment for slowing excessive hair growth is topical eflornithine, an inhibitor of the enzyme ornithine decarboxylase present in hair follicles that is important in hair growth. In general, treatment of hypertrichosis is more satisfactory for patients with localized involvement, than for those with generalized hypertrichosis.


Hair Follicle Hair Growth Ruby Laser Hair Removal Hypertrichosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



No sources of funding were used to assist in the preparation of this manuscript. The author has no conflicts of interest that are directly relevant to the content of this manuscript.


  1. 1.
    Barth J.H. Hypertrichosis. In: Rook A., Dawber R., editors. Diseases of the hair and scalp. Oxford: Blackwell Scientific Publications, 1991: 256Google Scholar
  2. 2.
    Fenton D.A. Hypertrichosis. Semin Dermatol 1985; 4: 58–67Google Scholar
  3. 3.
    Vashi R.A., Mancini A.J., Paller A.S. Primary generalized and localized hypertrichosis in children. Arch Dermatol 2001; 137: 877–84PubMedGoogle Scholar
  4. 4.
    Sinclair R.D., Banfield C.C., Dawber R.P.R. Handbook of diseases of the hair and scalp. Oxford: Blackwell Science, 1999: 40ffGoogle Scholar
  5. 5.
    McKusick V.A. Mendelian inheritance in man: catalogs of autosomal dominant, autosomal recessive, and x-linked phenotypes. 11th ed. Baltimore (MD): Johns Hopkins Press, 1994Google Scholar
  6. 6.
    Baumeister F.A.M., Egger J., Schildhauer M.T., et al. Ambras syndrome: delineation of a unique hypertrichosis universalis congenital and association with a balanced pericentric inversion (8) (p11.2; q22). Clin Genet 1993; 44: 121–8PubMedCrossRefGoogle Scholar
  7. 7.
    Macias-Flores M.A., Garcia-Cruz D., Rivera H., et al. A new form of hypertrichosis inherited as an X-linked dominant trait. Hum Genet 1984; 66: 66–70PubMedCrossRefGoogle Scholar
  8. 8.
    Barth J.H., Wilkinson J.D., Dawber R.P.R. Prepubertal hypertrichosis: normal or abnormal? Arch Dis Child 1988; 63: 666–8PubMedCrossRefGoogle Scholar
  9. 9.
    Prose N.S., Abson K.G., Scher R.K. Disorders of the nails and hair associated with human immunodeficiency virus infection. Int J Dermatol 1992; 31: 453–7PubMedCrossRefGoogle Scholar
  10. 10.
    Fretzin D.F. Malignant down. Arch Dermatol 1967; 95: 294–7PubMedCrossRefGoogle Scholar
  11. 11.
    Perniciario C. POEMS syndrome. Semin Dermatol 1995; 14: 162–5CrossRefGoogle Scholar
  12. 12.
    Beighton P. Familial hypertrichosis cubiti: hairy elbows syndrome. J Med Genet 1970; 7: 158–60PubMedCrossRefGoogle Scholar
  13. 13.
    Di Lernia V., Happle R. Hypertrichosis cubiti: disappearance of an hereditary trait with age. Eur J Dermatol 1997; 7: 257–8Google Scholar
  14. 14.
    Commens C., Rogers M., Kan A. Heterotopic brain tissue presenting as bald cysts with a collar of hypertrophic hair: the ‘hair collar’ sign. Arch Dermatol 1989; 125: 1253–6PubMedCrossRefGoogle Scholar
  15. 15.
    Drolet B.A., Clowry Jr L., McTigue M.K., et al. The hair collar sign: marker for cranial dysraphism. Pediatrics 1995; 96: 309–13PubMedGoogle Scholar
  16. 16.
    Bascom J. Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment. Surgery 1980; 87: 567–72PubMedGoogle Scholar
  17. 17.
    Liew S.H. Unwanted body hair and its removal: a review. Dermatol Surg 1999; 25: 431–9PubMedCrossRefGoogle Scholar
  18. 18.
    Draelos Z.K. Cosmetics in dermatology. New York: Churchill Livingstone, 1990: 99Google Scholar
  19. 19.
    Dawber R. Facial and body hair. In: Baran R., Maibach H.I., editors. Cosmetic dermatology. Baltimore (MD): Williams & Wilkins, 1994: 139Google Scholar
  20. 20.
    Wagner R.F. Physical methods for the management of hirsutism. Cutis 1990; 45: 19–26Google Scholar
  21. 21.
    Lynfield Y.L., MacWilliams P. Shaving and hair growth. J Invest Dermatol 1970; 55: 170–2PubMedCrossRefGoogle Scholar
  22. 22.
    Partridge J.W. Congenital hypertrichosis lanuginose: neonatal shaving. Arch Dis Child 1987; 62: 623–5PubMedCrossRefGoogle Scholar
  23. 23.
