Letters to the Editor

Minoxidil‑Induced Hypertrichosis in a Child with Alopecia Areata

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

Figure 1: Hypertrichosis over forehead with lack of eyebrows due to alopecia areata Figure 2: Hypertrichosis with ophiasis pattern of alopecia areata

Indian Dermatology Online Journal | Volume 8 | Issue 2 | March‑April 2017 147 Letters to the Editor discouraged in the pediatric age group. If required, lower hypertrichosis during treatment with 5% topical minoxidil. Br J concentration (2%) of minoxidil in gel‑based formulation Dermatol 1997;136:118‑20. should be used in pediatric age group because of relative 4. González M, Landa N, Gardeazabal J, Calderon MJ, Bilbao I, safety. Over the counter sale of minoxidil should be Diaz Perez JL. Generalized hypertrichosis after treatment with topical minoxidil. Clin Exp Dermatol 1994;19:157‑8. restricted completely or to a minimum concentration of 5. Roy K, Forman S. Miscellaneous topical agents. In: Wolverton S, preparation. Editor. Comprehensive dermatologic drug therapy. 3rd ed. Financial support and sponsorship Philadelphia: Elsevier; 2013. p. 629‑35. 6. Guerouaz N, Mohamed AO. Minoxidil induced hypertrichosis in Nil. children. Pan Afr Med J 2014;18:8. Conflicts of interest This is an open access article distributed under the terms of the Creative Commons There are no conflicts of interest. 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 Ajay Kumar Rai creations are licensed under the identical terms. Department of Dermatology, Era’s Lucknow Medical College and Hospital, Uttar Pradesh, India Access this article online Address for correspondence: Quick Response Code Dr. Ajay Kumar Rai, Website: Department of Dermatology, Era’s Lucknow Medical College and www.idoj.in Hospital, Uttar Pradesh, India. E‑mail: [email protected] DOI: References 10.4103/2229-5178.202269 1. Lorette G, Nivet H. Diffuse hypertrichosis caused by minoxidil in a 2‑and‑a‑half‑year‑old child. Ann Dermatol Venereol 1985;112:527‑8. How to cite this article: Rai AK. Minoxidil-induced hypertrichosis in a 2. Kaler SG, Patrinos ME, Lambert GH, Myers TF, Karlman R, child with alopecia areata. Indian Dermatol Online J 2017;8:147-8. Anderson CL. Hypertrichosis and congenital anomalies associated April, 2016. June, 2016. with maternal use of minoxidil. Pediatrics 1987;79:434‑6. Received: Accepted: 3. Peluso AM, Misciali C, Vincenzi C, Tosti A. Diffuse © 2017 Indian Dermatology Online Journal | Published by Wolters Kluwer - Medknow

Laugier–Hunziker Syndrome in a Young Female

Sir, macules [Figure 2b]. She was otherwise healthy with no Laugier–Hunziker syndrome (LHS) is a rare, complaints of any abdominal pain, diarrhoea, vomiting, acquired, disorder of pigmentation characterized by fatigue, and weight loss; she was not receiving any hyperpigmentation of lips, oral mucosa, and longitudinal medication (including antimalarials or minocycline). melanonychia. The disease is a diagnosis of exclusion No family history of any mucocutaneous disorder was and is diagnosed mainly on the basis of clinical and present. There was no history of any trauma prior to the histopathological features. This benign disease mostly pigmentation. General physical and systemic examination manifests in adults with no systemic features or malignant was normal. Routine hematological and biochemical potential. Early identification of LHS helps in ruling out investigations were within normal limits. Serum cortisol other severe syndromes associated with mucocutaneous level was also normal. X‑ray of the chest, ultrasound of the hyperpigmentation and malignant potential such as abdomen, endoscopy, and echocardiography were normal. Peutz–Jeghers syndrome. A 19‑year‑old female attended The histopathology of skin biopsy taken from the plantar our department with a history of hyperpigmentation lesion showed hyperkeratosis and acanthosis [Figure 3a]. on nails of fingers and toes with longitudinal Basal cell hyperpigmentation was scanty with few melanonychia, which had developed gradually over the melanocytes [Figure 3b]. Patient was diagnosed as a last 8–9 years [Figure 1a and b]. Patient also complained classical case of LHS. LHS is a rare disorder which was of pigmentation on the lower lip and tongue for the last first described by Laugier and Hunziker in 1970.[1] It is an 5 years [Figure 2a]. Hyperpigmented lesions were also acquired, benign pigmentary skin condition characterized present over the soft and hard palate. There were no by diffuse oral hypermelanosis with pigmentation of ulcers in the mouth, and orodental hygiene was good. the nails and longitudinal melanonychia.[2] Cutaneous Examination of hands and feet showed hyperpigmented manifestations can also be present in other areas of macules over the tips of all fingers and toes. The volar body and the term “idiopathic lenticular mucocutaneous aspect of finger tips and soles also had few pigmented pigmentation” has also been used.[3] This syndrome

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