International Journal of Trichology

CASE REPORT
Year
: 2018  |  Volume : 10  |  Issue : 3  |  Page : 138--139

Localized hypertrichosis at vaccination site


Kavita Poonia, Pragati Gogia, Mala Bhalla 
 Department of Dermatology, Venereology and Leprology, Government Medical College and Hospital, Chandigarh, India

Correspondence Address:
Dr. Mala Bhalla
Department of Dermatology, Venereology and Leprology, Government Medical College and Hospital, Sector 32, Chandigarh - 160 012
India

Abstract

Hypertrichosis is described as an increased hair growth on any part or over whole body in comparison to persons of the same age, sex, and race which is independent of androgen excess. It may be localized and generalized or alternatively acquired and congenital forms. The acquired localized hypertrichosis has been associated with various causes including local trauma, chronic irritation, inflammation, occlusion by cast, and drugs. Here, we report a case of 2½-month-old healthy infant presenting with localized area of hypertrichosis over anterolateral aspect of the left thigh which was confined to the site of vaccination.



How to cite this article:
Poonia K, Gogia P, Bhalla M. Localized hypertrichosis at vaccination site.Int J Trichol 2018;10:138-139


How to cite this URL:
Poonia K, Gogia P, Bhalla M. Localized hypertrichosis at vaccination site. Int J Trichol [serial online] 2018 [cited 2021 Jan 25 ];10:138-139
Available from: https://www.ijtrichology.com/text.asp?2018/10/3/138/234786


Full Text



 Introduction



Immunization programs are the cornerstone of public health and one of the essential interventions to protect children from life-threatening vaccine-preventable infection. Vaccine is an important cost-effective tool in saving lives, decreasing the mortality, and help in providing strong health to children.[1],[2] Although most vaccinations are considered to be relatively safe, untoward medical occurrence can occur with any vaccines, which are highly varied ranging from mild local reactions to serious life-threating one, usually occur within few hours. Some of these adverse reactions may occur by nonspecific inflammation and irritation at injection site, and some may cause a mild infection due to the live attenuated virus in the vaccines. Serious reactions like anaphylaxis are rare. The local adverse reactions include nonspecific erythema, swelling, pain, and tenderness at the vaccination site. Rare cutaneous reaction such as lichen planus, granuloma annulare, Sweet's syndrome, erythema multiforme, and hypertrichosis has also been reported.[3],[4],[5] Here, we are reporting a case of vaccine-induced localized hypertrichosis in a 2½-month-old healthy infant.

 Case Report



A 2½-month-old healthy male infant was born out of full-term normal vaginal delivery presented with focal area of increased hair growth over anterolateral aspect of the left thigh. The child develops localized swelling and mild erythema at the site of injection which was later followed by increased hair growth at the injection site after about 4 weeks of injection [Figure 1]. Bacille Calmette Guerin and the first dose of oral polio vaccine were given at birth with no adverse event noticed. There was no history of any other drug administered either in oral or topical forms, before or after the vaccination. On examination, there was an area of hypertrichosis about 4 cm × 3 cm over the anterolateral aspect of the left thigh. Underlying skin showed some postinflammatory hyperpigmentation. Rest of the physical examination were normal.{Figure 1}

 Discussion



Hypertrichosis is the term used for the increased hair growth on any part or over the whole body when related to persons of the same age, sex, and race which is independent to androgen excess. Hirsutism is a subclass of hypertrichosis, in which there is an increase of androgen-dependent hair growth. Hypertrichosis may be localized and generalized or alternatively acquired and congenital forms. This can present as an isolated finding or may be associated with other abnormalities. Underlying mechanism is not clear.[6]

The acquired localized hypertrichosis (ALH) has been found to be associated with various factors such as chronic irritation, inflammation and friction, around the edges of a burn, and also with drugs such as topical steroid, minoxidil, and phenytoin.[7],[8] It has been reported following varied procedures such as henna tattoos, sclerotherapy, and even subsiding psoriasis.[9],[10],[11] A mild form of ALH is usually observed after the plaster cast application. Although the exact mechanism is not known, few authors suggest that increased blood supply at the affected site would provide more oxygen and nutrients, and thus, lengthen the anagen phase of hair cycle resulting in hypertrichosis.[12]

Rarely, ALH has been observed after vaccination including measles and Diphtheria-Pertussis-Tetanus and Bacille Calmette Guerin vaccination.[13],[14] In our case, the infant had received his first DPT vaccine which contains three different agents. He initially developed swelling and erythema at the vaccination site which later followed by localized hypertrichosis and postinflammatory hyperpigmentation. This could be due to either the subcutaneous inflammation or the development of an immunological hypersensitivity reaction. A literature search showed that formation of subcutaneous nodule, eczema, and localized hypertrichosis at the site of DPT vaccination had been reported previously.[14]

DPT vaccine is given routinely as per the Universal Immunization Programme schedule, and ALH is a rare but benign side effect of which the dermatologists should be aware of as it resolves spontaneously without any treatment.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Sagar KS, Abdelmalik H, Wenger J, Haldar P, Goel N, Burgess C, et al. Routine immunisation in India. J Indian Med Assoc 2005;103:676-8.
2Vashishtha VM, Kumar P. 50 years of immunization in India: Progress and future. Indian Pediatr 2013;50:111-8.
3Martin BL, Nelson MR, Hershey JN, Engler RJ. Adverse reactions to vaccines. Clin Rev Allergy Immunol 2003;24:263-76.
4Rosenblatt AE, Stein SL. Cutaneous reactions to vaccinations. Clin Dermatol 2015;33:327-32.
5Kaur S, Handa S. Erythema multiforme following vaccination in an infant. Indian J Dermatol Venereol Leprol 2008;74:251-3.
6Wendelin DS, Pope DN, Mallory SB. Hypertrichosis. J Am Acad Dermatol 2003;48:161-79.
7Shafir R, Tsur H. Local hirsutism at the periphery of burned skin. Br J Plast Surg 1979;32:93.
8Miwa LJ, Shaefer MS, Stratta RJ, Wood RP, Langnas AM, Shaw BW Jr., et al. Drug-induced hypertrichosis: Case report and review of the literature. DICP 1990;24:365-8.
9Oh TS, Kim Y, Song HJ. Localized hypertrichosis after sclerotherapy. Dermatol Surg 2010;36 Suppl 2:1064-5.
10Durmazlar SP, Tatlican S, Eskioglu F. Localized hypertrichosis due to temporary henna tattoos: Report of three cases. J Dermatolog Treat 2009;20:371-3.
11Kumar B, Sandhu K, Kaur I. Localized hypertrichosis in subsiding psoriatic plaques. J Dermatol 2004;31:693-5.
12Ma 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.
13Ozkan H, Dündar NO, Ozkan S, Kumral A, Duman N, Gülcan H, et al. Hypertrichosis following measles immunization. Pediatr Dermatol 2001;18:457-8.
14Pembroke AC, Marten RH. Unusual cutaneous reactions following diphtheria and tetanus immunization. Clin Exp Dermatol 1979;4:345-8.