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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 10  |  Issue : 5  |  Page : 229-230  

Acquired hypertrichosis localized on a subsiding psoriatic plaque after plaster application


Department of Experimental, Diagnostic and Specialty Medicine, Dermatology Unit, University of Bologna, Bologna, Italy

Date of Web Publication3-Dec-2018

Correspondence Address:
Ambra Di Altobr
Department of Experimental, Diagnostic and Specialty Medicine, Dermatology Unit, University of Bologna, Via Massarenti 1, 40138 Bologna
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijt.ijt_50_18

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   Abstract 


Postcast hypertrichosis is a common transient occurrence in orthopedic patients and generally resolves within a few months. Until now, two cases of localized hypertrichosis occurring on more than one pre-existing psoriatic lesions are reported in the literature. We describe the case of a patient who simultaneously developed a single psoriatic plaque and overlying localized hypertrichosis after plaster application. This concurrence is exceptional and may be explained by the expression of several growth factors and cytokines influencing both the hair cycle and the psoriatic inflammatory working.

Keywords: Hypertrichosis, plaster application, psoriasis


How to cite this article:
Di Altobr A, Patrizi A, Pazzaglia M. Acquired hypertrichosis localized on a subsiding psoriatic plaque after plaster application. Int J Trichol 2018;10:229-30

How to cite this URL:
Di Altobr A, Patrizi A, Pazzaglia M. Acquired hypertrichosis localized on a subsiding psoriatic plaque after plaster application. Int J Trichol [serial online] 2018 [cited 2018 Dec 12];10:229-30. Available from: http://www.ijtrichology.com/text.asp?2018/10/5/229/246802




   Introduction Top


We describe the case of a young woman who developed localized hypertrichosis and psoriasis on her left lower extremity following a fracture and plaster application. The sudden appearance of postcast hypertrichosis and post-traumatic psoriasis are well-known events if considered separately, but their concurrence is exceptional and may be explained by the expression of several growth factors and cytokines involved in the pathogenesis of both conditions.


   Case Report Top


A 23-year-old woman was seen because of excessive hair growth on a psoriasis plaque of her leg, following prolonged immobilization in a plaster. In fact, approximately 1 month before the visit, she was involved in a motor vehicle accident and fractured her leg.

She had a 9-year history of mild psoriasis vulgaris, successfully controlled by the topical application of coal tar and steroids. However, she had been completely free from psoriasis lesions for the last year without any treatment.

On physical examination, a round erythematous scaly plaque measuring 4 cm × 4 cm with tufts of hair was present on the extensor aspect of the left leg, localized on where the plaster had rubbed [Figure 1]. Excessive hair growth was not evident in any other body region. The clinical findings were consistent with both localized hypertrichosis secondary to plaster application and psoriatic isomorphic response.
Figure 1: A round erythematous scaly plaque measuring 4 cm × 4 cm with well-defined borders and overlying localized hypertrichosis on a leg

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During the subsequent 2 weeks, a topical mid-potency corticosteroid cream was applied two times daily on the lesion, with a prompt resolution of the erythema and scaling. The hypertrichosis gradually lessened within 2 months, and no additional treatment was needed.


   Discussion Top


Post-cast hypertrichosis is a common transient occurrence in orthopedic patients and generally resolves within a few months. To exclude other possible causes of acquired localized hypertrichosis (drugs, infections, postinflammatory sequellae, scleroderma, vascular conditions, and postsurgery), a detailed patient history must be collected.[1],[2],[3]

The psoriatic hair alterations reported in the literature comprise temporary hair loss, scarring alopecia, ultrastructural abnormalities, and also two cases of localized hypertrichosis. However, in these cases, localized hypertrichosis occurred on more than one pre-existent psoriatic lesion, probably as a result of sustained arterial hyperemia due to chronic inflammatory stimuli, even if the exact underlying mechanism is still unknown.[4]

In our patient, the appearance of a single psoriatic plaque and overlying localized hypertrichosis were simultaneous, opening new scenarios on the relationship between psoriasis and hair.

Hair involvement in patients with psoriasis is one of the most common events over the course of the disease (50%–80% of cases). Hair loss due to scalp psoriasis is frequent, but alopecia is almost always noncicatricial, and complete regrowth occurs when inflammation burns out.[5],[6] In our case, psoriasis did not negatively interfere with the hair cycle, on the contrary, it seemed to stimulate hair growth. We hypothesize that the psoriatic Koebner phenomenon was at the basis of both hair growth and plaque appearance, probably through shared signaling pathways influencing the hair cycle and the psoriatic inflammatory process simultaneously. The expression and production of growth factors and cytokines involved in this mechanism should be further investigated.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Chang CH, Cohen PR. Ipsilateral post-cast hypertrichosis and dyshidrotic dermatitis. Arch Phys Med Rehabil 1995;76:97-100.  Back to cited text no. 1
    
2.
Yuen MW, Lai LK, Chan PF, Chao DV. Acquired localised hypertrichosis in a Chinese child after cast immobilisation. Hong Kong Med J 2015;21:369-71.  Back to cited text no. 2
    
3.
Ma HJ, Yang Y, Ma HY, Jia CY, Li TH. Acquired localized hypertrichosis induced by internal fixation and plaster cast application. Ann Dermatol 2013;25:365-7.  Back to cited text no. 3
    
4.
Kumar B, Sandhu K, Kaur I. Localized hypertrichosis in subsiding psoriatic plaques. J Dermatol 2004;31:693-5.  Back to cited text no. 4
    
5.
Almeida MC, Romiti R, Doche I, Valente NY, Donati A. Psoriatic scarring alopecia. An Bras Dermatol 2013;88:29-31.  Back to cited text no. 5
    
6.
George SM, Taylor MR, Farrant PB. Psoriatic alopecia. Clin Exp Dermatol 2015;40:717-21.  Back to cited text no. 6
    


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