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
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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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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" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 18 | 15 | 33 |
| 2024 Octubre | 118 | 32 | 150 |
| 2024 Septiembre | 116 | 27 | 143 |
| 2024 Agosto | 145 | 60 | 205 |
| 2024 Julio | 132 | 28 | 160 |
| 2024 Junio | 168 | 39 | 207 |
| 2024 Mayo | 93 | 40 | 133 |
| 2024 Abril | 114 | 44 | 158 |
| 2024 Marzo | 110 | 50 | 160 |
| 2024 Febrero | 96 | 41 | 137 |
| 2024 Enero | 92 | 44 | 136 |
| 2023 Diciembre | 111 | 20 | 131 |
| 2023 Noviembre | 92 | 35 | 127 |
| 2023 Octubre | 128 | 31 | 159 |
| 2023 Septiembre | 108 | 24 | 132 |
| 2023 Agosto | 88 | 17 | 105 |
| 2023 Julio | 121 | 34 | 155 |
| 2023 Junio | 89 | 23 | 112 |
| 2023 Mayo | 119 | 20 | 139 |
| 2023 Abril | 92 | 25 | 117 |
| 2023 Marzo | 120 | 24 | 144 |
| 2023 Febrero | 109 | 26 | 135 |
| 2023 Enero | 94 | 35 | 129 |
| 2022 Diciembre | 97 | 40 | 137 |
| 2022 Noviembre | 52 | 32 | 84 |
| 2022 Octubre | 74 | 25 | 99 |
| 2022 Septiembre | 67 | 36 | 103 |
| 2022 Agosto | 45 | 39 | 84 |
| 2022 Julio | 53 | 35 | 88 |
| 2022 Junio | 76 | 35 | 111 |
| 2022 Mayo | 125 | 31 | 156 |
| 2022 Abril | 118 | 43 | 161 |
| 2022 Marzo | 127 | 61 | 188 |
| 2022 Febrero | 154 | 41 | 195 |
| 2022 Enero | 214 | 47 | 261 |
| 2021 Diciembre | 244 | 49 | 293 |
| 2021 Noviembre | 129 | 50 | 179 |
| 2021 Octubre | 104 | 48 | 152 |
| 2021 Septiembre | 135 | 44 | 179 |
| 2021 Agosto | 171 | 36 | 207 |
| 2021 Julio | 138 | 27 | 165 |
| 2021 Junio | 131 | 23 | 154 |
| 2021 Mayo | 96 | 42 | 138 |
| 2021 Abril | 262 | 88 | 350 |
| 2021 Marzo | 187 | 46 | 233 |
| 2021 Febrero | 104 | 30 | 134 |
| 2021 Enero | 104 | 20 | 124 |
| 2020 Diciembre | 82 | 13 | 95 |
| 2020 Noviembre | 65 | 18 | 83 |
| 2020 Octubre | 55 | 19 | 74 |
| 2020 Septiembre | 57 | 7 | 64 |
| 2020 Agosto | 57 | 35 | 92 |
| 2020 Julio | 46 | 20 | 66 |
| 2020 Junio | 57 | 26 | 83 |
| 2020 Mayo | 34 | 31 | 65 |
| 2020 Abril | 48 | 29 | 77 |
| 2020 Marzo | 59 | 20 | 79 |
| 2020 Febrero | 5 | 7 | 12 |
| 2020 Enero | 4 | 6 | 10 |
| 2019 Diciembre | 8 | 6 | 14 |
| 2019 Noviembre | 4 | 3 | 7 |
| 2019 Octubre | 0 | 6 | 6 |
