Diffuse hypertrichosis during treatment with 5% topical minoxidil

Alopecia areata: a review on diagnosis, immunological etiopathogenesis and treatment options

Patients suffering from alopecia areata (AA) can lose hair in focal regions, the complete scalp, including eyelashes and eyebrows, or even the entire body. The exact pathology is not yet known, but the most described theory is a collapse of the immune privilege system, which can be found in some specific regions of the body. Different treatment options, local and systemic, are available, but none of them have been proven to be effective in the long term as well for every treatment there should be considered for the possible side effects. In many cases, treated or non-treated, relapse often occurs. The prognosis is uncertain and is negatively influenced by the subtypes alopecia totalis and alopecia universalis and characteristics such as associated nail lesions, hair loss for more than 10 years and a positive familial history. The unpredictable course of the disease also makes it a mental struggle and AA patients are more often associated with depression and anxiety compared to the healthy population. Research into immunology and genetics, more particularly in the field of dendritic cells (DC), is recommended for AA as there is evidence of the possible role of DC in the treatment of other autoimmune diseases such as multiple Sclerosis and cancer. Promising therapies for the future treatment of AA are JAK-STAT inhibitors and PRP.

Infantile generalized hypertrichosis caused by topical minoxidil

Rare cases of hypertrichosis have been associated with topically applied minoxidil. We present the first reported case in the Brazilian literature of generalized hypertrichosis affecting a 5-year-old child, following use of minoxidil 5%, 20 drops a day, for hair loss. The laboratory investigation excluded hyperandrogenism and thyroid dysfunction. Topical minoxidil should be used with caution in children.

Piggyback-acquired hypertrichosis

A 9-month-old girl exposed to 5% topical minoxidil for 2 months developed generalized hypertrichosis of the exposed and unexposed areas of her body. The infant's grandfather had been using minoxidil daily and then propping the baby on his shoulders for an hour or more a day. Minoxidil was eliminated from the child's environment and 4 months later her hair distribution returned to normal.

Sulfotransferase activity in plucked hair follicles predicts response to topical minoxidil in the treatment of female androgenetic alopecia

Two percent topical minoxidil is the only US Food and Drug Administration-approved drug for the treatment of female androgenetic alopecia (AGA). Its success has been limited by the low percentage of responders. Meta-analysis of several studies reporting the number of responders to 2% minoxidil monotherapy indicates moderate hair regrowth in only 13-20% of female patients. Five percent minoxidil solution, when used off-label, may increase the percentage of responders to as much as 40%. As such, a biomarker for predicting treatment response would have significant clinical utility. In a previous study, Goren et al. reported an association between sulfotransferase activity in plucked hair follicles and minoxidil response in a mixed cohort of male and female patients. The aim of this study was to replicate these findings in a well-defined cohort of female patients with AGA treated with 5% minoxidil daily for a period of 6 months. Consistent with the prior study, we found that sulfotransferase activity in plucked hair follicles predicts treatment response with 93% sensitivity and 83% specificity. Our study further supports the importance of minoxidil sulfation in eliciting a therapeutic response and provides further insight into novel targets for increasing minoxidil efficacy.

Long-pulsed Nd:YAG laser in the treatment of facial hypertrichosis during topical minoxidil therapy

Hypertrichosis is a well-recognized adverse effect of therapy with either oral or topical minoxidil. We report a case of fronto-temporal hypertrichosis occurring in an 8-year-old girl treated for patchy alopecia areata of the frontal area of the scalp with 2% minoxidil solution. After failure of 5-months minoxidil-discontinuation, hair removal with Nd:YAG laser (1064 nm line) (Smartepil II, Deka) was tested leading to complete resolution within 2 sessions.

Medical treatments for male and female pattern hair loss

Male and female pattern hair loss affects a large percentage of the population, and patients frequently present for treatment of this to their dermatologist. Here we review the many treatments available for hair loss. We review the evidence for each, and outline the most effective treatment strategies for both men and women.

LEARNING OBJECTIVE

At the conclusion of this article, the reader should be able to describe the most effective treatments for hair loss, understand their mechanism(s) of action, and explain which treatments are the best in different settings.

