Case and Research Letters
Generalized Hypertrichosis Due to Topical Minoxidil
Hipertricosis generalizada secundaria a minoxidil tópico
V. Gargallo
, C. Gutierrez, F. Vanaclocha, A. Guerra-Tapia
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Departamento de Dermatología, Hospital 12 de Octubre, Madrid, Spain
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Gargallo, C. Gutierrez, F. Vanaclocha, A. Guerra-Tapia" "autores" => array:4 [ 0 => array:4 [ "nombre" => "V." "apellidos" => "Gargallo" "email" => array:1 [ 0 => "vgmoneva@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Gutierrez" ] 2 => array:2 [ "nombre" => "F." "apellidos" => "Vanaclocha" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Guerra-Tapia" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Dermatología, Hospital 12 de Octubre, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hipertricosis generalizada secundaria a minoxidil tópico" ] ] "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" => 692 "Ancho" => 975 "Tamanyo" => 128808 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hypertrichosis on the lower back.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Topical minoxidil solution (TMS) has been used since 1986 to treat androgenetic alopecia.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> Frequent side effects include local intolerance and itching.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> Hypertrichosis has also been observed close to the areas where the solution is applied, mainly the face and especially the temple and the preauricular region.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2–4</span></a> In contrast, generalized or distant hypertrichosis is an uncommon side effect of TMS, and its etiology and pathogenesis remain unknown.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 42-year-old woman diagnosed with androgenetic alopecia who visited our clinic with generalized new hair growth after using 5% TMS for 2 weeks. The patient had been treated with a compounded formulation (5% minoxidil propylene glycol, 0.5% progesterone, and 0.05% clobetasol), which she had been applying twice daily. She remembered having used a random amount and carefully avoiding contact between the product and regions outside the scalp.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient reported having a certain amount of vellus facial hair before starting treatment. However, after 2 weeks of treatment, she noticed new growth of body hair, which became darker and thicker. The main regions affected were the forehead, cheeks, beard area, chest, lower back, arms, and legs (<a class="elsevierStyleCrossRefs" href="#fig0005">Figures 1 and 2</a>). Hormonal tests (follicle-stimulating hormone, prolactin, testosterone, dehydroepiandrosterone sulfate, and δ-4-androstenedione) revealed no abnormalities.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Six months after stopping TMS, the patient's condition began to improve, with persistence of hair on the beard area and trunk. Ten months after stopping treatment, the improvement has persisted, although her condition has not returned to normal.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Between 0% and 5% of patients who receive TMS are affected by hypertrichosis—mainly on the face—caused by local transfer of the product.