Case and research letter
Acquired Generalized Hypertrichosis Due to Diazoxide
Hipertricosis generalizada adquirida por diazóxido
R. Salido-Vallejo
, F.J. Gómez-García, G. Garnacho-Saucedo, M. Galán-Gutiérrez
Corresponding author
Servicio de Dermatología, Hospital Universitario Reina Sofía, Córdoba, Spain
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Salido-Vallejo, F.J. Gómez-García, G. Garnacho-Saucedo, M. Galán-Gutiérrez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "Salido-Vallejo" "email" => array:1 [ 0 => "rsalidovallejo@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "F.J." "apellidos" => "Gómez-García" ] 2 => array:2 [ "nombre" => "G." "apellidos" => "Garnacho-Saucedo" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Galán-Gutiérrez" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Reina Sofía, Córdoba, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hipertricosis generalizada adquirida por diazóxido" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2003 "Ancho" => 1667 "Tamanyo" => 323657 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hypertrichosis predominantly affecting the temporal regions, eyebrows, and upper lip.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">To the Editor:</span></p><p id="par1005" class="elsevierStylePara elsevierViewall">Hypertrichosis is defined as the excessive growth of hair on any part of the body.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In hirsutism, on the other hand, the hair follicles have different characteristics and an androgenic distribution. Clinically, hypertrichosis is classified according to its extension, as localized or generalized, and to its etiology, as congenital or acquired. The origin of acquired generalized hypertrichosis can be idiopathic, iatrogenic, or related to systemic diseases,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> such as hypothyroidism, porphyria, celiac disease, dermatomyositis, human immunodeficiency virus (HIV) infection, or tumors. The widespread appearance of lanugo in the adult may be a sign of internal cancer or portend the onset of malignant disease; however, there have been no reports of such cases in children.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 6-year-old boy who was referred to our outpatient clinic for the growth of terminal hair that had started to develop on the face, trunk, and limbs (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) during his first year of life and had been slowly progressive. The patient had been diagnosed with hyperinsulinemic hypoglycemia of infancy at 5 months of age and was on treatment with diazoxide, 20<span class="elsevierStyleHsp" style=""></span>mg/kg/d, with adequate control. There was no family history of interest. He did not present growth retardation, neurological disturbances, or other typically relevant underlying diseases or treatments. Physical examination revealed widespread hypertrichosis, most marked on the forehead, upper lip, and eyebrows, which had started to develop some months after introduction of the full dose of diazoxide (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). There was no predilection for sun-exposed areas. No other lesions were observed on the skin or mucosas and his teeth were normal. Blood tests including a complete blood count, routine biochemistry, thyroid hormones, and lactate dehydrogenase as well as antigliadin, antiendomysium, and antitransglutaminase antibodies were normal. HIV serology was negative. A diagnosis of acquired generalized hypertrichosis secondary to treatment with diazoxide was made on the basis of the above findings.