Hirsutism (hypertrichosis, hypertrichia, polytrichia,)

HIRSUTISM, hypertrichosis, hypertrichia, polytrichia, hirsuties and others, an excess of hair covering, expressed by an excessive number, length, thickness, or color of hair not native to the given place, sex, or age of the patient. This concept also includes increased hair growth rate at their natural localization, such as immoderate length of beard, head, genital, and other hair. Clinically, the following forms can be distinguished: I. Congenital. 1. Hirsutis lanuginosa foetalis (Brandt)—the entire surface of the skin is fully symmetric, except for areas where hair follicles are absent (palms, soles, prepuce, dorsal surfaces of terminal phalanges, etc.), but including the face, covered with long, thin, silky, and wavy hair like a poodle (“dog people”, see figure 1). A very rare anomaly, progressing to puberty and remaining in that state until death. Often exists together with physical development defects, especially with dystrophic aplasia of teeth. The hair bears an embryonic character. The pathogenesis is reduced to hypertrophy and persistence of embryonic hair. 2. Congenital local hirsutism—presence on sharply limited areas of the skin cover of abundant, various shades, straight or curly hair. In some cases, hair grows on pigmented skin—naevi pilosi; in others—on unchanged skin, as happens, for example, on the sacrum (“fawn’s tuft”). The pathogenesis is reduced to a congenital developmental defect of the nevus type.—II. Acquired. 1. Interscapular hirsutism—dense, long, vellus hair in the upper part of the back, between the shoulder blades, in tubercular children and adolescents. 2. Traumatic, or irritative hirsutism—intensified transformation of vellus hair into adult hair around chronic ulcers of any etiology or osteoperiostitis; at places of long-term application of irritating skin ointments, plasters, solutions, etc.; at areas innervated by a partially damaged nerve (Villa-ret). In these cases, along with hirsutism, hyperhidrosis also exists. 3. Pubertal hirsutism of virgins—intensified and rapid growth of vellus hair on the upper lip, chin, or cheeks in girls during the period of puberty with normal function of the genital organs and female build. Often, at the same time, vellus hair on the trunk and limbs also transforms into adult hair. 4. Climacteric hirsutism—appearance of hair on the lip, chin, sometimes on the cheeks in women from the climacteric period, sometimes with progressive hair loss on the head, with baldness close to male type, with their scarcity on the genitals, and along with the development of virilism signs. 5. Hirsutis alienarum (according to Dupre and Duflos)—growth of hair on the chin and upper lip; occurs significantly more often in mentally ill women than in mentally healthy ones. 6. Virilism hirsutism: a) mild form—appearance in an adult woman as the only male sign of a real beard while all other female distinctive features and functions are preserved (“bearded women”, see figure 2); many of such women suffer from a sharp metabolic disorder in the form of dietary glucosuria, along with large stature, obesity, and male voice; b) full form—gradual and sharp loss by an adult woman of distinctive female features and functions, with acquisition of male features and growth of hair in the male type; c) Apert’s hirsutism (see Hirsutismus); d) Hirsutis at pubertas praecox—premature, relative to age, development of secondary sexual signs with rapid body and external genital growth, sometimes along with premature sexual function; 55 e) Intermittent hirsutism—rare cases when a beard temporarily develops in women during pregnancy, disappearing shortly after childbirth (Slocum), or when with cessation of menstruation, decline in nutrition, and anemia, body hair intensively, starting from the calves, grows, again transforming into vellus hair from the moment of improvement of the general condition and appearance of menstruation (L. M. Ivanov). Pathogenesis. The causes of hirsutism, especially acquired and symmetric, have only begun to be elucidated in recent years. Facts accumulating indicate the dominant role of the endocrine apparatus in trihogenesis. The appearance of hair of maturity from the puberty period in both sexes and the special type of their location, predominantly on the pubis in men and women, clearly indicate the role of the gonads in trihogenesis, at least of known sections of the hair covering, which is confirmed by the clinical picture at pubertas praecox, the possibility of improving hair covering in humans and animals under the influence of rejuvenation operations by Voronov or Steinach, etc. On the other hand, the absence of vegetation on the face, with full preservation on the head, in castrated men and the possibility of appearance of hair growth on the face, with thinning on the vertex, in castrated, climacteric, or women suffering from ovarian sclerosis, give the right to think that in trihogenesis also participate other hormonal glands. Of the facts in this regard, the following can be mentioned as more obvious: the presence of hypernephroma in acquired virilism in adults, with the disappearance of all phenomena, including hypertrichosis, after the operation of tumor removal (Mauclair, Gordon, Holmes); heterosexual hypertrichosis in Apert’s hirsutism, sufficiently shading the role of the adrenal cortex in the etiology of hirsutism. Decrease in thyroid gland function causes weak hair growth, their loss, and even graying. In hyperthyroidism, even long before the appearance of its cardinal symptoms, intensified hair growth may be observed (Chvostek). Hypertrophy and hyperplasia of hair along with accelerated their growth in early stages of acromegaly and improvement of animal wool with injections of extract from the pituitary gland also indicate the trihogenic function of the appendage of the brain. There are also some facts, as if marking the influence of parathyroid glands and pineal gland on hair covering growth.—Treatment. The facts cited, indicating the stimulating influence of hormones of the entire endocrine apparatus on hair growth, have not yet given tangible results in practical terms for the therapy of hirsutism. Practically, for facial hirsutism in women, the following are applied: 1) bleaching of vellus hair with perhydrol or perhydrol ointment; 2) the method of “polishing” mentioned in the Talmud and Koran, using a piece of pumice after preliminary washing with soap and hot water, followed by the application of cold cream; repeating this procedure once in 7–10 days in the same place, a perfect result is obtained after many months (Sabouraud, M6rian); 3) electrolytic epilation, developed from the technical side by Broc. Attempts at local application of ointment from lead acetate (1%) are risky due to the danger of obtaining hair loss on the head and eyebrows. Epilation by X-rays on the face must be categorically rejected due to the risk of developing, even after several years, an atrophic dermatitis with telangiectasias and pigmentary disturbance.