Treatment of Hypertrichosis

Cosmetic treatment is usually undertaken, particularly for congenital hypertrichosis, where, unlike in many acquired hypertrichosis cases, the underlying problems cannot be cured. There is no single treatment for all hypertrichoses and patients. The site, nature and amount of growth, and the patients and their preferences are taken into account when deciding the most appropriate treatment method.

The common treatments are shaving, plucking, epilation, depilation, electrolysis and laser removal. Laser and electrolysis treatment approaches hold the promise of being permanent hair removal approaches. Other treatments are temporary and have to be repeated.

Cosmetic Hair Removal Treatment:

In most cases, excess hair growth caused by hypertrichosis is not due to any underlying medical problems. However, they produce severe emotional problems where cosmetic treatment is the only viable therapy. Where there is an underlying problem, it is a necessary part of the overall treatment regimen.

Several treatment options are available which differ in their efficacy, comfort levels and cost. The treatment mode depends on the site, nature of growth and the patient. In most cases, more than one treatment is needed.

Cosmetic treatment methods:

Shaving is the simplest and cheapest but leaves hair roots intact and therefore hair growth unaffected. Side effects are minimal but in some ethnic groups, folliculitis may occur. Women are averse to it because of its masculine nature.

Plucking and epilation involves removing the hair shaft and bulb. It is done singly by tweezers in plucking. In epilation, waxing is used to uproot a large number of hairs in one operation. This treatment is one of the least expensive and the cosmetic effect lasts for 4 to 8 weeks, but it is slow and not practical for large areas. Plucking is done in the anagen phase because if done in other phases it encourages further hair growth.

Side effects are sometimes caused by the waxing material and include burns due to hot wax, folliculitis, hyperpigmentation and scarring. Children have poor tolerance to plucking and epilation since degree of comfort is low.

Depilation uses variants of thioglycolates, used in perming, to dissolve the hair shaft, sparing the hair bulb. The cosmetic effect produced is excellent and lasts for about two weeks.

The thioglycolate variants are used in an alkali solution to get a pH concentration, which dissolves the hair without damaging the skin. For removing coarser terminal hairs, sulfides of strontium, barium and calcium are used. The bad odor of hydrogen sulfide gas, produced by sulfides is masked by fragrances.

Side effects include irritant dermatitis in 1% to 5% cases. Occasionally sulfides cause an allergic dermatitis. To prevent systemic absorption, depilatories for children should be used in only small localized areas.

Laser Hair Removal Treatment:

Excessive hair disorders are a great embarrassment and a source of emotional stress to affected individuals. Cosmetic treatment, which improves the appearance, is essential to lessen the pains of these unfortunate people.

Laser hair removal systems are currently widely used for long-term hair removal. The need to have a fast and non-invasive treatment method led to the development of this treatment.

All laser treatment systems use the principle of selective photothermolysis where a selected chromophore is targeted by the laser to produce the heat that destroys the follicle. Therefore deep penetrating wavelengths in the range of 600 – 1100 nano meters (nm) are used. Care is taken to limit skin damage by restricting damage to the target area. This is done by ensuring enough laser absorption by the target and using a pulse rate shorter than the thermal relaxation time of the target.

The systems differ in the parameters like wavelength, pulse duration, fluence, spot size and repetition rate and in the cooling system used. The cooling device reduces heat conduction limiting skin damage and pain. The selection of these parameters is important for getting the ideal laser for an individual.

All laser treatment systems are more or less equally effective attaining on an average 20% long-term hair reduction with every treatment in 80% of cases. This shows that multiple treatments give better results. Likelihood of long-term hair reduction bears a strong correlation to hair color. Dark hair on fair skin responds better to treatment than blond, red or white hair. The re-growing hair is sometimes thinner and lighter improving the overall appearance.

Electrolysis – Hair Removal Treatment:

Excessive hair disorder, such as, hypertrichosis and hirsutism are a source of great embarrassment and emotional stress to the affected individuals. Cosmetic treatment, which improves the appearance, is essential to lessen the pains of these unfortunate people.

