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Localized Hypertrichosis with Traumatic Panniculitis: A Case Report and Literature Review

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Monthanat Ploydaeng
Monthanat Ploydaeng
Monthanat Ploydaeng
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Salinee Rojhirunsakool at Srinakharinwirot University
Salinee Rojhirunsakool
Poonkiat Suchonwanit at Mahidol University
Poonkiat Suchonwanit
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Abstract and Figures

Localized hypertrichosis with traumatic panniculitis is considered a rare condition. Previous articles have reported occurrence in females aged between 20 and 35 years. Possible mechanisms of trauma-induced localized hypertrichosis include hyperemia and angiogenesis induced by local inflammation, which can alter the hair growth cycle. The presence of inflammatory cells and lipomembranous changes on histopathology can support the diagnosis. We herein present a 35-year-old female patient with localized hypertrichosis following blunt trauma.
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Case Rep Dermatol 2019;11:180–186
DOI: 10.1159/000501360
Published online: June 26, 2019
© 2019 The Author(s)
Published by S. Karger AG, Basel
www.karger.com/cde
This article is licensed under the Creative Commons Attribution-NonCommercial 4.0
International License (CC BY-NC) (http://www.karger.com/Services/OpenAccessLicense).
Usage and distribution for commercial purposes requires written permission.
Poonkiat Suchonwanit, MD
Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital
Mahidol University, 270 Rama VI Road
Rajthevi, Bangkok 10400 (Thailand)
E-Mail poonkiat@hotmail.com
Single Case
Localized Hypertrichosis with
Traumatic Panniculitis: A Case
Report and Literature Review
Monthanat Ploydaeng Salinee Rojhirunsakool Poonkiat Suchonwanit
Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University,
Bangkok, Thailand
Keywords
Fat necrosis · Trauma-induced hypertrichosis · Traumatic panniculitis
Abstract
Localized hypertrichosis with traumatic panniculitis is considered a rare condition. Previous
articles have reported occurrence in females aged between 20 and 35 years. Possible mecha-
nisms of trauma-induced localized hypertrichosis include hyperemia and angiogenesis in-
duced by local inflammation, which can alter the hair growth cycle. The presence of inflamma-
tory cells and lipomembranous changes on histopathology can support the diagnosis. We
herein present a 35-year-old female patient with localized hypertrichosis following blunt
trauma. © 2019 The Author(s)
Published by S. Karger AG, Basel
Introduction
Traumatic panniculitis refers to inflammation and necrosis of the subcutaneous fat fol-
lowing blunt trauma to the skin, the common areas being the breasts, shins, and forearms [1].
In rare cases, localized hypertrichosis can coexist with or follow panniculitis. We herein
Case Rep Dermatol 2019;11:180–186
DOI: 10.1159/000501360
© 2019 The Author(s). Published by S. Karger AG, Basel
www.karger.com/cde
Ploydaeng et al.: Localized Hypertrichosis with Traumatic Panniculitis: A Case Report and
Literature Review
181
present the case of a 35-year-old female with coexisting panniculitis and hypertrichosis in-
duced by previous trauma.
Case Presentation
A 35-year-old Thai female presented with a brownish plaque covered by numerous long
hairs on her left shin. Three months earlier, the patient fell over and hit her left shin on the
stairs. The area became soft and tender, without any break in the skin, and later developed
into a bruise. The bruise resolved within 2 weeks after the trauma, but a brownish plaque
remained. Two months later, she noticed that thick, long hairs had grown over the plaque (Fig.
1). The patient did not have any underlying diseases and denied histories of topical cortico-
steroids use, insect bite, or previous bone fracture in the area.
On physical examination, there was a solitary, ill-defined, brownish, indurated plaque
with localized hypertrichosis on the left shin. A 4-mm skin punch biopsy was performed on
the lesion. Histopathology revealed scattered lobular panniculitis with hemosiderin and sub-
acute focal lipomembranous fat necrosis (Fig. 2). The epidermis and upper dermis were unre-
markable. Based on the history, physical examination, and histopathological findings, the di-
agnosis of localized hypertrichosis with traumatic panniculitis was performed. The patient
was reassured and did not receive any treatment. Six months later, the lesion showed sponta-
neous resolution (Fig. 3).
