Facial hair growth in a patient with psoriasis

Case

A woman, 47 years of age, with chronic plaque-type psoriasis for the past 18 years but otherwise healthy, presented complaining of facial hair growth three months after starting systemic cyclosporine therapy (3.5 mg/kg/day). The patient had been previously treated with topical agents and narrowband ultraviolet B (NB-UVB) phototherapy. On physical examination, she had marked facial hair growth and improvement of psoriasis severity (Figure 1). No other skin lesions or symptoms were detected.

Question 1

What is the pathogenesis of this phenomenon?

Question 2

What is the most likely aetiology for hypertrichosis in this patient?

Question 3

Are there other possible side effects?

Question 4

How would you manage this patient?

Answer 1

Hypertrichosis is excessive hair growth on any part or whole of the body, compared with people of the same age, sex and racial group.1 The underlying pathogenesis remains unknown.2,3 Hypertrichosis is usually classified as generalised or localised. Each of these types is further divided into congenital and acquired subtypes.1 It can be a manifestation of a more general medical problem. The possible causes of acquired hypertrichosis are summarised in Table 1.1

Hypertrichosis must not be confused with hirsutism, which is defined as androgen-induced growth of terminal hair in women and children, in a male pattern distribution. Hirsutism is androgen-dependent, whereas hypertrichosis is not.1

Answer 2

The most likely aetiology for hypertrichosis in...