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Iatrogenic acquired generalized hypertrichosis preferentially affects the temporal and frontal regions, the flexor surfaces of the limbs, and the trunk and is usually reversible after withdrawal of the causative agent. The drugs most frequently implicated are ciclosporin, phenytoin, and minoxidil. Diazoxide is an uncommon cause of generalized hypertrichosis,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> which develops in 1% to 20% of adults receiving this treatment. In children, however, this figure may reach 100%. This adverse effect appears to be related to the dose and to the duration of treatment. In adults, diazoxide is principally used to control episodes of malignant hypertension, whereas the most common indication in children is hyperinsulinemic hypoglycemia of infancy,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> in which it is used for maintenance treatment. This would explain the higher incidence of generalized hypertrichosis in children. The pathogenesis is thought to be related to activation of the ATP-dependent potassium channels. These channels are present both on pancreatic cells and on cells in the hair follicles. A recent publication has described how drugs that act on these channels affect the anagen (growth) phase of hair follicles<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>: those that block the potassium channels, such as tolbutamide, shorten the anagen phase whereas agonists, such as minoxidil and diazoxide, lengthen this phase.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Treatment is limited to cosmetic hair removal with topical agents or the use of photoepilation systems. The application of 11.5% eflornitine cream has been shown to be effective in the treatment of facial hirsutism and has been used off-label in patients with facial hypertrichosis.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In view of these findings, studies must be performed in any child presenting generalized hypertrichosis to exclude the systemic diseases listed above and to look for possible causative drugs; if such a drug is detected, the risks and benefits of changing or withdrawing the treatment must be evaluated.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article: Salido R, et al. Hipertricosis generalizada adquirida por diazóxido. Actas Dermosifiliogr. 2013;104:166–7.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1203 "Ancho" => 1667 "Tamanyo" => 207885 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Widespread increase of terminal hair on the trunk and upper limbs.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2003 "Ancho" => 1667 "Tamanyo" => 323657 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hypertrichosis predominantly affecting the temporal regions, eyebrows, and upper lip.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Paus R, Olsen EA, Messenger AG. 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Lopez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Dermatologica" "fecha" => "1989" "volumen" => "179" "paginaInicial" => "221" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2620758" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Human hair follicules contain two forms of ATP-sensitive potassium channels, only one of which is sensitive to minoxidil" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K. Shorter" 1 => "N.P. Farjo" 2 => "S.M. Picksley" 3 => "V.A. Randall" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "FASEB" "fecha" => "2008" "volumen" => "22" "paginaInicial" => "1725" "paginaFinal" => "1736" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effects of topical diazoxide on hair follicular growth and physiology of the stumptailed macaque" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "H. Uno" 1 => "J.W. Kemnitz" 2 => "A. Cappas" 3 => "K. Adachi" 4 => "A. Sakuma" 5 => "H. Kamoda" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Dermatol Sci" "fecha" => "1990" "volumen" => "1" "paginaInicial" => "183" "paginaFinal" => "194" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2085505" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010400000002/v1_201304241618/S1578219013000115/v1_201304241618/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010400000002/v1_201304241618/S1578219013000115/v1_201304241618/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219013000115?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 17 | 15 | 32 |
| 2024 October | 118 | 32 | 150 |
| 2024 September | 116 | 27 | 143 |
| 2024 August | 145 | 60 | 205 |
| 2024 July | 132 | 28 | 160 |