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Dawber and Rundegren<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> studied facial hair growth and hypertrichosis (defined as new hair growth on parts of the body other than the face) as separate entities in women using 5% and 2% TMS compared with placebo. They observed more cases of hypertrichosis in the group treated with 5% TMS (up to 2% of cases after use). They also observed that the adverse effect was more common in women than in men and that within this group, the effect was more common in women aged >50 years and women with facial hair before starting treatment. The facial hair was often vellus hair. Of note, there is a clear association between androgenetic alopecia and hyperandrogenism, which leads to the onset of symptoms such as hirsutism,<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3,5</span></a> one of the main risk factors for development of hypertrichosis after treatment with TMS. Furthermore, individuals of Mediterranean, Hispanic, and Middle Eastern ethnicity more often have facial hair.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In the cases reported in the literature, hypertrichosis usually appears 2 to 3 months after starting treatment and disappears 1 to 5 months after discontinuation.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">4,6</span></a> As for the present case, the effect was earlier and more persistent. Although we cannot rule out synergistic action of topical clobetasol, the literature on hypertrichosis caused by topical corticosteroids shows that hypertrichosis appears after longer periods of use and is limited to the treatment site<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> or neighboring sites.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> No effects at distant sites have been reported.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Several hypotheses have been put forward to account for TMS-induced hypertrichosis.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> The initial recommendation was to apply the product manually or using an applicator, although these hypotheses do not explain the finding of generalized hypertrichosis.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Despite the dose-dependent onset of this side effect, which is more common in 5% TMS than in 2% TMS and when the amount applied exceeds the recommended dose,<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2,3</span></a> minoxidil was not detected in blood in any of the cases reported. Therefore, we can deduce that the response is idiosyncratic and that it results from hypersensitivity of the follicles to the product, leading to the onset of hypertrichosis, even at distant sites, in more sensitive patients.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Given that excess facial hair before treatment implies an increased risk of developing TMS-induced hypertrichosis,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> we must treat such cases with a lower concentration of minoxidil or choose an alternative therapy.</p><p id="par0055" class="elsevierStylePara elsevierViewall">In conclusion, before prescribing TMS, physicians should take a full clinical history and perform a physical examination to establish the risk of developing hypertrichosis, which would be highest in middle-aged women with facial hair at diagnosis. In addition, every effort should be made to avoid combination with other products whose synergistic action is not well-studied and, therefore, whose effect is not predictable, as is the case with topical corticosteroids.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gargallo V, Gutierrez C, Vanaclocha F, Guerra-Tapia A. Hipertricosis generalizada secundaria a minoxidil tópico. Actas Dermosifiliogr. 2015;106:599–600.</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" => 996 "Ancho" => 720 "Tamanyo" => 126924 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hypertrichosis on the face with involvement of the forehead, temples, cheeks, and beard area.</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" => 692 "Ancho" => 975 "Tamanyo" => 128808 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hypertrichosis on the lower back.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Minoxidil: mechanisms of action on hair growth" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.G. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 193 | 7 | 200 |
