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Patient Case: Hypertrichosis with Alopecia

Patient Case: Hypertrichosis with Alopecia

Discussion

A 12-year-old boy is brought to the dermatology clinic by his parents due to excessive hair growth on his back, arms, and face, which has been present since infancy. His parents report that while the hair on his body continues to grow excessively, he has been experiencing progressive hair loss on his scalp over the past two years. There is no history of similar conditions in the family, and he has no other significant medical history.

On physical examination, there is diffuse, coarse hair growth (hypertrichosis) on the face, back, and upper limbs, while the scalp shows patchy, non-scarring alopecia, particularly on the frontal and temporal areas. His eyebrows appear normal, and there are no signs of skin inflammation or lesions.

A diagnosis of hypertrichosis with alopecia is made. The patient and his family are counseled on possible underlying genetic causes and the importance of further evaluation. A referral to a geneticist is suggested, and potential treatment options such as laser hair reduction for excessive body hair and topical minoxidil for scalp hair regrowth are discussed.

Questions
  1. What is the most likely diagnosis for this patient’s condition?
    a) Androgenetic alopecia
    b) Hypertrichosis with alopecia
    c) Alopecia areata
    d) Hirsutism
  2. Which of the following best differentiates hypertrichosis from hirsutism?
    a) Hypertrichosis affects only the scalp, while hirsutism affects the entire body
    b) Hypertrichosis is influenced by androgens, whereas hirsutism is not
    c) Hypertrichosis is excessive hair growth in any body region, while hirsutism is male-pattern hair growth in females due to androgen excess
    d) Hirsutism is always congenital, while hypertrichosis is acquired
  3. Which of the following is a possible cause of congenital hypertrichosis with alopecia?
    a) Genetic mutations
    b) Fungal infections
    c) Autoimmune disorders
    d) Iron deficiency anemia
  4. What is the best initial management approach for this patient’s condition?
    a) Immediate systemic corticosteroids
    b) Genetic evaluation and symptomatic treatment with laser hair reduction and topical minoxidil
    c) Chemotherapy to suppress hair growth
    d) Avoidance of sun exposure and use of antifungal creams
Reveal answers

Answers

  1. (b) Hypertrichosis with alopecia
    • The presence of excessive body hair (hypertrichosis) alongside progressive scalp hair loss (alopecia) is characteristic of this condition, which can have genetic or acquired causes.
  2. (c) Hypertrichosis is excessive hair growth in any body region, while hirsutism is male-pattern hair growth in females due to androgen excess
    • Hypertrichosis is a generalized excessive hair growth that is not related to androgens, while hirsutism occurs in females due to excess androgens, leading to male-pattern hair growth (e.g., beard, chest).
  3. (a) Genetic mutations
    • Congenital hypertrichosis with alopecia is often linked to genetic mutations affecting hair growth cycles. Some rare syndromes also present with both excess body hair and scalp hair loss.
  4. (b) Genetic evaluation and symptomatic treatment with laser hair reduction and topical minoxidil
    • Genetic testing can help identify underlying mutations. Laser hair reduction can manage excessive body hair, while topical minoxidil may help slow scalp hair loss and promote regrowth.