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LETTER TO THE EDITOR
Year : 2017  |  Volume : 8  |  Issue : 2  |  Page : 143-145  

Nevoid hypertrichosis in a pre-adolescent girl


1 Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, University of Delhi, New Delhi, India
2 Department of Pathology, University College of Medical Sciences and GTB Hospital, University of Delhi, New Delhi, India

Date of Web Publication16-Mar-2017

Correspondence Address:
Chander Grover
Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, University of Delhi, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5178.202285

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How to cite this article:
Daulatabad D, Grover C, Tanveer N. Nevoid hypertrichosis in a pre-adolescent girl. Indian Dermatol Online J 2017;8:143-5

How to cite this URL:
Daulatabad D, Grover C, Tanveer N. Nevoid hypertrichosis in a pre-adolescent girl. Indian Dermatol Online J [serial online] 2017 [cited 2017 May 28];8:143-5. Available from: http://www.idoj.in/text.asp?2017/8/2/143/202285

Sir,

The presence of coarse terminal hair in facial distribution is commonly attributed to an underlying hormonal disturbance. However, nevoid conditions could uncommonly be responsible. We report the case of a 12-year-old girl brought to our dermatology outpatient department with complaints of increased hair growth over the chin for the past 1 year. The girl was pre-adolescent, had not attained menarche, and had not yet developed any secondary sexual changes. There was no similar family history.

On examination, a 3 × 2 cm localized patch of coarse terminal black hair was present over the left-side of the chin with no underlying cutaneous anomaly or any underlying pigmentation [Figure 1]. No urtication or induration was observed on rubbing the lesion. A thorough clinical examination did not reveal any musculoskeletal, ocular, or central nervous system abnormality. The child was otherwise physically and mentally normal but significantly distressed because of the distinctly visible abnormal hair growth on the chin. The histopathological examination revealed the presence of increased number of fully-formed normal appearing hair follicular units with an increase in adnexal structures [Figure 2] and [Figure 3]. Based on these findings, a diagnosis of nevoid hypertrichosis (NH) was made and the patient was explained regarding the condition. She was referred to another center for laser hair reduction.
Figure 1: Localized patch of coarse terminal hair over the left-side of the chin

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Figure 2: Increased number of fully-formed normal appearing hair follicular units with an increase in adnexal structures can be observed (H and E stained section; 40× magnification)

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Figure 3: The increase in the hair follicular units is better appreciated on Masson trichrome stained section (40× magnification)

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NH is an uncommon condition presenting with a circumscribed patch of coarse terminal hair. Mostly, it presents at or soon after birth;[1] although, uncommonly, it may present at a later age (around puberty).[2] The lesion is known to remain stable, with any increase in size being proportional to the growth of the child. It tends to persist, although spontaneous resolution has rarely been reported.[3] It is usually localized in the form of solitary or multiple patches.[2] Variable distribution patterns such as Blaschkoid, linear, segmental, or checkerboard patterns have been reported. There are no specific sites of predilection. The classical, unifying feature for these lesions is the absence of any underlying pigmentary change or any other lesion. The color of the lesional hair is the same as the scalp hair; however, reports exist of depigmented hair as well as premature graying of hair in the patch.[2] The condition is often not associated with an underlying musculoskeletal, central nervous system, or ocular abnormality.

The diagnosis is based on classical cutaneous presentation and histopathological evaluation. For cases with early onset, differential diagnoses which need to be excluded are congenital hairy melanocytic nevus (CMN), plexiform neurofibroma, congenital hypertichosis lanuginosa, and generalized hypertrichosis (if much larger areas are involved). For cases with a delayed onset, the possibility of Becker's nevus, late onset melanocytic nevus, and smooth muscle hamartoma should always be considered. Our patient developed hypertrichosis on the chin. In such a scenario, hirsutism should also be ruled out by examining the surrounding skin as well as other hormone dependent sites.

NH is considered to be a disorder of mosaicism explaining the occurrence of linear, segmental, or other patterns. Twin spotting, a phenomenon unique to the disorders of mosaicism, has also been observed with NH. This refers to a co-occurrence of two unrelated nevoid skin conditions, expressing themselves simultaneously but mutually exclusive of each other. One such entity known to occur simultaneously with NH is Hypomelanosis of Ito.[4]

For management, the patient needs to be counseled regarding the benign nature of the condition allaying their concerns. Treatment aims at cosmetic improvement, especially if the lesion is on an exposed area of the body. Laser hair reduction with long pulsed neodymium-doped yttrium aluminium garnet and alexandrite lasers have been attempted with good cosmetic outcome.[5]

Our patient presented with unique features in the form of a late onset with involvement of the chin with coarse terminal hair. The psychological impact of coarse hair on the chin in a girl child can be immense. This case serves to highlight an uncommon presentation and its management, especially the significance of early recognition, counseling, and appropriate treatment.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Vergani R, Betti R, Martino P, Crosti C. Giant nevoid hypertrichosis in an Iranian girl. Pediatr Dermatol 2002;19:64-6  Back to cited text no. 1
    
2.
Chang SN, Hong CE, Kim DK, Park WH. A case of multiple nevoid hypertrichosis. J Dermatol 1997;24:337-41.  Back to cited text no. 2
    
3.
Dudding TE, Rogers M, Roddick LG, Relic J, Edwards MJ. Nevoid hypertrichosis with multiple patches of hair that underwent almost complete spontaneous resolution. Am J Med Genet 1998;79:195-6.  Back to cited text no. 3
    
4.
López Barrantes O, Torrelo A, Mediero IG, Zambrano A, Happle R. Nevoid hypertrichosis and hypomelanosis. Eur J Dermatol 2002;12:583-5.  Back to cited text no. 4
    
5.
Koch D, Pratsou P, Szczecinska W, Lanigan S, Abdullah A. The diverse application of laser hair removal therapy: A tertiary laser unit's experience with less common indications and a literature overview. Lasers Med Sci 2015;30:453-67.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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