178
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Minoxidil-Induced Hypertrichosis in a Child with Alopecia Areata

      letter
      Indian Dermatology Online Journal
      Medknow Publications & Media Pvt Ltd

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Sir, Here, we are reporting development of severe hypertrichosis in a 3-year-old child with alopecia areata secondary to topical minoxidil, a commonly used off-label topical therapy for the same. A 3-year-old male child developed acute onset multiple bald patches diffusely distributed over the scalp (30% scalp area), along with loss of eyebrows. Parents started twice daily application of 5% minoxidil lotion on suggestion of a chemist and continued the same for more than 2 months without any dermatological consultation. No standard method of application of minoxidil was followed and it was applied as ordinary hair oil (2 times a day in liberal amount, 3 bottles of 60 ml were used in 2 months). There was no significant improvement in bald patches; however, slowly the boy developed hypertrichosis over forehead, cheek and neck [Figures 1 and 2]. No other cutaneous or systemic side-effects were noticed by parents during minoxidil use. No other topical or systemic medications (such as steroids) were used before or during minoxidil use. General physical and cutaneous examination of the child was within normal limit, excluding any other systemic cause for hypertrichosis. No serum hormonal investigations were performed due to lack of clinical indication. Parents were counselled regarding the cause of excessive hair growth and advised to discontinue minoxidil use. Figure 1 Hypertrichosis over forehead with lack of eyebrows due to alopecia areata Figure 2 Hypertrichosis with ophiasis pattern of alopecia areata Pharmacologically, minoxidil, originally manufactured as an antihypertensive drug, is mainly used for alopecia. It affects hair growth through various plausible mechanisms such as increased duration of the anagen growth phase, agonistic effects on adenosine-triphosphate (ATP)-sensitive potassium channels, and prostaglandin stimulation in the dermal papillae. Though it is primarily approved for androgenetic alopecia of both sexes, its off-label uses include topical application in alopecia areata. There have been several reports of systemic administration of minoxidil either by oral administration to the mother during pregnancy or by oral ingestion by the child, leading to diffuse hypertrichosis of the newborn and children.[1 2] Hypertrichosis is also a common side effect of topical minoxidil use more commonly seen in women. Systemic absorption of the drug is <2% with topical therapy. It is usually localized to the head and neck; it may occasionally involve other body areas.[3 4 5] Severe affection by topical use, as in our case, is uncommonly reported.[6] Hypertrichosis caused by topical minoxidil depends on various factors such as higher amount or concentration of application, excessive systemic absorption, and high sensitivity of the follicular apparatus to minoxidil. In our patient, the high dose and unsupervised application (both in terms of concentration and daily quantity) in combination with the patient's low body weight and age favored the development of hypertrichosis. The efficacy of topical minoxidil in alopecia areata has never been definitively proven. Because of higher chances of adverse effects, use of topical minoxidil should be discouraged in the pediatric age group. If required, lower concentration (2%) of minoxidil in gel-based formulation should be used in pediatric age group because of relative safety. Over the counter sale of minoxidil should be restricted completely or to a minimum concentration of preparation. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

          Related collections

          Most cited references6

          • Record: found
          • Abstract: found
          • Article: not found

          Diffuse hypertrichosis during treatment with 5% topical minoxidil.

          Five women affected by androgenetic alopecia developed severe hypertrichosis of the face and limbs after 2-3 months of treatment with 5% topical minoxidil. Minoxidil was discontinued and in all patients the hypertrichosis disappeared from the face and arms after 1-3 months, and from legs after 4-5 months. Systemic absorption of minoxidil, and a high sensitivity to minoxidil of the follicular apparatus in these areas, is hypothesized.
            Bookmark
            • Record: found
            • Abstract: not found
            • Article: not found

            Hypertrichosis and congenital anomalies associated with maternal use of minoxidil.

              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Generalized hypertrichosis after treatment with topical minoxidil.

              Generalized hypertrichosis is a common side-effect of oral minoxidil treatment for hypertension. However, hypertrichosis is uncommon after treatment with topical minoxidil for alopecia, and normally only occurs in areas close to the site of application. A 16-year-old girl is presented who developed generalized hypertrichosis 3 months after applying topical minoxidil for treatment of diffuse alopecia in doses greater than that prescribed. Four months after discontinuing treatment, the abnormal hair gradually diminished and disappeared.
                Bookmark

                Author and article information

                Journal
                Indian Dermatol Online J
                Indian Dermatol Online J
                IDOJ
                Indian Dermatology Online Journal
                Medknow Publications & Media Pvt Ltd (India )
                2229-5178
                2249-5673
                Mar-Apr 2017
                : 8
                : 2
                : 147-148
                Affiliations
                [1] Department of Dermatology, Era's Lucknow Medical College and Hospital, Uttar Pradesh, India
                Author notes
                Address for correspondence: Dr. Ajay Kumar Rai, Department of Dermatology, Era's Lucknow Medical College and Hospital, Uttar Pradesh, India. E-mail: raigeorgian@ 123456gmail.com
                Article
                IDOJ-8-147
                10.4103/2229-5178.202269
                5372443
                28405563
                4ca08029-1a0c-4292-a2fa-5c6030b5d0a0
                Copyright: © 2017 Indian Dermatology Online Journal

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                : April 2016
                : June 2016
                Categories
                Letters to the Editor

                Dermatology
                Dermatology

                Comments

                Comment on this article