Discussion
Traumatic panniculitis with localized hypertrichosis is a rare condition. To date, only 4
cases have been reported in the literature (Table 1) [2–4]. All patients were young Asian fe-
males with a lesion on their lower extremities. The accident preceded hypertrichosis by 1–2
months. The histopathological changes are not specific. At an earlier stage, inflammatory cells
such as lymphocytes and macrophages can be found in the adipose tissue around the vessels
and septa, while in a late stage, fibrotic replacement of damaged fat may be observed. Li-
pomembranous changes are also described in previous case reports [1, 5].
Hypertrichosis is defined as excessive body hair growth above the average level. The con-
dition can be classified as generalized or localized, depending on the area of involvement; or
congenital or acquired, according to the age of onset. In the clinical presentation of acquired
localized hypertrichosis, the differential diagnoses should include Becker’s nevus, hypertri-
chosis of the pinna, and hypertrichosis associated with local inflammation (e.g., chemical-in-
duced dermatitis, bone fracture, orthopedic cast removal, vaccination, and trauma) [4]. The
diagnosis of localized hypertrichosis with traumatic panniculitis in our case was based on the
history of earlier trauma, clinical presentation, and histopathological findings.
The mechanism through which local inflammation induces hypertrichosis is unclear. The
previous report has proposed that the sudden increase in blood supply allows sufficient nu-
trition for stimulation of the hair follicle. Another hypothesis is that inflammation-induced an-
giogenesis may prolong the anagen phase of the hair follicle, leading to longer and thicker hair
growth. In cases with trauma-induced panniculitis, it is possible that inflammation deep in the
Case Rep Dermatol 2019;11:180–186
DOI: 10.1159/000501360
© 2019 The Author(s). Published by S. Karger AG, Basel
www.karger.com/cde
Ploydaeng et al.: Localized Hypertrichosis with Traumatic Panniculitis: A Case Report and
Literature Review
182
subcutaneous tissue does not directly affect the hair follicles but allows intense and uniform
blood supply to the area, stimulating the hair matrix [6, 7]. Interestingly, localized hypertri-
chosis has also been documented following lupus panniculitis [8].
Currently, there is no specific treatment for localized hypertrichosis with traumatic pan-
niculitis. All reported cases, including the present case, reveal spontaneous resolution within
5 months to 2 years. However, in cases with cosmetic concerns, hypertrichosis can be treated
by shaving, hair reduction lasers, electrolysis, or depilatory creams, etc. [9, 10].
In conclusion, we report a case of localized hypertrichosis with traumatic panniculitis.
The condition should always be considered in patients who develop localized hypertrichosis
after blunt trauma, especially within the past 1–2 months.
Statement of Ethics
The patient provided written informed consent to perform all necessary investigations,
to take clinical photographs, and use them for research purposes and publication.
Disclosure Statement
The authors have no conflicts of interest to declare.
Author Contributions
All named authors meet the International Committee of Medical Journal Editors (ICMJE)
criteria for authorship for the manuscript, take responsibility for the integrity of the work as
a whole, and have given final approval to the version to be published.
References
1 Requena L, Sánchez Yus E. Panniculitis. Part II. Mostly lobular panniculitis. J Am Acad Dermatol. 2001
Sep;45(3):325–61; quiz 362–4.
2 Won TH, Park SD, Seo PS. A case of traumatic panniculitis with localized hypertrichosis. Korean J Dermatol.
2008;46(6):812–4.
3 Lee DJ, Kim YC. Traumatic panniculitis with hypertrichosis. Eur J Dermatol. 2011 Mar-Apr;21(2):258–9.
4 Lee JH, Jung KE, Kim HS, Kim HO, Park YM, Lee JY. Traumatic panniculitis with localized hypertrichosis: two
new cases and considerations. J Dermatol. 2013 Feb;40(2):139–41.
5 Moreno A, Marcoval J, Peyri J. Traumatic panniculitis [vii.]. Dermatol Clin. 2008 Oct;26(4):481–3.
6 Frost H. The regional acceleratory phenomenon. Orthop Clin North Am. 1981;12:725–6.
7 Mecklenburg L, Tobin DJ, Müller-Röver S, Handjiski B, Wendt G, Peters EM, et al. Active hair growth (anagen)
is associated with angiogenesis. J Invest Dermatol. 2000 May;114(5):909–16.
8 García-Doval I, Roson E, Abalde M, Feal C, Cruces MJ. Coexistence of acquired localized hypertrichosis and
lipoatrophy after lupus panniculitis. J Am Acad Dermatol. 2004 May;50(5):799–800.