| 2024 June | 168 | 39 | 207 |
| 2024 May | 93 | 40 | 133 |
| 2024 April | 114 | 44 | 158 |
| 2024 March | 110 | 50 | 160 |
| 2024 February | 96 | 41 | 137 |
| 2024 January | 92 | 44 | 136 |
| 2023 December | 111 | 20 | 131 |
| 2023 November | 92 | 35 | 127 |
| 2023 October | 128 | 31 | 159 |
| 2023 September | 108 | 24 | 132 |
| 2023 August | 88 | 17 | 105 |
| 2023 July | 121 | 34 | 155 |
| 2023 June | 89 | 23 | 112 |
| 2023 May | 119 | 20 | 139 |
| 2023 April | 92 | 25 | 117 |
| 2023 March | 120 | 24 | 144 |
| 2023 February | 109 | 26 | 135 |
| 2023 January | 94 | 35 | 129 |
| 2022 December | 97 | 40 | 137 |
| 2022 November | 52 | 32 | 84 |
| 2022 October | 74 | 25 | 99 |
| 2022 September | 67 | 36 | 103 |
| 2022 August | 45 | 39 | 84 |
| 2022 July | 53 | 35 | 88 |
| 2022 June | 76 | 35 | 111 |
| 2022 May | 125 | 31 | 156 |
| 2022 April | 118 | 43 | 161 |
| 2022 March | 127 | 61 | 188 |
| 2022 February | 154 | 41 | 195 |
| 2022 January | 214 | 47 | 261 |
| 2021 December | 244 | 49 | 293 |
| 2021 November | 129 | 50 | 179 |
| 2021 October | 104 | 48 | 152 |
| 2021 September | 135 | 44 | 179 |
| 2021 August | 171 | 36 | 207 |
| 2021 July | 138 | 27 | 165 |
| 2021 June | 131 | 23 | 154 |
| 2021 May | 96 | 42 | 138 |
| 2021 April | 262 | 88 | 350 |
| 2021 March | 187 | 46 | 233 |
| 2021 February | 104 | 30 | 134 |
| 2021 January | 104 | 20 | 124 |
| 2020 December | 82 | 13 | 95 |
| 2020 November | 65 | 18 | 83 |
| 2020 October | 55 | 19 | 74 |
| 2020 September | 57 | 7 | 64 |
| 2020 August | 57 | 35 | 92 |
| 2020 July | 46 | 20 | 66 |
| 2020 June | 57 | 26 | 83 |
| 2020 May | 34 | 31 | 65 |
| 2020 April | 48 | 29 | 77 |
| 2020 March | 59 | 20 | 79 |
| 2020 February | 5 | 7 | 12 |
| 2020 January | 4 | 6 | 10 |
| 2019 December | 8 | 6 | 14 |
| 2019 November | 4 | 3 | 7 |
| 2019 October | 0 | 6 | 6 |
| 2019 September | 4 | 7 | 11 |
| 2019 August | 4 | 3 | 7 |
| 2019 July | 4 | 11 | 15 |
| 2019 June | 6 | 0 | 6 |
| 2019 May | 4 | 20 | 24 |
| 2019 April | 2 | 10 | 12 |
| 2019 March | 4 | 8 | 12 |
| 2019 February | 0 | 1 | 1 |
| 2019 January | 3 | 0 | 3 |
| 2018 December | 4 | 2 | 6 |
| 2018 October | 6 | 2 | 8 |
| 2018 September | 4 | 0 | 4 |
| 2018 April | 0 | 2 | 2 |
| 2018 March | 22 | 3 | 25 |
| 2018 February | 79 | 7 | 86 |
| 2018 January | 74 | 5 | 79 |
| 2017 December | 74 | 11 | 85 |
| 2017 November | 55 | 7 | 62 |
| 2017 October | 89 | 2 | 91 |
| 2017 September | 75 | 12 | 87 |
| 2017 August | 67 | 9 | 76 |
| 2017 July | 86 | 9 | 95 |
| 2017 June | 86 | 14 | 100 |
| 2017 May | 61 | 14 | 75 |
| 2017 April | 41 | 12 | 53 |
| 2017 March | 55 | 21 | 76 |
| 2017 February | 108 | 10 | 118 |
| 2017 January | 68 | 15 | 83 |
| 2016 December | 75 | 11 | 86 |
| 2016 November | 131 | 14 | 145 |
| 2016 October | 133 | 23 | 156 |
| 2016 September | 191 | 18 | 209 |
| 2016 August | 104 | 14 | 118 |
| 2016 July | 71 | 15 | 86 |
| 2016 June | 7 | 14 | 21 |
| 2016 May | 9 | 9 | 18 |
| 2016 April | 6 | 12 | 18 |
| 2016 March | 9 | 1 | 10 |
| 2016 February | 7 | 3 | 10 |
| 2016 January | 13 | 4 | 17 |
| 2015 December | 10 | 1 | 11 |
| 2015 November | 6 | 5 | 11 |
| 2015 October | 9 | 5 | 14 |
| 2015 September | 11 | 2 | 13 |
| 2015 August | 11 | 1 | 12 |
| 2015 July | 163 | 14 | 177 |
| 2015 June | 117 | 5 | 122 |
| 2015 May | 190 | 33 | 223 |
| 2015 April | 111 | 16 | 127 |
| 2015 March | 156 | 11 | 167 |
| 2015 February | 109 | 12 | 121 |
| 2015 January | 67 | 13 | 80 |
| 2014 December | 147 | 7 | 154 |
| 2014 November | 68 | 4 | 72 |
| 2014 October | 141 | 5 | 146 |
| 2014 September | 90 | 5 | 95 |
| 2014 August | 73 | 5 | 78 |
| 2014 July | 62 | 6 | 68 |
| 2014 June | 100 | 4 | 104 |
| 2014 May | 65 | 6 | 71 |
| 2014 April | 59 | 10 | 69 |
| 2014 March | 59 | 6 | 65 |
| 2014 February | 35 | 8 | 43 |
| 2014 January | 49 | 8 | 57 |
| 2013 December | 34 | 7 | 41 |
| 2013 November | 13 | 4 | 17 |
| 2013 October | 11 | 3 | 14 |
| 2013 September | 7 | 10 | 17 |
| 2013 August | 6 | 4 | 10 |
| 2013 July | 6 | 12 | 18 |
| 2013 June | 6 | 9 | 15 |
| 2013 May | 8 | 17 | 25 |
| 2013 April | 5 | 15 | 20 |
| 2013 March | 8 | 5 | 13 |
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