HYPERTRICHOSIS

The medical term for excessive hair growth that affect both men and women is hypertrichosis . It can be generalized, symmetrically affecting most of the torso and limbs, or localized, affecting an area of skin. The hair does not usually cover the eye area, hands or the feet. It may be mild or severe. In most cases, the term is used to refer to an above-average amount of normal body hair that is unwanted and is an aspect of human variability. It is also known as Werewolf syndrome which comes from the characteristics of a mythological werewolf of which the person is completely covered in hair or fur

DISTRIBUTION OF HAIRBody hair-Nearly all the skin of the human body except palms of hands and soles of feet is covered with hairs. The density of the hairs (in hair follicles per square centimeter) thickness of the hairs, color of the hairs, speed of hair growth, and qualities such as kinkiness, vary from one part of the body to another, and from one person to another. All of these features have strong genetic determinants, as demonstrated by the heritability of these qualities.

Vellus hair- It is the hair on the rest of the body which has not been stimulated and transformed by sex hormones. Even children are covered with fine vellus hair, varying in density, length, and heaviness, but usually white due to a lack of pigment.It is evident that a slight genetic variation, or variation in hormone signalling, could turn this vellus hair into full thickness hair. Pigmented thick hairs may grow from a scar, presumably because in the process of growing a scar, the vellus hair follice is triggered into to growing as a thicker pigmented hair follicle.Also, thick, pigmented hair is noted to grow on the skin near the site of a spinal injury. It is the ordinarily vellus hair follicle responding to a signal even though there is no scar, callous, or other change to the skin.

Duck down-With yet another minor genetic variation, a single hair follicle may start producing a bunch of hairs, which remain in a bundle at the base, but split apart if it grows long enough, and this resembles duck down. This is most common in male facial hair.

Androgenic hair- It is the hair that greatly increases in heaviness and rate of growth with puberty. The hair follicles on much of the body respond to androgens (primarily testosterone and its derivatives). Generally, the rate of hair growth increases and the heaviness of the hairs increases in direct proportion to the androgen levels. However, different areas respond with different sensitivities. As puberty progresses, the sequence of appearance of sexual (androgenic) hair reflects the gradations of androgen sensitivity. The pubic area is most sensitive, and heavier hair usually grows there first in response to androgens. The following regions also respond to androgens, in order of decreasing sensitivity: axillary and perianal areas, sideburns, above the upper lip, periareolar areas, chin and beard areas, arms and legs, chest, shoulders, buttocks, back, and abdomen.It is the hair in these areas that appears earlier or grows to excess in disorders of excess androgen (e.g., precocious puberty, late-onset congenital adrenal hyperplasia, and polycystic ovary syndrome).

TYPES OF HYPERTRICHOSIS

1. Vellus hair and hypertrichosis When the unwanted or excessive hair occurs in other places, and especially in other sequences of appearance, it is rarely due to a disorder of androgen excess. For example, it is not unusual for a young girl to be taken to a pediatric endocrinologist because her mother is distressed by the heaviness of the girl's arm and leg hair, but this condition is never due to a disorder of androgen excess if pubic hair has not appeared.

2. Most hypertrichosis is genetic, but a small number of unusual systemic disorders can sometimes increase vellus hair. Some drugs (e.g., diazoxide, diphenylhydantoin, and minoxidil) and toxins (e.g., mercury) can induce generalized hair growth as well. Unusual hypertrichosis can also be caused by untreated infection, or by malnutrition. For this reason, it is an occasional sign of anorexia nervosa.

3. Severe hypertrichosisSevere hypertrichosis is quite rare, almost certainly due to unknown genetic defects, and can result in excessive or animal-like hair on both face and body.

4. Localized hypertrichosisIn some cases an area of skin can react to repeated trauma or to some other asymmetric stimulus (such as wearing of a cast) with increased hair growth.

5. Acquired Hypertrichosis Lanuginosa: Foetal hair follicles produce fine soft Lanugo hair. This embryonic hair is lost before birth. During normal life thereafter the human skin produces hair of various types through endocrine influences. People with 'acquired hypertrichosis lanuginosa' will have lost their lanugo hair prior to birth. The condition may a symptom of other illness i.e. malignancy. Though the causal mechanism is not fully understood some dermatologists / endocrinologists suggest that it is associated with a disruption of hormone concentrations. Others suggest the disorder may be producing its own hair growth stimulator.