Of all the cosmetic treatment techniques available today, electrolysis is the only cosmetic treatment, which has the potential to become a permanent hair remover. It is a kind of electrosurgical depilation where the hairs are electrochemically destroyed using electric current. Electrolysis treatment is carried out with a very sophisticated machine, called the depilator, which is operated by highly skilled personnel. This apparatus is used to send a regulated and controlled electric current to the hair follicle.

Today, by broad consent, the term electrolysis is used to describe the general process of electrochemical destruction of hair. Under this broad term there are three available techniques to carry out the process. These are galvanic electrolysis, thermolysis and a blend method. The aim of all three techniques is to destroy the hair follicle without causing any serious scarring.

Eflornithine Hair Removal Treatment:

Excess hair growth disorders, such as, hypertrichosis are a common problem seldom discussed in primary care setting. Unwanted hairs are a source of great embarrassment and distress to those affected and can badly disturb their social life. Hair removal treatments are therefore an important part of the total treatment regimen.

There are several treatment options all varying in their efficacy, degree of discomfort and cost. They are shaving, plucking, depilation, epilation, electrolysis and laser treatment. A single treatment will not work on all body sites and patients. The treatment selected depends on the body site, nature of hair growth, the patients and cost. In most cases, more than one method of treatment is needed.

Side effects:

Side effects are mainly local and include acne, stinging, burning and erythema. They are more common in patients treated with eflornithine than in those given placebo treatment. Percutaneous absorption of eflornithine, which causes these side effects, is 4 percent. But it is less than 1 percent when the 15 percent eflornthine cream is applied twice a day on a shaved 50 sq.cm. area of skin under the chin. The no-effect dose is presently not known. However, these side effects generally resolve without treatment or discontinuation of eflornithine.

The use of eflornithine in the generalized forms of hypertrichosis is limited because no data is available regarding the maximum area it can be applied on. Safety and efficacy of eflornithine (vaniqa) for various types of hypertrichosis and on a wider patient population, especially children, has not been established. Eflornithine is a pregnancy category C medication, and it is not known whether it is excreted in human breast milk.

Types of Hypertrichosis

Congenital Hypertrichosis Lanuginosa (CHL):

This is a very rare inherited disorder with about 50 cases reported worldwide since the Middle Ages. In earlier times, the patients were considered an exotic "species", much prized for their curiosity value. At birth, the long and silky lanugo hairs, normally shed before or shortly after birth, remain on the infant’s entire body, sparing only the palms and soles. The growth is typically more on the face, ears and shoulders. In the documented cases, no reduction in hair growth was seen later in life.

A variant of generalized congenital hypertrichosis is congenital hypertrichosis lanuginosa (CHL) where the hair is fine, blond, lanugo type hair. The patients are normal except for abnormal dental eruptions. The hypertrichosis may persist, decrease or increase with age. Brachmann de Lange is a variant of CHL where the growth is less generalized and the infants have a particular appearance due to associated mental and growth retardation. Hair shedding begins in the first year of life starting at the trunk and progressing to the limbs.

Generalized Acquired Hypertrichosis:

Acquired generalized hypertrichosis is commonly caused by drugs like phenytoin, cyclosporine A, and minoxidil among others. Hypertrichosis disappears once the drug intake is discontinued. The time taken depends on the growth site and is usually 3 months to a year. Less commonly, hypertrichosis is caused by head injuries, malnutrition, starvation and AIDS.

Generalized hypertrichosis is also caused by a class of disorders known as porphyries, which are often triggered by exposure to chemicals of which hexachlorobenzene is a common example. Excess growth tends to disappear once exposure ceases.

Localized Congenital Hypertrichosis:

Localized hypertrichosis here is restricted to a single or just a few sites such as the back, elbows, ears and nevi. Excess hair on the back can be a sign of underlying neural abnormalities or spinal defects. Therefore, early daignosis treatment is critically important.

Excess hairs on the elbows are termed hypertrichosis cubiti. The growth becomes more prominent in early childhood and usually disappears partially or fully in adolescence.

Hairy pinna is excessive hair on the ears and is more common among older men. In babies, it can be associated with a diabetic mother. AIDS patients and diabetic patients can also have excess hair on their ears.

