|Year : 1993 | Volume
| Issue : 3 | Page : 140-142
Acquired hypertrichosis lanuginosa
Pramod Kumar, Jerome Pinto, Kamath
Source of Support: None, Conflict of Interest: None
Acquired hypertirichosis lanuginose developed rapidly in a patient with no detectable malignancy. Soft, fine, downy hair growth was noticed on the face, ears, limbs and trunk. Bilaterally symmetrical vitiliginous macules were present on the ear and preauricular region. This case is reported because of its rarity, absence of any detectable malignancy and development of vitiligo, which to our knowledge has not been reported earlier.
Keywords: Acquired hypertrichosis lanuginosa, Vitiligo, Malignancy
|How to cite this article:|
Kumar P, Pinto J, Kamath. Acquired hypertrichosis lanuginosa. Indian J Dermatol Venereol Leprol 1993;59:140-2
| Introduction|| |
Acquired hypertrichosis lanuginosa  is a rare disorder of which only 55 cases have been reported. It is characterized by excessive growth of fine, downy, hypopigmented lanugo-like hair on the face, trunk and limbs. The hair may grow rapidly upto several cm in a few weeks. They may or may not replace hairs which were normally present in the scalp, beard, axillae and pubis. Palms and soles are spared. This condition may be associated with other features , like glossitis, disturbed taste, diarrhoea, ichthyotic changes, follicular keratosis and pigmentation of the skin and oral mucosa. Some cases with acanthosis nigricans have also occurred. Malignant tumours , of the GIT, lung, bladder, breast and uterus have been known to precipitate such hair growth; lymphomas and leukaemias are also reported to occur.  In most of the cases the malignancy is detectable but in some only postmortem examination confirmed the existence of a carcinoma. Acquired hypertrichosis lanuginosa may precede the diagnosis of a neoplasm by several years.  This condition should be differentiated from congenital hypertrichosis lanuginosa and iatrogenic hypertrichosis. , The former presents usually at birth and persists for life, and the latter occurs with use of drugs such as corticosteroids, phenytoin, diazoxide, streptomycin, thiacetazone,  minoxidil, psoralen and penicillamine, which is reversible on withdrawing the drug.
| Case Report|| |
A 38-year-old man developed excessive hair growth with rapid onset on his body of 2 months duration associated with lightening of colour of the existing scalp and body hair. He had lost weight and experienced severe burning pain in the tongue with altered taste one month preceding the growth of hair. He was a smoker and an alcoholic. There was no history of ingestion of any medicaments prior to the onset of the complaints. History suggestive of photosensitivity was absent. Family members were not affected. On cutaneous examination excessive, downy hair growth was seen on his forehead, ears, trunk and limbs sparing palms and soles [Figure - 1]. The hairs were hypo as well as depigmented and varying from 0.5 cm to 4 cm in length. Hairs on scalp, face, axillae and pubis were hypopigmented. In addition bilaterally symmetrical vitiligo macules were seen over the lobules of the ears and preauricular areas [Figure - 1]. These macules had developed along with the presenting complaints. The tongue was erythematous, swollen and bald with multiple fissures. Extensive hyperpigmented macules were present on the oral mucosa [Figure - 2].
His pulse rate, blood pressure were normal and systemic examination did not reveal any findings. Routine blood, urine and stool examinations were normal. ESP, was 35 mm at 1 hour. Liver function tests were within normal limits. ELISA for HIV was negative. Chest X-ray was normal, Gastroendoscopy examination was suggestive of oesophagitis, antral gastritis and duodenitis. Ultrasound scanning of abdomen and pelvis did not reveal any abnormal growth. Patient was treated with antacid and discharged on request. Six weeks later the patient reported back to the hospital with hoarseness of voice and cough of sudden onset. ENT examination and bronchoscopy did not reveal any growth. Bronchial lavage cytology did not show any malignant cells. Repeat chest X-ray and barium meal follow through X-ray revealed no tumour. He was administered antibiotics, NSAIDS and antihistamines. Two weeks later his voice improved, cough was reduced. He, was discharged and advised to come for further investigations at regular monthly intervals to detect the possible clinical appearance of a malignancy.
| Comments|| |
The case mentioned here had rapid onset of excessive hair growth on his face, trunk and limbs a month after he developed burning pain and fissuring of the tongue. When hypertrichosis is associated with oral pigmentation, glossitis, oesophagitis and gastroduodenal ulceration, it points towards a underlying gastrin producing tumour.  An apudoma  can also induce hypertrichosis. However, in this patient routine tests, radiological examination, gastroendoscopy and ultrasound scanning did not reveal any underlying malignancy. Some cases of acquired hypertrichosis lanuginosa may precede the development of a detectable tumour by several years' and probably this case belongs to such a group. However, further regular follow-up will be needed to detect the growth. This case report also highlights the development of bilateral, vitiliginous macules on the ears and preauricular region, appearing with the onset of the presenting complaints.
The association of acquired hypertrichosis lanuginosa and vitiligo has not been reported in earlier reviews. , We propose to add vitiligo to the list of associated cutaneous features of acquired hypertrichosis lanuginosa.
| Acknowledgements|| |
The authors are indebted to Dr Anand Kini, Department of Surgery and Dr Naveen Chandra Shetty, Department of Radiodiagnosis, Kasturba Medical College, Mangalore, for their help.
| References|| |
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[Figure - 1], [Figure - 2]