6. Congenital Hypertrichosis & Congenital Hypertrichosis Lanuginosa (CHL) ( Syn. Congenital Hypertrichosis Universalis, Hypertrichosis Universalis, Hypertrichosis Lanuginosa,and Hypertrichosis Lanuginosa Universalis.)Congenital hypertrichosis is a general term for any excessive hair growth visible on a child at birth. This may involve the entire body having a covering of fine long hair, or be restricted to specific areas. This very rare X-linked dominant condition has been responsible for the descriptions 'dog faced' and 'werewolf'.

HIRSUTISM AND HYPERTRICHOSISIn medical practice, once generalized hypertrichosis has been distinguished from hirsutism, it is most often considered a variation of normal, primarily resulting from genetic factors. Hirsutism (from Latin hirsutus = shaggy, hairy) is defined as excessive and increased hair growth in women in locations where the occurrence of terminal hair

normally is minimal or absent. It refers to a male pattern of body hair (androgenic hair) and it is therefore primarily of cosmetic and psychological concern. Hirsutism is a symptom rather than a disease and may be a sign of a more serious medical indication, especially if it develops well after puberty. The cause of hirsutism can be either an increased level of androgens (male hormones) or an oversensitivity of hair follicles to androgens. Male hormones such as testosterone stimulate hair growth, increase size and intensify the growth and pigmentation of hair. Other symptoms associated with a high level of male hormones include acne and deepening of the voice and increased muscle mass.It may have a congenital or exogenous origin. Causes:

Increased production of androgens (hyper-androgenism) and androstenedione or the increased sensitivity of the skin to them.

Advancing years. Drugs: Danazol, androgenic oral contraceptives. Polycystic ovarian syndrome (onset in the teens or early 20s - gradual

worsening). Hyperthecosis (Hyperplasia of the theca (sheath) cells of the vesicular ovarian

follicles) Late onset congenital adrenal hyperplasia - (due to hormone metabolism changes

at puberty) Pregnancy related - e.g. ovarian changes or hyperprolactinemia (increased

prolactin in the blood associated with lactation). Tumors that stimulate the ovarian stroma, adrenal tumors, Cushing's disease. Growing evidence implicates high circulating levels of insulin in women to the

development of hirsutism. This theory is consistent with the observation that obese (and thus presumably insulin resistant hyperinsulinemic) women are at high risk of becoming hirsute. Further, treatments that lower insulin levels will lead to a reduction in hirsutism. It is speculated that insulin, at high enough concentration, stimulates the ovarian theca cells to produce androgens. There may also be an effect of high levels of insulin to activate the insulin-like growth factor-I (IGF-1) receptor in those same cells. Again, the result is increased androgen production

TREATMENT FOR HYPERTRICHOSIS/HIRSUTISMBleach the hair. Theoretically a safe treatment but may cause skin reaction/irritation.

Depilate with creams which dissolve hair at the skin level. Stubble is avoided, but skin irritation may result. Creams based on thiols may have a pungent odour. We recommend an allergy test before use on face.

Electrolysis /Diathermy will destroy individual dermal papillae via a platinum needle inserted into the hair follicle and the passage of an electric current. This treatment may be painful, expensive, not always reliable and progress is slow. Not all practitioners are qualified. Skin may suffer minute scarring.

Laser epilation is the latest and perhaps best local treatment option. Treatment is very expensive and should be carried out under medical supervision. Side effects: may include redness, skin tone changes, possible scarring. Read more about laser therapy

Shaving is the safest method. Requires daily attention. Produces stubble and may irritate sensitive skin.

Weight Loss- Obese persons may find this type of hair growth is reduced with weight reduction.

Medicines - Anti-androgens.

ROLE OF HOMEOPATHYHomeopathy comes into action when there is a underlying pathological cause for hypertrichosis/ hirsutism like PCOD, Adrenal hyperplasia. Remedies are prescribed on the basis of constitutional make up of the patients. H

The miasm which lies behind hypertrichosis is mainly sycosis.Some of the drugs found useful are Thuja, Sepia, Cortisone, Medorrhinum.