Hypertrichosis due to lanugo hair growth can be aquired as a consequence of medical problems

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Acquired Hypertrichosis Lanuginosa (AHL)

The excessive hair growth in hypertrichosis is mainly a cosmetic problem but the disorder could also be a sign of underlying medical problems. This is the reason for using hypertrichosis as a tool for diagnosis of those problems.

To facilitate study of hypertrichosis the disorder has been classified as generalized hypertrichosis and localized hypertrichosis. Each of these two types has been further sub-divided into congenital and acquired sub-types. The acquired sub-types, of which acquired generalized hypertrichosis is a part, are more common.

Hypertrichosis involves three types of hairs. These are lanugo, vellus and terminal hairs. Acquired generalised hypertrichosis involves more commonly vellus hairs. In the very rare cases when it involves pre-natal lanugo hairs the disorder is called acquired hypertrichosis lanuginosa (AHL).

Acquired hypertrichosis lanuginosa is a well-known disorder. It typically manifests as a sudden growth of long, fine, lanugo-like light colored hair. Also known as “malignant down”, it involves a late cutaneous manifestation of some internal malignancy and usually occurs in patients with widely spread or advanced disease. This association of AHL with malignancy was first observed in 1865. The disorder appears when normal hair follicles suddenly revert to pre-natal lanugo hairs. Distinguishing feature of this disorder is the typical craniocaudal spread of the lanugo hairs. This lanugo hair may vary from dense to downy hair and grows usually on the face.

AHL is most commonly associated with abnormalities of the lung and colon. Less frequently it is also associated with lymphomas, bronchus cancer It has also been reported with malignancies of gall bladder, the rectum, kidney, pancreas, breast, ovary and uterus. AHL has also been observed with other cutaneous internal abnormalities such as acanthosis nigrican and acquired ichthyosis. It has been observed that any neoplasia is preceded and followed by hypertrichosis and the sudden appearance justifies a thorough investigation into any malignancy.

Often Acquired Hypertrichosis Lanuginosa is accompanied by abnormalities such as burning or painful tongue, hypertrophied pappilae, prominent furrows and/or oral pigmentation. In such cases presence of AHL alone, particularly with tongue abnormalities, is reason enough for further investigation for a source.

The hair growth in Acquired Hypertrichosis Lanuginosa (AHL) is generalized and un-pigmented or lightly pigmented. The hair is not as long as in congenital hypertrichosis lanuginose, though there are exceptions.

Acquired hypertrichosis lanuginosa associated with cancer

AHL could be the first clue to an underlying cancer. In a group of 34 affected patients 15 were found with AHL before malignancy was detected about two years later. This period of two years between occurrence of AHL and detection of cancer probably accounts for the well-noted rare cases of AHL without any associated malignancy. These may be due to premature reporting or lack of adequate investigation. Further investigation has usually revealed, previously undetected, underlying cancer.

No one type of cancer is associated with Acquired Hypertrichosis Lanuginosa but cancer associated with Acquired Hypertrichosis Lanuginosa appearing with the cutaneous malignancy, acanthosis nigrican, has always been adenocarcinoma. Metastatic adenocarcinoma patients have increased hair growth in the pubic, axillary, chest and abdominal areas. Well worth noting is the fact that cancer producing embryonic antigen have been found in the intestines, liver and pancreas of the foetus during the third to the seventh month of pregnancy at a time when the pre-natal lanugo hairs are also growing

The lack of any consistency in endocrinal abnormalities has led to many speculations regarding the cause of this disorder. One of the hypotheses is that a tumor secreted cancer factor stimulates hair growth leading to acquired hypertrichosis lanuginose. Endocrine type secretory granules were examined by electron microscope in the tumor of a type of colon cancer but the tumor tested negative for epidermal growth factor. Elevated cancers causing embryonic antigens were found in some cases but their link with acquired hypertrichosis lanuginosa could not be established.

In cases of Acquired Hypertrichosis Lanuginosa induced by cancer, successful surgical removal of the cancer affected part has produced reduction of excessive hair growth.

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