Causes and Management of Hypertrichosis

Abstract

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.

This is a preview of subscription content, access via your institution.

Table I
Table II
Table III

Notes

  1. 1.

    Use of tradenames is for product identification only and does not imply endorsement.

References

  1. 1.

    Barth J.H. Hypertrichosis. In: Rook A., Dawber R., editors. Diseases of the hair and scalp. Oxford: Blackwell Scientific Publications, 1991: 256

    Google Scholar 

  2. 2.

    Fenton D.A. Hypertrichosis. Semin Dermatol 1985; 4: 58–67

    Google Scholar 

  3. 3.

    Vashi R.A., Mancini A.J., Paller A.S. Primary generalized and localized hypertrichosis in children. Arch Dermatol 2001; 137: 877–84

    PubMed  CAS  Google 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: 40ff

    Google 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, 1994

    Google 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: 121–8

    PubMed  Article  CAS  Google 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: 66–70

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Barth J.H., Wilkinson J.D., Dawber R.P.R. Prepubertal hypertrichosis: normal or abnormal? Arch Dis Child 1988; 63: 666–8

    PubMed  Article  CAS  Google 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: 453–7

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Fretzin D.F. Malignant down. Arch Dermatol 1967; 95: 294–7

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Perniciario C. POEMS syndrome. Semin Dermatol 1995; 14: 162–5

    Article  Google Scholar 

  12. 12.

    Beighton P. Familial hypertrichosis cubiti: hairy elbows syndrome. J Med Genet 1970; 7: 158–60

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Di Lernia V., Happle R. Hypertrichosis cubiti: disappearance of an hereditary trait with age. Eur J Dermatol 1997; 7: 257–8

    Google 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: 1253–6

    PubMed  Article  CAS  Google 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: 309–13

    PubMed  CAS  Google Scholar 

  16. 16.

    Bascom J. Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment. Surgery 1980; 87: 567–72

    PubMed  CAS  Google Scholar 

  17. 17.

    Liew S.H. Unwanted body hair and its removal: a review. Dermatol Surg 1999; 25: 431–9

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Draelos Z.K. Cosmetics in dermatology. New York: Churchill Livingstone, 1990: 99

    Google Scholar 

  19. 19.

    Dawber R. Facial and body hair. In: Baran R., Maibach H.I., editors. Cosmetic dermatology. Baltimore (MD): Williams & Wilkins, 1994: 139

  20. 20.

    Wagner R.F. Physical methods for the management of hirsutism. Cutis 1990; 45: 19–26

    Google Scholar 

  21. 21.

    Lynfield Y.L., MacWilliams P. Shaving and hair growth. J Invest Dermatol 1970; 55: 170–2

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Partridge J.W. Congenital hypertrichosis lanuginose: neonatal shaving. Arch Dis Child 1987; 62: 623–5

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Camacho F. Hypertrichosis. In: Camacho F., Montagna W., editors. Trichology: diseases of the pilosebaceous follicle. Madrid: Aula Medica, 1997

  24. 24.

    Gudat W., Hassoun G. Epilation. Deutsche Dermatol 1992; 3: 354–7

    Google Scholar 

  25. 25.

    Scott M.J., Scott III M.J., Scott H.M. Epilation. Cutis 1990; 46: 216–7

    PubMed  Google Scholar 

  26. 26.

    Yamasaki R., Dekio S., Jidio J. Allergic contact dermatitis to ammonium thioglycolate [letter]. Contact Dermatitis 1984; 11: 255

    PubMed  Article  CAS  Google Scholar 

  27. 27.

    Smith R.S., Shear G. Corneal alkali burns arising from accidental instillation of a hair straightener. Am J Ophthalmol 1975; 79: 602–5

    PubMed  CAS  Google 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: 296–303

    CAS  Google Scholar 

  29. 29.