    Camacho F. Hypertrichosis. In: Camacho F., Montagna W., editors. Trichology: diseases of the pilosebaceous follicle. Madrid: Aula Medica, 1997Google Scholar
  24. 24.
    Gudat W., Hassoun G. Epilation. Deutsche Dermatol 1992; 3: 354–7Google Scholar
  25. 25.
    Scott M.J., Scott III M.J., Scott H.M. Epilation. Cutis 1990; 46: 216–7PubMedGoogle Scholar
  26. 26.
    Yamasaki R., Dekio S., Jidio J. Allergic contact dermatitis to ammonium thioglycolate [letter]. Contact Dermatitis 1984; 11: 255PubMedCrossRefGoogle Scholar
  27. 27.
    Smith R.S., Shear G. Corneal alkali burns arising from accidental instillation of a hair straightener. Am J Ophthalmol 1975; 79: 602–5PubMedGoogle Scholar
  28. 28.
    Freeman M.V., Draize J.H., Smith P.K. Some aspects of the absorption, distribution and excretion of sodium thioglycolate. J Pharm Exp Ther 1956; 118: 296–303Google Scholar
  29. 29.
    Hobbs E.R., Ratz J.L., James B. Electrosurgical epilation. Dermatol Clin 1985; 5: 437–44Google Scholar
  30. 30.
    Richards R.N., Meharg G.E. Electrolysis: observation from 13 years and 140000 hours of experience. J Am Acad Dermatol 1995; 33: 662–6PubMedCrossRefGoogle Scholar
  31. 31.
    Dawber R. Facial and body hair. In: Baran R., Maibach H.L., editors. Cosmetic dermatology. Baltimore (MD): Lippincott, Williams & Wilkins, 1994Google Scholar
  32. 32.
    Ross E.V., Ladin Z., Kreindel M., et al. Theoretical considerations in laser hair removal. Dermatol Clin 1999; 17: 333–55PubMedGoogle Scholar
  33. 33.
    Dierickx C., Alora M.B., Dover J.S. A clinical overview of hair removal using lasers and light sources. Dermatol Clin 1999; 17: 357–66PubMedGoogle Scholar
  34. 34.
    Olsen E.A. Methods of hair removal. J Am Acad Dermatol 1999; 40: 143–55PubMedCrossRefGoogle Scholar
  35. 35.
    Liew S.H. Laser hair removal: guidelines for management. Am J Clin Dermatol 2002; 3 (2): 107–15PubMedCrossRefGoogle Scholar
  36. 36.
    Grossman M.C., Dierickx C., Farinelli W., et al. Damage to hair follicles by normal-mode ruby laser irradiation. J Am Acad Dermatol 1996; 35: 889–94PubMedCrossRefGoogle Scholar
  37. 37.
    Gault D.T., Grobbelaar A.O., Grover R., et al. The removal of unwanted hair using a ruby laser. Br J Plast Surg 1999; 52: 173–7PubMedCrossRefGoogle Scholar
  38. 38.
    Bjerring P., Zacharia H., Lybecker H., et al. Evaluation of the free-running ruby laser for hair removal: a retrospective study. Acta Derm Venereol (Stockh) 1998; 78: 48–51CrossRefGoogle Scholar
  39. 39.
    Lask G., Elman M., Slatkine M., et al. Laser-assisted hair removal by selective photothermolysis: preliminary results. Dermatol Surg 1997; 23: 737–9PubMedCrossRefGoogle Scholar
  40. 40.
    Williams R., Havoonjian H., Isagholian K., et al. A clinical study of hair removal using the long-pulsed ruby laser. Dermatol Surg 1998; 24: 837–42PubMedCrossRefGoogle Scholar
  41. 41.
    Williams R.M., Christian M.M., Moy R.L. Hair removal using the long-pulsed ruby laser. Dermatol Clin 1999; 17: 367–72PubMedCrossRefGoogle Scholar
  42. 42.
    Polderman M.C.A., Pavel S., Le Cessie S., et al. Efficacy, tolerability, and safety of a long-pulsed ruby laser system in the removal of unwanted hair. Dermatol Surg 2000; 26: 240–3PubMedCrossRefGoogle Scholar
  43. 43.
    Wimmershoff M.B., Scherer K., Lorenz S., et al. Hair removal using a 5 msec long-pulsed ruby laser. Dermatol Surg 2000; 26: 205–9PubMedCrossRefGoogle Scholar
  44. 44.
    Liew S.H., Grobbelaar A.O., Gault D.T., et al. Ruby laser-assisted hair removal: repeated treatments and clinical efficacy. Eur J Plast Surg 2000; 23: 121–6CrossRefGoogle Scholar
  45. 45.
    Finkel B., Eliezri Y.D., Waldman A., et al. Pulsed alexandrite laser technology for noninvasive hair removal. J Clin Laser Med Surg 1997; 15: 225–9PubMedGoogle Scholar
  46. 46.
    Connolly C.S., Paolini L. Study reveals successful removal of unwanted hair with LPIR laser. Cosmet Dermatol 1997; 10: 38–40Google Scholar
  47. 47.
