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Case Report

Minoxidil induced hypertrichosis in a 2 year-old child

[version 1; peer review: 2 approved]
PUBLISHED 28 Oct 2013
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Abstract

We report a case of a 2 year-old male patient who developed generalized hypertrichosis after 2 months of treatment with 5% minoxidil foam for alopecia areata. This report highlights the danger of prescribing  topical minoxidil to young children and the need to correctly instruct caretakers about its administration.

Case

Topical minoxidil is widely utilized as an off-label therapy for alopecia areata in adults and children. We report here a case of generalized hypertrichosis in a 2 year old child.

The patient was a 2-year old hispanic boy with no other significant medical history, who was affected by patchy alopecia areata involving 40% of the scalp since the age of 1 year. Three months before the patient came to our clinic he was prescribed 5% minoxidil foam to be applied to affected areas of the scalp twice a day. After two months the parents noticed hair regrowth but also growth of long pigmented hairs on his face, trunk and limbs. The patient’s mother admitted that she had possibly been applying more product than originally instructed.

Clinical examination showed patchy alopecia areata involving 10% of the scalp and generalized hypertrichosis (Figure 1). No other side effects were observed. The patient was referred to a pediatric endocrinologist who excluded underlying endocrinological abnormalities. Minoxidil was discontinued and considerable clinical improvement of the hypertrichosis and the scalp alopecia areata was observed at two month follow up.

3e2a8715-425e-4485-b175-2240edd9cb1b_figure1.gif

Figure 1. Note the augmented number and thickness of hairs in the back and face of this young child caracterizing hypertrichosis.

Discussion

Minoxidil affects hair growth through incompletely understood mechanisms; known effects include increased duration of the anagen growth phase, agonistic affects on adenosine-triphosphate (ATP)-sensitive potassium channels, and prostaglandin stimulation in the dermal papillae. It is clinically indicated as a therapy for androgenetic alopecia, however off-label uses include topical application in alopecia areata in both adults and children.

Systemic administration of minoxidil either by oral administration to the mother during pregnancy or by oral ingestion by the child, has led to rarely reported instances of diffuse hypertrichosis in children1,2 and newborns via maternal–fetal transmission3,4.

Hypertrichosis is a common side effect of topical minoxidil treatment in women. Although usually localized to the face, it may occasionally involve limbs and other body areas5,6. To our knowledge there are no reports of generalized hypertrichosis in a pediatric population.

Systemic absorption of the drug is typically minimal with topical therapy, with 1.4% of the applied dose being absorbed7. However, hypotheses on the pathogenesis of the diffuse hypertrichosis reaction routinely include systemic absorption, as well as high sensitivity of the follicular apparatus to minoxidil5. In our patient, the excessive dose (both in terms of concentration and daily quantity) in combination with the patient’s low body weight favoured systemic adsorption. Further support for systemic effects are noted in the reported cardiovascular side affects in three patients from 10 to 14 years of age treated for alopecia areata with minoxidil 2% topically twice a day8. These effects included sinus tachycardia, sensation of palpitation and dizziness.

Conclusion

The efficacy of topical minoxidil in alopecia areata has never been definitively proven9. The possibility of systemic absorption contraindicates, in our opinion, this treatment in young children, who can develop serious cutaneous or systemic side effects. Furthermore, there are some alternative treatments of alopecia areata in children that are considered safer, for example topical immunotherapy and topical anthraline application.

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VERSION 1 PUBLISHED 28 Oct 2013
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Herskovitz I, Freedman J and Tosti A. Minoxidil induced hypertrichosis in a 2 year-old child [version 1; peer review: 2 approved]. F1000Research 2013, 2:226 (https://doi.org/10.12688/f1000research.2-226.v1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
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Open Peer Review

Current Reviewer Status: ?
Key to Reviewer Statuses VIEW
ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions
Version 1
VERSION 1
PUBLISHED 28 Oct 2013
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Reviewer Report 11 Nov 2013
Johannes Steffen Kern, Department of Dermatology and Venereology, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany 
Approved
VIEWS 13
This is a well-written and instructive case report. It emphasizes that minoxidil, which is not a standard first line therapy in alopecia areata, should probably not be used in young children because of possible side effects.

Some comments:
  1. Detailed information about the
... Continue reading
CITE
CITE
HOW TO CITE THIS REPORT
Kern JS. Reviewer Report For: Minoxidil induced hypertrichosis in a 2 year-old child [version 1; peer review: 2 approved]. F1000Research 2013, 2:226 (https://doi.org/10.5256/f1000research.2444.r2221)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
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11
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Reviewer Report 05 Nov 2013
Mohamed Badawy Hassan Tawfik Abdel-Naser, Faculty of Medicine, Ain Shams University, Cairo, Egypt 
Approved
VIEWS 11
This case report is well written and informative. Here are a few comments:

1. "The patient was referred to a pediatric endocrinologist who excluded underlying endocrinological abnormalities."

- It would be very helpful if a short paragraph about the possible endocrinologic causes ... Continue reading
CITE
CITE
HOW TO CITE THIS REPORT
Abdel-Naser MBHT. Reviewer Report For: Minoxidil induced hypertrichosis in a 2 year-old child [version 1; peer review: 2 approved]. F1000Research 2013, 2:226 (https://doi.org/10.5256/f1000research.2444.r2220)
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.

Comments on this article Comments (0)

Version 1
VERSION 1 PUBLISHED 28 Oct 2013
Comment
Alongside their report, reviewers assign a status to the article:
Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions
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