What are the other Names for this Condition? (Also known as/Synonyms)

• Acquired Hypertrichosis Lanuginosa Acquisita
• Hypertrichosis Lanuginosa Acquisita
• Paraneoplastic Hypertrichosis Lanuginosa

What is Acquired Hypertrichosis Lanuginosa? (Definition/Background Information)

• Acquired Hypertrichosis Lanuginosa (AHL) is an uncommon skin condition that is marked by the abnormal appearance of fine unpigmented (lanugo) hair, typically on the face and trunk, with other signs and symptoms such as tongue inflammation, diarrhea, and weight loss
• Fine short unpigmented hairs are normally seen on the face and attract notice only on close inspection. Lanugo hairs are a derivative of these hairs, growing more densely and longer, and are readily noticed
• In a vast majority of cases, Acquired Hypertrichosis Lanuginosa develops from an underlying malignancy (cancer of the urinary bladder, colon, lung, or breast). It may also occur from other factors such as anorexia, HIV infection, thyroid disease, or use of certain medications
• The management of Acquired Hypertrichosis Lanuginosa includes promptly treating the underlying malignant neoplasm. The abnormal hair condition and other presentations may be resolved via symptomatic treatments. Nevertheless, the overall outcomes depend on the nature and severity of the underlying cause

Who gets Acquired Hypertrichosis Lanuginosa? (Age and Sex Distribution)

• Acquired Hypertrichosis Lanuginosa is rare disorder that typically affects adults. When it is associated with a malignancy, the age group noted is between 40 and 70 years
• Both males and females may be affected. The condition is predominantly observed in women
• Worldwide, individuals of all racial and ethnic groups may be affected

What are the Risk Factors for Acquired Hypertrichosis Lanuginosa? (Predisposing Factors)

Internal malignancies are the most commonly observed risk factors for Acquired Hypertrichosis Lanuginosa. In such cases, it is known as Paraneoplastic Hypertrichosis Lanuginosa Acquisita.

• The most common malignant associations include:
  • Cancer of the urinary bladder, gastrointestinal system (colorectal), lungs, breast, uterus, or ovary
  • Lymphoma
• Less common non-malignant associations include:
  • Anorexia nervosa leading to malnutrition
  • Human immunodeficiency virus (HIV) infection, including AIDS
  • Hyperthyroidism
  • Use of certain medications such as cyclosporine, interferon, phenytoin, and corticosteroids

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Acquired Hypertrichosis Lanuginosa? (Etiology)

Presently, the exact cause of development of Acquired Hypertrichosis Lanuginosa (AHL) is not well-understood.

• The terminology hypertrichosis lanuginosa indicates an abnormal hair growth on the body (hypertrichosis) consisting of lanugo hairs
• Lanugo hairs are the first (thin, soft, and colorless) hairs formed by fetal hair follicles usually around 12-16 weeks of gestation
• These are normally shed prior to birth but may be sometimes seen at birth, disappearing within a few weeks thereafter

In Acquired Hypertrichosis Lanuginosa, lanugo-type hairs appear later in life possibly due to an underlying causative condition/factor such as cancer.

• It is believed that AHL may be a response to chemicals secreted by the malignant tumor (such as certain hormones)
  • In men, the common causative malignancy is lung cancer followed by colorectal cancer
  • In women, it is colorectal, lung, and breast cancer in decreasing order of incidence
• Hormonal imbalance can also be brought about by conditions, such as hyperthyroidism, which can lead to AHL
• In addition, AHL may also be caused by infections (such as HIV infection), or as a side effect of medications such as corticosteroids, spironolactone, or interferon

What are the Signs and Symptoms of Acquired Hypertrichosis Lanuginosa?