Paradoxical hypertrichosis after laser epilation

OBJECTIVE

Hair removal using lasers or broadband intense pulsed light has become one of the most ubiquitous medical procedures. At our center a small proportion of patients have spontaneously reported what they believed to be increased hair growth at sites of previous laser epilation. We sought to retrospectively review the prevalence and features of this paradoxical effect.

METHODS

This was a single center, retrospective study that included all patients who underwent laser hair removal during a 4-year period with a long-pulsed alexandrite laser. All cases of laser-induced hypertrichosis were assessed clinically by history, examination, and laboratory tests, and confirmed by review of serial clinical photographs taken during the course of the laser treatments. The clinical features of patients with postlaser hypertrichosis were compared with 50 patients randomly selected from among all those who had undergone laser hair removal at our center (n = 489).

RESULTS

Of 489 patients, 3 (0.6%, 95% confidence interval: 0.01-1.9%) treated with the long-pulsed alexandrite laser (755 nm) reported increased hair after laser hair epilation. There was a trend for this adverse effect to occur in darker skin phototypes (IV) and with black hair as compared with the unaffected comparison group (n = 50). However, the small number of cases (n = 3) did not provide sufficient power to adequately test factors such as age, sex, treatment settings, and number of treatments statistically.

CONCLUSION

Postlaser hair removal hypertrichosis is a real but rare occurrence in our experience.

Drug delivery across the skin

Since the introduction of the first through the skin (TTS) therapeutic in 1980, a total of 34 TTS products have been marketed and numerous drugs have been tested by more than 50 commercial organisations for their suitability for TTS delivery. Most of the agents which have been tested have had low molecular weights, due to the impermeability of the skin barrier. This barrier resides in the outermost skin layer, the stratum corneum. It is mechanical, anatomical, as well as chemical in nature; laterally overlapping cell multi-layers are sealed by tightly packed, intercellular, lipid multi-lamellae. Chemical skin permeation enhancers increase the transport across the barrier by partly solubilising or extracting the skin lipids and by creating hydrophobic pores. This is often irritating and not always well-tolerated. The TTS approach allows drugs (< 400 kDa in size) to permeate through the resulting pores in the skin, with a short lag-time and subsequent steady-state period. Drug bioavailability for TTS delivery is typically below 50%, avoiding the first pass effect. Wider, hydrophilic channels can be generated by skin poration, with the aid of a small electrical current (> 0.4 mA/cm2) across the skin (iontophoresis) or therapeutic ultrasound (few W/cm2; sonoporation). High-voltage (> 150 V, electroporation) widens the pores even more and often irreversibly. These standard poration methods require experience and equipment and are therefore, not practical; at best, charged/small molecules (< or = 4000 kDa in size) can be delivered efficiently across the skin. In spite of the potential harm of gadget-driven skin poration, this method is used to deliver molecules which conventional TTS patches are unable to deliver, especially polypeptides. Lipid-based drug carriers (liposomes, niosomes, nanoparticle microemulsions, etc.) were proposed as alternative, low-risk delivery vehicles. Such suspensions provide an improved drug reservoir on the skin, but the aggregates remain confined to the surface. Conventional carrier suspensions increase skin hydration and/or behave as skin permeation enhancers. The recently developed carriers; Transferomes, comprise pharmaceutically-acceptable, established compounds and are thought to penetrate the skin barrier along the naturally occurring transcutaneous moisture gradient. Transfersomes are believed to penetrate the hydrophilic (virtual) channels in the skin and widen the former after non-occlusive administration. Both small and large hydrophobic and hydrophilic molecules are deliverable across the stratum after conjugation with Transfersomes. Drug distribution after transdermal delivery probably proceeds via the lymph. This results in quasi-zero order kinetics with significant systemic drug levels reached after a lag-time of up to a few hours. The relative efficiency of TTS drug delivery with Transfersomes is typically above 50 %; with the added possibility of regional drug targeting.

Hypertrichosis

Hypertrichosis is hair growth that is abnormal for the age, sex, or race of an individual, or for a particular area of the body. Recognized forms of hypertrichosis are reviewed. Hirsutism, which is male-pattern hair growth in a female or child, is not included in this review. Hypertrichosis is categorized as congenital or acquired, and regional or generalized. Methods of managing hypertrichosis are also briefly reviewed