hypertrichosislanugocyclosporineeflornithine

Hypertrichosis

היפרטריכוזיס

📖 מבוא

Hypertrichosis — גידול יתר של שיער beyond normal for age, sex, and ethnicity (NOT androgen-dependent — DDx hirsutism). Congenital vs acquired. Generalized vs localized. Drug-induced common (minoxidil, cyclosporine, phenytoin). Bologna Ch 95.

📝 אנמנזה

שיער יתר — כללי או ממוקם? מלידה או נרכש? תרופות — cyclosporine, minoxidil, phenytoin, diazoxide, corticosteroids? מחלות: thyroid, anorexia nervosa, porphyria? היסטוריה משפחתית?

🔍 בדיקה

Generalized: vellus or terminal hair increase over entire body. Localized: specific areas — nevoid hypertrichosis, congenital melanocytic nevus (hairy nevus), hypertrichosis cubiti (elbows). ⚠️ Lanugo hair acquisition (fine, soft, generalized) — consider underlying malignancy or anorexia nervosa. Drug-induced: usually vellus, diffuse, reversible.

📋 סיכום

היפרטריכוזיס. יש לברר אטיולוגיה ולהבדיל מהירסוטיזם.

💊 המלצות

📋 מידע כללי

-DDx from hirsutism (CRITICAL): Hirsutism = androgen-dependent, terminal hair in male pattern (face, chest, linea alba) in women. Check: free testosterone, DHEA-S, 17-OHP (CAH). Hypertrichosis = NON-androgen-dependent, anywhere, any sex. ⚠️ If female with male-pattern hair + irregular menses → hirsutism workup (PCOS, adrenal tumor, CAH).

💊 טיפול

-אטיולוגיות נרכשות: תרופות — Cyclosporine (generalized hypertrichosis, 60-80% of transplant patients), Minoxidil (topical→local, oral→generalized), Phenytoin/valproic acid, Diazoxide, Corticosteroids (vellus). מחלות — Anorexia nervosa (lanugo hair, malnutrition), Hypothyroidism, Porphyria cutanea tarda (face, forearms), Dermatomyositis. ⚠️ Acquired hypertrichosis lanuginosa ("malignant down") — rapid onset lanugo → search for internal malignancy (lung, colon, breast).

-טיפול: Treat underlying cause (stop drug, treat disease). Hair removal: Laser hair removal (Nd:YAG for darker skin, alexandrite for lighter — most effective long-term). IPL (intense pulsed light). Eflornithine (Vaniqa) 13.9% cream x2/d — slows facial hair growth (inhibits ornithine decarboxylase). Electrolysis — permanent but slow. Shaving, waxing, depilatory creams (temporary). ⚠️ Cyclosporine — switching to tacrolimus may reduce hypertrichosis.

📅 מעקב

-ביקורת בעוד חודש-חודשיים.

⚗ מרשם

-Topical EFLORNITHINE (Vaniqa) 13.9% Crm x2/d to affected facial areas - 1OP