Hairy nevi are the most common hypertrichosis among babies. Additionally the nevi are often pigmented. It is usually not anindicator of any underlying abnormality.

Localized Acquired Hypertrichosis:

These are transient hypertrichoses caused by a variety of injuries like trauma, irritation or inflammation, which transform vellus hairs into coarse terminal hairs as a repsonse to the local injury.

Becker’s nevus is a common disorder where sunburn or other injuries to the shoulder cause excess hair growth and pigmentation of the site. It heals with time and is more common among men. The application of plaster casts for broken bones often causes excess hair growth underneath the cast. AIDS is known to cause excess hair growth of the eyelashes, a disorder called trichomegaly.

Naevoid Hypertrichosis:

This is an unusual form of hypertrichosis where a solitary circumscribed area of terminal hair growth occurs. It is not usually associated with any other diseases, except if it arises as a faun-tail on the lower back, when it may indicate underlying spina bifida. Naevoid hypertrichosis can occur at birth or appear later in life. An example of naevoid circumscribed hypertrichosis is the presence of a solitary and very bushy eyebrow.

What is hypertrichosis?

Hypertrichosis is excessive hair growth over and above the normal for the age, sex and race of an individual, in contrast to hirsutism, which is excess hair growth in women following a male distribution pattern. Hypertrichosis can develop all over the body or can be isolated to small patches.

Hypertrichosis may be congenital (present at birth) or acquired (arises later in life).

Hypertrichosis is really a blanket medical term that refers to excessive body hair. It can actually be generalized, symmetrically affecting most of the torso and limbs, or localized, affecting only a small area or location. The term is, however, usually reserved to refer to very above-average amount of normal body hair that is unwanted.

Nearly all the skin of the human body – with the exception of the palms and soles of the feet – are covered with hairs or hair follicles. The density of the hairs per square centimeter, the thickness of the hairs, color of the hairs, speed of hair growth, and qualities such as kinkiness tend to vary from one part of the body to another and also from one person to another. But in hypertrichosis all of the various controllers for the regulation of that genetic information are these lacking, damaged or none existent. Furthermore, there are a few subcategories of hypertrichosis.

Congenital hypertrichosis terminalis is the variation most people associate with the condition. This version involves all over body hair growth. Interestingly this form of hypertrichosis is almost always associated with gingival hyperplasia – meaning these ‘savage and vicious’ wolf men often posses very few teeth. Furthermore persons afflicted are said to have soft, smooth and gentle voices. Naevoid hypertrichosis is an unusual form of hypertrichosis where a solitary circumscribed area of hair growth occurs. It is not usually associated with any other diseases, except if it arises as a faun-tail on the lower back, then it may indicate underlying spina bifida. Naevoid hypertrichosis can occur at birth or appear later in life and symptoms can range from hairy tufted ears, tails, a heavy unibrow or excessive beard growth in females and males alike. Finally, Congenital hypertrichosis lanuginosa is a very rare form of hypertrichosis with only about 50 cases reported worldwide since the Middle Ages.

The condition is characterized by excessive hair growth on a child at birth. Most of the body is covered with lanugo hair, which is a fine, soft and silky hair that covers the fetus and which is usually shed at around 8 months gestation and replaced with fine vellus hair. In this condition the hair continues to grow throughout life. The initial shock of a fur covered infant, however, is luckily a very rare occurrence.

The exact cause of hypertrichosis is unknown. But it is believe to be a genetic disorder that is inherited or occurs as a result of spontaneous mutation.

Types of hair involved:

To understand hypertrichosis, it is necessary to be familiar with the three types of hairs that grow on humans.

Lanugo hairs: These are long, silky and light colored hairs which normally grow on embryos in the womb and are shed anytime from the seventh month of pregnancy to the first several months after birth.

Vellus hairs: These are short non-pigmented hairs, which after birth replace the lanugo hairs on all parts of the body except the scalp and eyebrows of a baby.

Terminal hairs are coarser and thicker hairs and usually pigmented. These hair follicles cover the scalp and eyebrows and, later with the onset of puberty, start to grow in the groin and underarm areas.

Generalized hypertrichosis can involve all three types of hair while localized hypertrichosis usually involves conversion of vellus hairs into terminal hairs.