eMedicine Specialties > Dermatology > Diseases of the Adnexa

Congenital Hypertrichosis Lanuginosa: Treatment & Medication

Author: Sarah K Taylor, MD, Resident Physician, Department of Dermatology, Walter Reed Army Medical Center and National Naval Medical Center
Coauthor(s): Kenneth J Galeckas, MD, Assistant Professor, Department of Dermatology, Uniformed Services University of the Health Sciences; Staff Dermatologist, Director, Laser and Cosmetic Clinic, Intern and Medical Student Coordinator, Department of Dermatology, National Naval Medical Center
Contributor Information and Disclosures

Updated: Jun 18, 2009

Treatment

Medical Care

  • The use of eflornithine (Vaniqa cream), 13.9% or hair removal by means of repeated shaving, depilatory methods (eg, chemical, electric methods), or bleaching can improve congenital hypertrichosis lanuginosa (CHL) patients’ appearance.
  • Older techniques of hair removal are mentioned in the literature; these rarely used techniques include diathermy and radiation therapy.
  • Clinicians should consider the use of antidepressant medications in patients with psychological sequelae, including depression.

Surgical Care

  • Laser hair removal has been proposed as a treatment option, although there are conflicting reports regarding the proposed efficacy of lasers in removing the vellus hairs in congenital hypertrichosis lanuginosa.
  • Littler found a 40-80% reduction in unwanted hair using the Q-switched Nd:YAG laser after the application of a topical carbon-based solution. This therapy may be a well-tolerated method of hair removal in children because the lower fluences required resulted in decreased associated pain during treatment.
  • Vashi et al suggest that because of the difference in the penetrance of laser light into nonpigmented hair versus pigmented hair, laser therapy may not be effective in unpigmented lanugo or vellus hairs .20

Consultations

  • Genetic consultation may be indicated for the family members of patients with congenital hypertrichosis or Ambras syndrome.
    • Congenital hypertrichosis lanuginosa and Ambras syndrome may have an autosomal dominant pattern of inheritance; however, an association with a genetic defect has not been demonstrated in all patients.
    • Belengeanu et al describe 2 siblings with purported Ambras syndrome born to normal parents and propose that these patients might represent either an autosomal recessive pattern or germline mosaicism.35
  • Psychiatric evaluation may be indicated in patients in whom the physical findings of the syndrome cause psychological morbidity.

Medication

The goal of pharmacotherapy is to improve the patient's appearance.

Dermatologic agents

Agents with antiprotozoal action (eg, eflornithine) are effective in patients with hypertrichosis.


Eflornithine (Vaniqa cream, 13.9%)

Indicated for reduction of unwanted facial hair in women. Interferes with ornithine decarboxylase in skin hair follicles needed for hair growth. Not a depilatory but appears to retard hair growth to improve the condition and patient's appearance. Slows hair growth and improves appearance where applied. Improvement may be seen in 4-8 wk to 6 mo. Clinical studies show that hair returns to previous condition 8 wk after treatment stopped. Studied only on face and adjacent involved areas under chin of individuals with hypertrichosis; therefore, limit use in these areas. Patients will likely need to continue hair-removal methods with eflornithine.

Adult

Apply thin layer to affected and adjacent areas q8h; do not wash treated areas for at least 4 h after application

Pediatric

Not established

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

For external use only; transient stinging or burning may occur when applied to abraded or broken skin; reported adverse effects include acne, pseudofolliculitis, headache, dry skin, pruritus, erythema, skin irritation, rash, cheilitis, lip swelling, contact dermatitis, rosacea, bleeding skin, herpes simplex, and numbness

More on Congenital Hypertrichosis Lanuginosa

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Differential Diagnoses & Workup: Congenital Hypertrichosis Lanuginosa
Treatment & Medication: Congenital Hypertrichosis Lanuginosa
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Multimedia: Congenital Hypertrichosis Lanuginosa
References
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References

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Further Reading

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Keywords

congenital hypertrichosis lanuginosa, CHL, congenital hypertrichosis universalis, hypertrichosis universalis, hypertrichosis lanuginosa universalis, hypertrichosis disorders, hypertrichosis syndromes, Ambras syndrome, persistent hypertrichosis universalis, hirsutism, dog-men, hair-men, human Skye terriers, ape-men, werewolves, Homo silvestris, hypertrichosis of the dog-men, lanugo hair

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Contributor Information and Disclosures

Author

Sarah K Taylor, MD, Resident Physician, Department of Dermatology, Walter Reed Army Medical Center and National Naval Medical Center
Disclosure: Nothing to disclose.

Coauthor(s)

Kenneth J Galeckas, MD, Assistant Professor, Department of Dermatology, Uniformed Services University of the Health Sciences; Staff Dermatologist, Director, Laser and Cosmetic Clinic, Intern and Medical Student Coordinator, Department of Dermatology, National Naval Medical Center
Kenneth J Galeckas, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society for Dermatologic Surgery, and Association of Military Dermatologists
Disclosure: Nothing to disclose.

Medical Editor

Leonard Sperling, MD, Chair, Professor, Department of Dermatology, Uniformed Services University of the Health Sciences
Leonard Sperling, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey P Callen, MD, Professor of Medicine, Chief, Division of Dermatology, University of Louisville School of Medicine
Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and American College of Rheumatology
Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Honoraria Consulting; Centocor Honoraria Consulting; Genetech Honoraria Consulting; Celgene Honoraria Consulting

CME Editor

Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital
Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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