    Garcia C., Alamoudi H., Nakib M., et al. Alexandrite laser hair removal is safe for Fitzpatrick skin types IV-VI. Dermatol Surg 2000; 26: 130–4PubMedCrossRefGoogle Scholar
  48. 48.
    McDaniel D.H., Lord J., Ash K., et al. Laser hair removal: a review and report on the use of the long-pulsed alexandrite laser for hair reduction of the upper lip, leg, back, and bikini region. Dermatol Surg 1999; 25: 425–30PubMedCrossRefGoogle Scholar
  49. 49.
    Goldberg D.J., Ahkami R. Evaluation comparing multiple treatments with a 2 msec and 10 msec Alexandrite laser for hair removal. Lasers Surg Med 1999; 25: 223–8PubMedCrossRefGoogle Scholar
  50. 50.
    Lou W.W., Quintana A.T., Geronemus R.G., et al. Prospective study of hair reduction with diode laser (800 nm) with long-term follow-up. Dermatol Surg 2000; 26: 428–32PubMedCrossRefGoogle Scholar
  51. 51.
    Campos V.B., Dierickx C.C., Farinelli W.A., et al. Hair removal with an 800 nm pulsed diode lader. J Am Acad Dermatol 2000; 43: 442–7PubMedCrossRefGoogle Scholar
  52. 52.
    Goldberg D.J., Littler C.M., Wheeland R.G. Topical suspension-assisted Q-switched Nd: YAG laser hair removal. Dermatol Surg 1997; 23: 741–5PubMedCrossRefGoogle Scholar
  53. 53.
    Nanni C.A., Alster T.S. Optimizing treatment parameters for hair removal using a topical carbon-based solution and 1064-nm Q-switched neodymium: YAG laser energy. Arch Dermatol 1997; 133: 1546–9PubMedCrossRefGoogle Scholar
  54. 54.
    Liew S.H., Gault D.T. Laser-assisted hair removal at 1064 nm without added chromophore. Br J Plast Surg 1999; 5: 109–13Google Scholar
  55. 55.
    Goldberg D.J., Samady J.A. Evaluation of a long-pulse Q-switched Nd: YAG laser for hair removal. Dermatol Surg 2000; 26: 109–13PubMedCrossRefGoogle Scholar
  56. 56.
    Gold M.H., Bell M.W., Foster T.D., et al. Long-term epilation using the epilight broad band, intense pulsed light hair removal system. Dermatol Surg 1997; 23: 909–13PubMedCrossRefGoogle Scholar
  57. 57.
    Fitzpatrick R.F., Goldman M.P., Sriprachyaanut S. Hair removal utilizing the ESC Epilight device [abstract]. Am Soc Laser Med Surg 1997; 9: 36Google Scholar
  58. 58.
    Weiss R.A., Weiss M.A., Marwaha S., et al. Hair removal with a non-coherent filtered flash-lamp pulsed light source device [abstract]. Am Soc Laser Med Surg 1998; 10: 40Google Scholar
  59. 59.
    Smith S.R., Tse Y., Adit S.K., et al. Long-term results of hair photo-epilation [letter]. Lasers Surg Med 1998; 10: 43Google Scholar
  60. 60.
    Schroeter C.A., Raulin C., Thürlimann W., et al. Hair removal in 40 hirsute women with an intense laser-like light source. Eur J Dermatol 1999; 9: 374–9PubMedGoogle Scholar
  61. 61.
    Barman Balfour J.A., McCellan K. Topical eflornithine. Am J Clin Dermatol 2001; 2: 197–201CrossRefGoogle Scholar
  62. 62.
    Grossman M.C. What is new in cutaneous laser research. Dermatol Clin 1997; 15: 1–8PubMedGoogle Scholar
  63. 63.
    Hebert J.M., Rosenquist T., Gotz J., et al. FGF5 asa regulator of the hair growth cycle: evidence from targeted and spontaneous mutations. Cell 1994; 78: 1017–25PubMedCrossRefGoogle Scholar
  64. 64.
    Pierce G.F., Yanagihara D., Klopchin K., et al. Stimulation of all epithelial elements during skin regeneration by keratinocyte growth factor. J Exp Med 1994; 179: 831–40PubMedCrossRefGoogle Scholar
  65. 65.
    Guo L., Degenstein L., Fuchs E. Keratinocyte growth factor is required for hair development but not for wound healing. Genes Dev 1996; 10: 165–75PubMedCrossRefGoogle Scholar
  66. 66.
    Ahmad W., Faiyaz ul Haque M., Brancolini V., et al. Alopecia universalis associated with a mutation in the human hairless gene. Science 1998; 279: 720–4PubMedCrossRefGoogle Scholar
  67. 67.
    Li L., Hoffman R.M. The feasibility of targeted selective gene therapy of the hair follicle. Nat Med 1995; 1: 705–6PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 2002

Authors and Affiliations

  1. 1.Department of DermatologyUniversity Hospital of ZurichZurichSwitzerland

Personalised recommendations