The signs and symptoms of Acquired Hypertrichosis Lanuginosa may vary in type and severity among affected individuals. It also depends on the underlying causative condition and its severity. The signs and symptoms may include:

• Appearance of fine and thin (lanugo) hair on the face, especially on the forehead, ears, nose, and around the eyebrows
• In some, large areas of the chest, back, shoulders, armpits, and limbs may present extensive hairy appearance
• The hair is typically colorless or unpigmented
• The mucus membranes, scalp, palms and soles, and groin regions typically do not present abnormal hair growth

Additionally, the following signs and symptoms may be noted:

• Inflammation of the tongue and abnormally large tongue
• Acanthosis nigricans
• Chronic diarrhea
• Swollen lymph nodes
• Loss of taste sensation
• Loss of appetite
• Weight loss
• High blood pressure

The signs and symptoms of other causative factors may be noted. It is reported that in many individuals with an underlying malignancy, the abnormal hair growth (hypertrichosis) is noted during advanced stages of cancer progression. Occasionally, hypertrichosis can be observed even two years before detection of a malignancy.

How is Acquired Hypertrichosis Lanuginosa Diagnosed?

If Acquired Hypertrichosis Lanuginosa (AHL) is suspected, it is important to undertake comprehensive investigations and scanning procedures to detect the associated malignancy or underlying causative condition.

A diagnosis of AHL may involve the following exams and procedures:

• Physical examination of the individual and medical history evaluation
• Blood tests and culture studies
• Dermoscopy: Dermoscopy is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Imaging studies of the affected regions, which may include CT and MRI scans
• Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis
• Direct and indirect immunofluorescence studies on the skin biopsy specimen

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Acquired Hypertrichosis Lanuginosa?

The complications of Acquired Hypertrichosis Lanuginosa may include:

• Difficulties with chewing and swallowing food due to enlarged tongue
• Emotional stress from cancer
• Low self-esteem due to cosmetic (hairy) appearance
• Metastasis of malignancies that are causing Acquired Hypertrichosis Lanuginosa
• Complications that develop from other causative factors such as HIV infection, hyperthyroidism, or severe malnutrition

Complications may occur with or without treatment, and in some cases, due to treatment also.

How is Acquired Hypertrichosis Lanuginosa Treated?

The treatment for Acquired Hypertrichosis Lanuginosa (AHL) is determined by its underlying cause.

• If a malignancy causes the condition, then treatment of the causative cancer is crucial for overall improved outcomes
• Similarly, if the cause of AHL is HIV infection, hyperthyroidism, or malnutrition, then considering adequate treatment of the same is important
• Discontinuing the medication responsible for AHL may result in a cure, or in improvement of the condition
• For cosmetic reasons, hair removal may be attempted through application of topical creams, laser therapy, and chemical or mechanical depilation (i.e., removal of body hair)
• Other treatment methods are largely symptomatic and supportive

Regular follow up visits with the healthcare provider is important and highly recommended.

How can Acquired Hypertrichosis Lanuginosa be Prevented?

In some cases, Acquired Hypertrichosis Lanuginosa (AHL) may be preventable, by regular medical screening at periodic intervals with tests and physical examinations in order to facilitate an early diagnosis of causative conditions.

• Undertaking early diagnosis and prompt treatment of underlying factors, such as malignancy, infection, thyroid disease, or anorexia, is important
• Drugs that cause the condition may be discontinued or alternative medication prescribed
• Active research is currently being performed to explore the possibilities for treatment and prevention of acquired conditions such as Acquired Hypertrichosis Lanuginosa

Adequately managing the underlying cause is known to result in improvement of the signs and symptoms of AHL, including regression of the abnormal hair growth.

What is the Prognosis of Acquired Hypertrichosis Lanuginosa? (Outcomes/Resolutions)

• The prognosis of individuals with Acquired Hypertrichosis Lanuginosa (AHL) may be unpredictable to poor if it occurs as a result of a malignancy. This is because AHL typically occurs during the advanced stages of cancer
• If AHL develops from an underlying infection, malnutrition, or thyroid disease, the overall prognosis may be assessed on a case-by-case basis, and it depends on the severity of the underlying condition

Additional and Relevant Useful Information for Acquired Hypertrichosis Lanuginosa:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/skin-disorders/