Hypotrichosis

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What is hypotrichosis?

Hypotrichosis is the presence of less than the normal amount of hair on the head, eyelashes or body. Hypotrichosis disorders are a broad spectrum of hair loss conditions.

They are generally congenital and hereditary. The disorders are present at the time of birth or manifest in infancy and may remain with the affected patients throughout their lives.

In alopecia, the hair which is already present on the scalp or body is lost partially or wholly. However hypotrichosis is a state of hair loss right from the birth. The normal terminal hair may get replaced by soft, short and unpigmented vellus hair. Most of the congenital depilations are caused by defective embryonic growth or genetic aberrations. There is no known standard treatment for these hypotrichosis hair loss conditions.

These hypotrichosis disorders coexist with many other physical or mental problems. Disorders like Graham-Little syndrome, Hallermann–Streiff syndrome, Ofuji syndrome, congenital aplasia, alopecia triangularis, papular atrichia, metaphyseal chondrodysplasia, EEM Syndrome and cartilage-hair hypoplasia, manifest with the symptoms of hypotrichosis. There are hundreds of genetic congenital depilation disorders.

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Though these hypotrichosis disorders are commonly generalized, in some cases depilation lesions may occur at single or multiple sites. The severity of the congenital hair loss may vary depending upon the afflicting disorder and the patient's health status.

Hypotrichosis causes

The basic causes of these types of congenital hair loss are defective embryonic growth and genetic aberrations. There are hundreds of genetic hypotrichosis disorders.

Congenital and hereditary hypotrichosis

There are many hereditary and congenital forms of hypotrichosis. We may consider a few of them to understand the complex diversity of these genetic disorders.

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Hereditary hypotrichosis simplex (HHS) affected patients have normal hair at birth, but with progress of age hair is diffusely thinned. There is progressive hair follicle miniaturization. This congenital disorder is inherited either as an autosomal recessive trait or as an autosomal dominant trait. There is thinning of body hair, axillary hair, and pubic hair. The hair shafts of the eyebrows, eyelashes and male beard are found to be normal.

Localized autosomal recessive hypotrichosis affects both the scalp and body hair. In this congenital disorder, hairs get sparse, become fragile and break easily. Though scalp, eyebrows and eyelashes may be affected, beard, pubic and axillary hairs are generally spared. The patients may suffer from follicular papules, erythema and pruritus.

Marie Unna type of hypotrichosis (hereditary trichodysplasia) is characterized by the presence of a twisting hair dystrophy. This congenital hereditary disorder was reported by Marie Unna. Hairs of the scalp, body, eyebrows and eyelashes are involved and the disorder can progress into irreversible universal alopecia.

Eyelash hypotrichosis

In this disorder, there is inadequate or absence of eyelash. Loss of eyelash is not merely a cosmetic and aesthetic issue like most of us think, but is a medical condition.

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The depilation of eyelashes may be congenital and genetic. Certain diseases, cancer treatment, radiation, chemotherapy and certain neurotic habits can cause the loss of eyelashes. The absence of eyelashes mars the facial appearance. But there is a silver lining. Ophthalmic prostaglandin and prostamide analogs are used in the treatment of glaucoma. Incidentally these ocular hypotensive agents have been found to cause hypertrichosis (excessive growth of hair) of eyelashes. The use of bimatoprost (prostaglandin analog) 0.03% solution was approved by the US Food and Drug Administration (FDA) for the treatment of hypotrichosis of the eyelashes.

Congenital hypotrichosis treatment

There is no standard treatment available for these types of congenital hair loss. Hair loss of the eyelashes has been successfully treated with ophthalmic prostaglandin and prostamide analogs.

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Reference: 1.Simon K Law. Bimatoprost in the treatment of eyelash hypotrichosis. Clin Ophthalmol. 2010; 4: 349–358.

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Current topic on natural skin care: Hypotrichosis (congenital - eyelash) and treatment.