| 2024 Octubre | 1609 | 44 | 1653 |
| 2024 Septiembre | 1469 | 35 | 1504 |
| 2024 Agosto | 1504 | 67 | 1571 |
| 2024 Julio | 1501 | 34 | 1535 |
| 2024 Junio | 949 | 42 | 991 |
| 2024 Mayo | 867 | 28 | 895 |
| 2024 Abril | 815 | 29 | 844 |
| 2024 Marzo | 1058 | 26 | 1084 |
| 2024 Febrero | 1389 | 40 | 1429 |
| 2024 Enero | 1434 | 30 | 1464 |
| 2023 Diciembre | 1398 | 25 | 1423 |
| 2023 Noviembre | 1537 | 68 | 1605 |
| 2023 Octubre | 1430 | 28 | 1458 |
| 2023 Septiembre | 1225 | 42 | 1267 |
| 2023 Agosto | 898 | 36 | 934 |
| 2023 Julio | 836 | 61 | 897 |
| 2023 Junio | 715 | 40 | 755 |
| 2023 Mayo | 702 | 60 | 762 |
| 2023 Abril | 629 | 39 | 668 |
| 2023 Marzo | 551 | 41 | 592 |
| 2023 Febrero | 522 | 51 | 573 |
| 2023 Enero | 648 | 46 | 694 |
| 2022 Diciembre | 452 | 60 | 512 |
| 2022 Noviembre | 340 | 51 | 391 |
| 2022 Octubre | 309 | 42 | 351 |
| 2022 Septiembre | 297 | 65 | 362 |
| 2022 Agosto | 199 | 41 | 240 |
| 2022 Julio | 148 | 57 | 205 |
| 2022 Junio | 201 | 53 | 254 |
| 2022 Mayo | 559 | 54 | 613 |
| 2022 Abril | 784 | 109 | 893 |
| 2022 Marzo | 915 | 91 | 1006 |
| 2022 Febrero | 756 | 50 | 806 |
| 2022 Enero | 825 | 72 | 897 |
| 2021 Diciembre | 641 | 59 | 700 |
| 2021 Noviembre | 679 | 88 | 767 |
| 2021 Octubre | 601 | 86 | 687 |
| 2021 Septiembre | 508 | 68 | 576 |
| 2021 Agosto | 574 | 82 | 656 |
| 2021 Julio | 475 | 61 | 536 |
| 2021 Junio | 572 | 51 | 623 |
| 2021 Mayo | 563 | 70 | 633 |
| 2021 Abril | 1174 | 121 | 1295 |
| 2021 Marzo | 648 | 48 | 696 |
| 2021 Febrero | 477 | 36 | 513 |
| 2021 Enero | 451 | 51 | 502 |
| 2020 Diciembre | 469 | 49 | 518 |
| 2020 Noviembre | 349 | 40 | 389 |
| 2020 Octubre | 282 | 40 | 322 |
| 2020 Septiembre | 315 | 67 | 382 |
| 2020 Agosto | 269 | 58 | 327 |
| 2020 Julio | 189 | 41 | 230 |
| 2020 Junio | 169 | 70 | 239 |
| 2020 Mayo | 170 | 43 | 213 |
| 2020 Abril | 74 | 61 | 135 |
| 2020 Marzo | 34 | 48 | 82 |
| 2020 Febrero | 12 | 22 | 34 |
| 2020 Enero | 2 | 4 | 6 |
| 2019 Diciembre | 3 | 19 | 22 |
| 2019 Noviembre | 5 | 12 | 17 |
| 2019 Octubre | 1 | 24 | 25 |
| 2019 Septiembre | 7 | 36 | 43 |
| 2019 Agosto | 3 | 35 | 38 |
| 2019 Julio | 3 | 41 | 44 |
| 2019 Junio | 6 | 39 | 45 |
| 2019 Mayo | 8 | 44 | 52 |
| 2019 Abril | 22 | 52 | 74 |
| 2019 Marzo | 2 | 26 | 28 |
| 2019 Febrero | 2 | 15 | 17 |
| 2019 Enero | 12 | 24 | 36 |
| 2018 Diciembre | 11 | 10 | 21 |
| 2018 Noviembre | 19 | 3 | 22 |
| 2018 Octubre | 1 | 0 | 1 |
| 2018 Septiembre | 6 | 8 | 14 |
| 2018 Agosto | 0 | 18 | 18 |
| 2018 Julio | 0 | 12 | 12 |
| 2018 Junio | 0 | 9 | 9 |
| 2018 Mayo | 0 | 17 | 17 |
| 2018 Abril | 0 | 12 | 12 |
| 2018 Marzo | 0 | 12 | 12 |
| 2018 Febrero | 103 | 15 | 118 |
| 2018 Enero | 106 | 14 | 120 |
| 2017 Diciembre | 101 | 14 | 115 |
| 2017 Noviembre | 48 | 13 | 61 |
| 2017 Octubre | 68 | 12 | 80 |
| 2017 Septiembre | 46 | 20 | 66 |
| 2017 Agosto | 50 | 22 | 72 |
| 2017 Julio | 41 | 34 | 75 |
| 2017 Junio | 46 | 58 | 104 |
| 2017 Mayo | 52 | 35 | 87 |
| 2017 Abril | 53 | 35 | 88 |
| 2017 Marzo | 26 | 27 | 53 |
| 2017 Febrero | 27 | 21 | 48 |
| 2017 Enero | 22 | 28 | 50 |
| 2016 Diciembre | 75 | 24 | 99 |
| 2016 Noviembre | 38 | 37 | 75 |
| 2016 Octubre | 26 | 36 | 62 |
| 2016 Septiembre | 0 | 21 | 21 |
| 2016 Agosto | 0 | 8 | 8 |
| 2016 Julio | 6 | 6 | 12 |
| 2016 Junio | 11 | 7 | 18 |
| 2016 Mayo | 12 | 2 | 14 |
| 2016 Abril | 6 | 1 | 7 |
| 2016 Marzo | 5 | 18 | 23 |
| 2016 Febrero | 0 | 1 | 1 |
| 2016 Enero | 0 | 12 | 12 |
| 2015 Diciembre | 0 | 6 | 6 |
| 2015 Noviembre | 0 | 2 | 2 |
| 2015 Octubre | 0 | 4 | 4 |
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