9 Wendelin DS, Pope DN, Mallory SB. Hypertrichosis. J Am Acad Dermatol. 2003 Feb;48(2):161–79, quiz 180–
1.
10 Somani N, Turvy D. Hirsutism: an evidence-based treatment update. Am J Clin Dermatol. 2014 Jul;15(3):247–
66.
Case Rep Dermatol 2019;11:180–186
DOI: 10.1159/000501360
© 2019 The Author(s). Published by S. Karger AG, Basel
www.karger.com/cde
Ploydaeng et al.: Localized Hypertrichosis with Traumatic Panniculitis: A Case Report and
Literature Review
183
Fig. 1. Solitary, ill-defined, brownish, indurated plaque with localized hypertrichosis on the left shin.
Case Rep Dermatol 2019;11:180–186
DOI: 10.1159/000501360
© 2019 The Author(s). Published by S. Karger AG, Basel
www.karger.com/cde
Ploydaeng et al.: Localized Hypertrichosis with Traumatic Panniculitis: A Case Report and
Literature Review
184
Fig. 2. Scattered lobular panniculitis with lipomembranous fat necrosis. HE. ×20.
Case Rep Dermatol 2019;11:180–186
DOI: 10.1159/000501360
© 2019 The Author(s). Published by S. Karger AG, Basel
www.karger.com/cde
Ploydaeng et al.: Localized Hypertrichosis with Traumatic Panniculitis: A Case Report and
Literature Review
185
Fig. 3. The lesion on the left shin shows improvement without any treatment (6 months).
Case Rep Dermatol 2019;11:180–186
DOI: 10.1159/000501360
© 2019 The Author(s). Published by S. Karger AG, Basel
www.karger.com/cde
Ploydaeng et al.: Localized Hypertrichosis with Traumatic Panniculitis: A Case Report and
Literature Review
186
Table 1. Reported cases of traumatic panniculitis with hypertrichosis
First author
[ref.],
year
Age,
years
Gender
Location
Duration to
hypertrichosis,
months
Histopathological
findings
Management
Clinical course
Present
case
35
female
left
shin
2
Lobular panniculitis,
lipomembranous fat
necrosis, hemosiderin (+)
reassure
Spontaneous
resolution
within 6
months
Won [2],
2008
31
female
right
shin
1
Lobular panniculitis, fat
necrosis, fibrotic change,
and lipomembranous
change
reassure
Spontaneous
resolution
within 5
months
Lee [3],
2011
33
female
left
shin
1
Multiple variably sized fat
cystic changes and focal fat
necrosis with mild
lymphohistiocytic infiltration
in the subcutaneous fat layer,
lipomembranous fat necrosis
with eosinophilic
membranes lining the cystic
space in the subcutaneous fat
lobule
reassure
Spontaneous
resolution
within 2 years
Lee [4],
2013
22
female
right
shin
2
Lobular panniculitis,
lipomembranous fat
necrosis, hemosiderin (+)
reassure
Spontaneous
resolution
within 15
months
Lee [4],
2013
25
female
right
calf
2
Mild lobular panniculitis
reassure
Spontaneous
resolution
within 14
months
... Localized hypertrichosis as seen in our case has been mentioned secondary to multiple trigger factors compiled in Table 1. [1,2] The exact pathogenesis is still unclear, but multiple hypotheses have been proposed to justify the phenomenon. Regenerating epidermis might be the key for neogenesis of hair follicle under the influence of complex interplay between the receptors and growth factors. ...
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... O cabelo é uma estrutura relevante para o corpo na qual desempenha diversas funções fisiológicas, porém, anormalidades na distribuição e no seu crescimento ocasionalmente acontecem e podem levar a diversos problemas psicossociais (Choi, 2018). O crescimento demasiado de pelo corporal em determinadas áreas do corpo sem dependência androgênica é definido como hipertricose (Pavone, et al., 2015;Ploydaeng, et al., 2019). ...
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A case of traumatic panniculitis with localized hypertrichosis
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A 32-year-old woman had a brownish hard plaque with localized hypertrichosis. She had fallen down some stairs 1 year previously, and the injury had left a scar on her right shin. Even though pain and the scar had gone, the brown patch had remained. During that time hair had been grown on the site. Histologic examination showed lobular panniculitis, fat necrosis, fibrotic change and lipomembranous change. We diagnosed the patient as a traumatic panniculitis with localized hypertrichosis, based on the trauma history, skin lesion and histologic findings. We report a case of traumatic panniculitis with localized hypertrichosis.
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