| 2019 Septiembre | 4 | 7 | 11 |
| 2019 Agosto | 4 | 3 | 7 |
| 2019 Julio | 4 | 11 | 15 |
| 2019 Junio | 6 | 0 | 6 |
| 2019 Mayo | 4 | 20 | 24 |
| 2019 Abril | 2 | 10 | 12 |
| 2019 Marzo | 4 | 8 | 12 |
| 2019 Febrero | 0 | 1 | 1 |
| 2019 Enero | 3 | 0 | 3 |
| 2018 Diciembre | 4 | 2 | 6 |
| 2018 Octubre | 6 | 2 | 8 |
| 2018 Septiembre | 4 | 0 | 4 |
| 2018 Abril | 0 | 2 | 2 |
| 2018 Marzo | 22 | 3 | 25 |
| 2018 Febrero | 79 | 7 | 86 |
| 2018 Enero | 74 | 5 | 79 |
| 2017 Diciembre | 74 | 11 | 85 |
| 2017 Noviembre | 55 | 7 | 62 |
| 2017 Octubre | 89 | 2 | 91 |
| 2017 Septiembre | 75 | 12 | 87 |
| 2017 Agosto | 67 | 9 | 76 |
| 2017 Julio | 86 | 9 | 95 |
| 2017 Junio | 86 | 14 | 100 |
| 2017 Mayo | 61 | 14 | 75 |
| 2017 Abril | 41 | 12 | 53 |
| 2017 Marzo | 55 | 21 | 76 |
| 2017 Febrero | 108 | 10 | 118 |
| 2017 Enero | 68 | 15 | 83 |
| 2016 Diciembre | 75 | 11 | 86 |
| 2016 Noviembre | 131 | 14 | 145 |
| 2016 Octubre | 133 | 23 | 156 |
| 2016 Septiembre | 191 | 18 | 209 |
| 2016 Agosto | 104 | 14 | 118 |
| 2016 Julio | 71 | 15 | 86 |
| 2016 Junio | 7 | 14 | 21 |
| 2016 Mayo | 9 | 9 | 18 |
| 2016 Abril | 6 | 12 | 18 |
| 2016 Marzo | 9 | 1 | 10 |
| 2016 Febrero | 7 | 3 | 10 |
| 2016 Enero | 13 | 4 | 17 |
| 2015 Diciembre | 10 | 1 | 11 |
| 2015 Noviembre | 6 | 5 | 11 |
| 2015 Octubre | 9 | 5 | 14 |
| 2015 Septiembre | 11 | 2 | 13 |
| 2015 Agosto | 11 | 1 | 12 |
| 2015 Julio | 163 | 14 | 177 |
| 2015 Junio | 117 | 5 | 122 |
| 2015 Mayo | 190 | 33 | 223 |
| 2015 Abril | 111 | 16 | 127 |
| 2015 Marzo | 156 | 11 | 167 |
| 2015 Febrero | 109 | 12 | 121 |
| 2015 Enero | 67 | 13 | 80 |
| 2014 Diciembre | 147 | 7 | 154 |
| 2014 Noviembre | 68 | 4 | 72 |
| 2014 Octubre | 141 | 5 | 146 |
| 2014 Septiembre | 90 | 5 | 95 |
| 2014 Agosto | 73 | 5 | 78 |
| 2014 Julio | 62 | 6 | 68 |
| 2014 Junio | 100 | 4 | 104 |
| 2014 Mayo | 65 | 6 | 71 |
| 2014 Abril | 59 | 10 | 69 |
| 2014 Marzo | 59 | 6 | 65 |
| 2014 Febrero | 35 | 8 | 43 |
| 2014 Enero | 49 | 8 | 57 |
| 2013 Diciembre | 34 | 7 | 41 |
| 2013 Noviembre | 13 | 4 | 17 |
| 2013 Octubre | 11 | 3 | 14 |
| 2013 Septiembre | 7 | 10 | 17 |
| 2013 Agosto | 6 | 4 | 10 |
| 2013 Julio | 6 | 12 | 18 |
| 2013 Junio | 6 | 9 | 15 |
| 2013 Mayo | 8 | 17 | 25 |
| 2013 Abril | 5 | 15 | 20 |
| 2013 Marzo | 8 | 5 | 13 |
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