Hirsutism and hypertrichosis: what it is, what causes it, and the solutions for it.

Have you noticed an unusual increase in your body or facial hair? Hypertrichosis may be the reason for the appearance of excessive hair in localised areas or throughout your body. It is a pathology of which the causes are not yet known, although there may be hereditary reasons behind it, or it may be associated with an undiagnosed disorder. It is a major aesthetic problem for people who suffer from it, especially women. 

Fortunately, there are increasingly effective and painless hair removal methods that greatly improve the appearance of people suffering from this condition. Because, while hypertrichosis does not in itself pose a health problem, it can cause psychological problems for those who suffer from it.

What is hypertrichosis or hirsutism? 

Hypertrichosis is the excessive growth of hair, either in quantity or thickness, anywhere on the body. It can occur in a localised area or in general all over the body. Although it is uncommon, hypertrichosis can affect both men and women and involves an increase in the density of hair and the transformation of vellus hair into terminal hair. Hypertrichosis is primarily an aesthetic issue, rather than a health problem. However, some diseases and syndromes may be associated with hypertrichosis, such as late cutaneous porphyria.

Types of hypertrichosis

Depending on the area of hair growth, hypertrichosis can be generalised, affecting the whole body, or localised, such as hypertrichosis cubiti (hairy elbows syndrome) or lumbosacral hypertrichosis. The main types of hypertrichosis are the following:

Congenital terminal. It has to do with the X chromosome. It is also called werewolf syndrome.

Lumbosacral or spinal. Hair grows on the spinal region, also known as faun tail.

Irritative or acquired. This can result from impacts on the skin, inflammatory processes or subjecting a part of the body to repetitive stress.

Eyebrows and Eyelashes. Exaggerated growth of the hair in these areas.

Anterior Cervical. Known as “hairy throat”, it involves a small area of hair located above the Adam’s apple.

Pinna. Abnormal hair growth on and inside the ears. This mainly affects elderly and diabetic patients.

Differences between hirsutism and hypertrichosis

Although these terms are sometimes used interchangeably, they should be differentiated. Hypertrichosis is a rare disease in which excessive hair grows in areas of the body not affected by androgens. It occurs regardless of sex, race or age and is simply abnormal hair growth. 

Meanwhile, hirsutism is characterised by abnormal hair growth in areas that do depend on androgens. It affects women, causing the growth of dark, thick hair that follows typically masculine patterns (upper lip, chin, chest, etc.). It occurs when there are hormonal disorders such as the polycystic ovary (in fact, PCOS is the most frequent cause of hirsutism), or adrenal cortex tumours. It may also be linked to the use of oral contraceptives.

What causes hypertrichosis? (Causes)

The root cause is unknown, although there is a genetic factor to congenital hypertrichosis. Generalised acquired hypertrichosis may result from late cutaneous porphyria, malnutrition (e.g., associated with anorexia), or pharmacological treatments such as cyclosporine (an immunosuppressant), phenytoin (an anticonvulsant), or Minoxidil. Infections such as HIV, skin diseases such as dermatomyositis, as well as thyroid abnormalities or brain alterations can also trigger it. 

Localised acquired hypertrichosis may have to do with skin friction, sustained pressure on a certain part of the body, the wearing of orthopaedic devices (casts) and diseases such as systemic lupus erythematosus, linear scleroderma, atopic dermatitis or chronic lichen simplex.

How to avoid hypertrichosis?

There is no way to avoid hypertrichosis unless you are treated with medications that can cause it, in which case, you should always let your doctor know about any excessive and unusual hair growth. Once presented, the only way to avoid the evolution of hypertrichosis is to treat the cause and undergo permanent hair removal techniques since other treatments will not stop the hair growth.

Symptoms of hypertrichosis

The main symptom of hypertrichosis is the excessive and abnormal growth of hair in unusual areas. Three types of hair can appear: lanugo (long, thin, and soft, similar to that of newborns and which sheds on its own), vellus (short, soft, and pigmented, appearing anywhere except on mucous membranes, palms of the hands, and soles of the feet), and terminal (darkest, thickest, hardest, roughest, and longest hairs). The latter is usually developed in cases of hirsutism in women, appearing on the face, back, arms and chest.

Treatment for hypertrichosis

Treatment should always be aimed at eliminating the cause of hypertrichosis, although when the causes are genetic, it is more difficult to find effective treatment. Therefore, the diagnosis is key to finding out if the cause is medicamentous, requiring a change in medication, or if it is hormonal, requiring a treatment to restore balanced hormonal levels.

There are pharmacological treatments for hypertrichosis, such as the topical administration of eflornithine, a specific inhibitor of hair growth. But, in most cases, the only treatment available is hair removal. Laser hair removal, pulsed light, or electrolysis are the most recommended methods, as they prevent the hair from appearing again, unlike other methods.

Razor hair removal. The fastest and most common method, it allows you to easily remove hair from any part of the body. This is not the best option if you suffer from hypertrichosis because the hair will quickly reappear afterwards, requiring very regular shaving, which can be aggressive to the skin.

Waxing. It is not recommended when there is a lot of hair because it is a painful method. This is also true of hair removal by mechanical methods, with appliances that pull the hair from the root. In addition, the skin is subjected to unnecessary stress.

Electric hair removal. Recommended for localised hirsutism, or to finish a laser hair removal treatment, it is a definitive hair removal, although it cannot remove hair from large areas.

Pulsed Light Hair Removal (IPL). Pulsed light hair removal inhibits or weakens hair growth, attacking the hair follicle with pulses of light. It is fast, painless and effective for removing hair from large areas.

Laser hair removal. It is a permanent hair removal method suitable for hypertrichosis because it can remove hair over large areas quickly and painlessly. It is very effective for white skin with dark hair. It removes the hair almost completely, destroying the follicle by selective photothermolysis.

Preventing hypertrichosis

As we mentioned before, there is no effective way to prevent hypertrichosis, except by paying attention to hormonal alterations, maintaining a balanced diet and having regular gynaecological check-ups in the case of an SOP diagnosis. Likewise, avoiding medicines that include hair growth among their adverse reactions can also reduce the chances of developing hypertrichosis.

If you detect an unusual growth of hair, it is advisable to consult a specialist doctor. In addition to the physical examination, you will need to have a blood test to find out if your hormone levels are correct. Imaging tests, such as ultrasound or tomography, may also be necessary to rule out the presence of tumours or other disorders that may be causing excessive hair growth

At Insparya we have a multidisciplinary team, composed of specialists in dermatology, general medicine, psychiatry and corrective and reconstructive medicine that will offer you the best solutions for hypertrichosis and hirsutism. Contact us now and schedule your first appointment at one of our clinics.