    Hobbs E.R., Ratz J.L., James B. Electrosurgical epilation. Dermatol Clin 1985; 5: 437–44

    Google 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: 662–6

    PubMed  Article  CAS  Google Scholar 

  31. 31.

    Dawber R. Facial and body hair. In: Baran R., Maibach H.L., editors. Cosmetic dermatology. Baltimore (MD): Lippincott, Williams & Wilkins, 1994

  32. 32.

    Ross E.V., Ladin Z., Kreindel M., et al. Theoretical considerations in laser hair removal. Dermatol Clin 1999; 17: 333–55

    PubMed  CAS  Google 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: 357–66

    PubMed  CAS  Google Scholar 

  34. 34.

    Olsen E.A. Methods of hair removal. J Am Acad Dermatol 1999; 40: 143–55

    PubMed  Article  CAS  Google Scholar 

  35. 35.

    Liew S.H. Laser hair removal: guidelines for management. Am J Clin Dermatol 2002; 3 (2): 107–15

    PubMed  Article  Google 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: 889–94

    PubMed  Article  CAS  Google 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: 173–7

    PubMed  Article  CAS  Google 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: 48–51

    Article  CAS  Google Scholar 

  39. 39.

    Lask G., Elman M., Slatkine M., et al. Laser-assisted hair removal by selective photothermolysis: preliminary results. Dermatol Surg 1997; 23: 737–9

    PubMed  Article  CAS  Google 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: 837–42

    PubMed  Article  CAS  Google Scholar 

  41. 41.

    Williams R.M., Christian M.M., Moy R.L. Hair removal using the long-pulsed ruby laser. Dermatol Clin 1999; 17: 367–72

    PubMed  Article  CAS  Google 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: 240–3

    PubMed  Article  CAS  Google 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: 205–9

    PubMed  Article  CAS  Google 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: 121–6

    Article  Google 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: 225–9

    PubMed  CAS  Google Scholar 

  46. 46.

    Connolly C.S., Paolini L. Study reveals successful removal of unwanted hair with LPIR laser. Cosmet Dermatol 1997; 10: 38–40

    Google 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: 130–4

    PubMed  Article  CAS  Google 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: 425–30

    PubMed  Article  CAS  Google 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: 223–8

    PubMed  Article  CAS  Google 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: 428–32

    PubMed  Article  CAS  Google 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: 442–7

    PubMed  Article  CAS  Google 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: 741–5

    PubMed  Article  CAS  Google 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: 1546–9

    PubMed  Article  CAS  Google 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: 109–13

    Google 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: 109–13

    PubMed  Article  CAS  Google 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: 909–13

    PubMed  Article  CAS  Google 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: 36

    Google 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: 40

    Google 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: 43

    Google 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: 374–9

    PubMed  CAS  Google Scholar 

  61. 61.

    Barman Balfour J.A., McCellan K. Topical eflornithine. Am J Clin Dermatol 2001; 2: 197–201

    Article  Google Scholar 

  62. 62.

    Grossman M.C. What is new in cutaneous laser research. Dermatol Clin 1997; 15: 1–8

    PubMed  CAS  Google 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: 1017–25

    PubMed  Article  CAS  Google 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: 831–40

    PubMed  Article  CAS  Google 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: 165–75

    PubMed  Article  CAS  Google 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: 720–4

    PubMed  Article  CAS  Google Scholar 

  67. 67.

    Li L., Hoffman R.M. The feasibility of targeted selective gene therapy of the hair follicle. Nat Med 1995; 1: 705–6

    PubMed  Article  Google Scholar 

Download references

Acknowledgments

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.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Dr Ralph M. Trüeb.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Trüeb, R.M. Causes and Management of Hypertrichosis. Am J Clin Dermatol 3, 617–627 (2002). https://doi.org/10.2165/00128071-200203090-00004

Download citation

Keywords

  • Hair Follicle
  • Hair Growth
  • Ruby Laser
  • Hair Removal
  • Hypertrichosis