Patient Presentation
A 1-week-old male infant came to clinic for health supervision. He was born at 35 1/2 week gestation but had no problems in the newborn period and was discharged at day 3 of life. He was breastfeeding every 1.5-2.5 hours for about 30 minutes and would easily wake for feeding. His mother’s milk had come in on day 3 of life. His elimination showed multiple stools which had transitioned from meconium. His bilirubin level on day of life 5 was decreased from his discharge level and the parents said his jaundice was improving. His parents had no unusual newborn questions except were wondering if he was too hairy overall. The past medical history showed a second child born without prenatal or natal complications other than being premature. The family history was positive for cardiac disease and hypertension in older relatives. They were from South Asia. The review of systems was normal.
The pertinent physical exam showed a well-appearing child with good cry and suck. His weight was 2590 grams which was up 10 grams from two days previous and was 5% decreased from birth. He had minimal scleral icterus. The skin examination showed fine langugo hair especially over the legs, arms, back and around the hairline. His scalp hair was also somewhat prominent along the sideburn area of the face and he had thick eyebrows also. The rest of his examination was normal. The diagnosis of a healthy previously preterm infant who was gaining appropriate weight, but with congenital hypertrichosis was made. The physician told the family that the lanugo hair would decrease as the infant aged. They were also told that the amount of facial hair is usually genetic but that it would be monitored. The father noted that he himself seemed to have more hair in similar areas as the infant, than other people.
Discussion
Body hair, including its amount and distribution, have cultural norms and social implications that vary according to the group and individual. There are entire industries which cater to removing hair in certain body parts (i.e. underarms and legs for western women) and adding hair in other locations (i.e. head for western men). Excessive body hair (relatively) is usually often due to normal physiologic process (such as puberty) or genetic. Two definitions which are often confused are:
- Hypertrichosis – excessive, non-androgen induced hair growth in a localized or generalized pattern distribution in males or females.
- Hirsuitism – excessive, androgen-induced hair growth in a male pattern distribution in children and women.
Learning Point
The differential diagnosis of excessive body hair includes:
- Congenital hypertrichosis – normal process where there is excessive lanugo, often due to prematurity
- Central nervous system
- Faun-tail – occult spinal dysraphism
- Hair colla – cranial meningocoeles, encephalocoele
- Multiple sclerosis
- Plexiform neurofibroma
- Postencephalopathic hypertrichosis
- Drug and toxins
- Androgens
- Cyclosporine
- Diazoxide
- Minoxidil
- Penicillamine
- Phenytoin
- Psoralens
- Steroids
- Endocrine
- Androgen producing tumor
- Adrenocortical hyperplasia
- Adrenal insufficiency
- Cushing’s syndrome
- Hypothyroidism
- Idiopathic Hirsuitism
- Polycystic ovary disease
- Genetic
- Barber Say syndrome
- Cornelia de Lange Syndrome
- Epidemolysis bullosa
- Hairy elbows syndrome
- Hereditary gingival hyperplasia with hypertrichosis
- Hypertrichosis lanuginosa
- Lipoatrophy
- Mitochondrial disease
- Mucopolysaccaridosis – Hurler’s syndrome
- Porphyria
- Rubinstein-Taybi
- Waardenburg syndrome
- Localized
- Becker nevus
- Hairy nevus
- Linear nevus sebaceous syndrome
- Nevoid hypertrichosis
- Hemihypertrophy
- Other
- Anorexia nervosa
- Henna tattoos
- Dermatomyositis
- Severe malnutrition
Questions for Further Discussion
1. What causes decreased amounts of body hair?
2. For suspected endocrine-related excessive body hair, what workup should be completed?
Related Cases
- Disease: Hair Problems
- Symptom/Presentation: Not applicable
- Specialty: Dermatology
- Age: Premature Newborn
To Learn More
To view pediatric review articles on this topic from the past year check PubMed.
Evidence-based medicine information on this topic can be found at SearchingPediatrics.com, the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.
Information prescriptions for patients can be found at MedlinePlus for this topic: Hair Problems
To view current news articles on this topic check Google News.
To view images related to this topic check Google Images.
Illingworth RS. Common Symptoms of Disease in Children. Blackwell Scientific Publications: Oxford. 1988:355-56.
Hurwitz S. Clinical Pediatric Dermatology. 2nd Edit. 1993;501-504.
Baumeister FA, Schwarz HP, Stengel-Rutkowski S. Childhood hypertrichosis: diagnosis and management. Arch Dis Child. 1995 May;72(5):457-9.
Vashi RA, Mancini AJ, Paller AS. Primary generalized and localized hypertrichosis in children. Arch Dermatol. 2001 Jul;137(7):877-84.
Rudolph CD, et.al. Rudolph’s Pediatrics. 21st edit. McGraw-Hill, New York, NY. 2003:1213-1214.
Durmazlar SP, Tatlican S, Eskioglu F. Localized hypertrichosis due to temporary henna tattoos: report of three cases. J Dermatolog Treat. 2009;20(6):371-3.
ACGME Competencies Highlighted by Case
1. When interacting with patients and their families, the health care professional communicates effectively and demonstrates caring and respectful behaviors.
2. Essential and accurate information about the patients’ is gathered.
5. Patients and their families are counseled and educated.
10. An investigatory and analytic thinking approach to the clinical situation is demonstrated.
11. Basic and clinically supportive sciences appropriate to their discipline are known and applied.
13. Information about other populations of patients, especially the larger population from which this patient is drawn, is obtained and used.
17. A therapeutic and ethically sound relationship with patients is created and sustained.
Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa Children’s Hospital
Pediatric Education 