Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obervation Letter
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF
Net letter
2012:78:1;122-122
doi: 10.4103/0378-6323.90972
PMID: 22199084

Coexistence of acquired hypertrichosis and scalp alopecia in a patient with infiltrating ductal carcinoma

Ru-Zhi Zhang1 , Wen-Yuan Zhu2 , Lei Zhou3
1 Department of Dermatology, Hospital of Bengbu Medical College, Anhui 233004, China
2 Department of Dermatology, Hospital of Nanjing Medical University, Nanjing 210029, China
3 Department of Pathology, Hospital of Bengbu Medical College, Anhui 233004, China

Correspondence Address:
Wen-Yuan Zhu
Department of Dermatology, Hospital of Nanjing Medical University, Nanjing 210029
China
How to cite this article:
Zhang RZ, Zhu WY, Zhou L. Coexistence of acquired hypertrichosis and scalp alopecia in a patient with infiltrating ductal carcinoma. Indian J Dermatol Venereol Leprol 2012;78:122
Copyright: (C)2012 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Hypertrichosis is hair growth that is abnormal for the age, sex, or race of an individual, or for a particular area of the body. It is not only cosmetically disturbing, but the marker of an underlying disease also. [1] Alopecia areata (AA) is postulated to be an organ-specific autoimmune disease with genetic predisposition and an environmental trigger. Although hypertrichosis and scalp alopecia are common signs, coexistence of acquired hypertrichosis and scalp alopecia in the same patient with infiltrating ductal carcinoma is infrequent. Here, we describe this rare condition.

A 55-year-old woman visited our department for evaluation of asymptomatic alopecic areas since one year ago and progressive hypertrichosis over her entire body for 3 months. Two years ago, she was diagnosed with infiltrating ductal carcinoma of the right breast, T2N0M0, stage IIa, and received a modified radical mastectomy with total axillary lymph node dissection and six cycles of chemotherapy, which consisted of pemetrexed injection, cisplatin, capecitabine, and goserelin.

One year ago, the scalp alopecia developed without obvious causative factors; she had not sought medical advice about it. During the past three months, the patient observed many pigmented long and fine hairs occurring on her face, shoulders, and outer aspects of the arms and legs, and was increasing.

Physical examination revealed an apparently healthy woman with multiple, fine, long, pigmented hairs distributed diffusely on the forehead, nuchal region, shoulders, back, abdomen, and lateral aspects of the limbs. Bushy eyebrows and trichomegaly were also observed [Figure - 1]. The axillary and pubic hair appeared normal and there was no evidence of virilization. The scalp hair loss pattern was present as a combination of ophiasis and patches [Figure - 2]. The affected skin appears normal with no epidermal alteration grossly visible, such as scaling or follicular abnormalities. A punch biopsy at the outer edge of the lesion was performed, which did showed the pathological features of metastatic carcinoma compatible with primary tumor of the breast, but clinically indicated common AA.

Figure 1: Facial hypertrichosis (the hollowed arrows indicate the areas of hypertrichosis), bushy eyebrows, and trichomegaly
Figure 2: Scalp alopecia with smooth non-inflamed scalp and intact follicular openings

Comprehensive screening to rule out an underlying metastasis was undertaken. No suspected local recurrence or metastatic lesion was demonstrated, although CA153 level was significantly higher than the normal value. Without any treatments for AA and hypertrichosis, at a follow-up appointment 4 months later, regrowth of hairs on the alopecic area was seen, but hypertrichosis over the trunk and extremities almost remained unchanged.

Discussion

The mechanisms of hypertrichosis mainly involve two aspects: conversion of vellus to terminal hairs and changes of hair-growth cycle. [2] Another less well-established mechanism of hypertrichosis is an increase in hair follicle density. Systemic diseases, central nervous system diseases, and some drugs could cause hypertrichosis. [3] In our patient, no history of treatment with any drugs related with hypertrichosis, none of the systemic and central nervous system diseases were diagnosed, except for infiltrating ductal carcinoma. It is worth noting that the hair excess presenting as vellus-type hypertrichosis, implying the conversion of vellus to terminal hairs, other than as lanugo type-acquired hypertrichosis, which frequently appears in those patients with malignant tumors. Therefore, we propose that the generalized hypertrichosis over the patient was caused by an as yet unidentified tumor-derived humoral factor may lead to a prolongation of the anagen phase of vellus hair follicles, resulting in hypertrichosis. [4]

If the patient has only hypertrichosis, the value of this report maybe pretty. It is intriguing and puzzling that acquired hypertrichosis and scalp alopecia coexisted in the same patient. To our knowledge, scalp hair loss occurring to a patient with malignant tumor is a frequent side effect of chemotherapy. Doxorubicin containing regimens produce near or total alopecia in most patients. The cyclophosphamide, methotrexate, and fluorouracil regimen was not associated with total hair loss but rather with generalized thinning. However, the scalp hair loss pattern in our patient presented as a combination of ophiasis and patches.

Considering that a rare sequelae of previously diagnosed breast carcinoma metastatic to the scalp is alopecia neoplastica (AN), breast cancer is the primary malignancy in 84% of patients with AN. [5] The punch biopsy of the scalp alopecia was performed, and the AN was ruled out. Four months after initial presentation, we noted that the hairs regrew on the scalp, although the regrowth hairs were not enough to cover the alopecic regions, and hypertrichosis remained unchanged. This observation suggests that some unknown factors impacting the hair growth in AA are eliminated or decreased, but the factors resulting in hypertrichosis were retained. We believe our observation will provide information for understanding of the pathogenetic mechanisms of the abnormal hair growth or loss and the possible relationship to internal malignant neoplasms.

References
1.
Wendelin D, Pope D, Mallory S. Hypertrichosis. J Am Acad Dermatol 2003;48:161-79.
[Google Scholar]
2.
Stenn KS, Paus R. Controls of hair follicle cycling. Physiol Rev 2001;81:449-94.
[Google Scholar]
3.
Trüeb RM. Causes and management of hypertrichosis. Am J Clin Dermatol 2002;3:617-27.
[Google Scholar]
4.
Uno H, Kurata S. Chemical agents and peptides affect hair growth. J Invest Dermatol 1993;101:143-7S.
[Google Scholar]
5.
Conner KB, Cohen PR. Cutaneous metastasis of breast carcinoma presenting as alopecia neoplastica. South Med J 2009;102:385-9.
[Google Scholar]

Fulltext Views
90

PDF downloads
77
Show Sections