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Nail growth revisited
226
Journal of the American Academy of Dermatology
Correspondence
not suggesting a mechanism of androgenic stimulation. The true incidence and accurate descriptions of hypertrichosis are probably inadequately reported in the literature since most investigators have been nondermatologists. A calcium thioglycolate standard depilatory has been effective in managing the hypertrichosis 7 H a i r regrowth. Although other peripheral vasodilators (such as diazoxide) are said to increase cutaneous blood flow and may produce hypertrichosis, it appears that minoxidil most significantly enhances cutaneous blood flow. At a dose of 1 mg/kg intravenously in dogs, blood flow increases 62.5% in the skin (0.8 m m / m i n / g m tissue control vs 1.3 m m / m i n / g m tissue with minoxidil). 8 Minoxidil does not reduce the blood pressure of normotensive individuals. The mechanism of minoxidil-induced hypertrichosis is unknown. Burton et aP also described diazoxide hypertrichosis. Burton and his associates postulated increased cutaneous perfusion as the possible mechanism for hypertrichosis with potent peripheral vasodilators. Localized hypertrichosis has been suspected to be associated with increased cutaneous blood flow in some cutaneous inflammatory conditions, as well as in association with arteriovenous aneurysms, t0,11 Earhart et al 7 evaluated a possible systemic androgen effect by finding normal plasma testosterone and normal excretion of urinary hydroxysteroids and ketosteroids in patients treated with oral minoxidil. Local changes in dihydrotestosterone or the reductase enzyme have not been reported. Cutaneous receptor effects have not been reported.
Virginia C. Weiss, M.D. Dennis P. West, M.S. Catherine E. Mueller, B.S. Department of Dermatology, Abraham Lincoln School of Medicine, and the Department of Pharmacy Practice, College of Pharmacy University of [Uinois at the Medical Center P.O. Box 6998 Chicago, [L 60680
REFERENCES 1. Dargie HJ, Dollery CT, Daniel J: Minoxidil in resistant hypertension. Lancet 2:515-518, 1977. 2. Devine BL, Fife R, Trust PM: Minoxidil for severe hypertension after failure of other hypotensive drugs. Br Med J 2:667-669, 1977. 3. Zappacosta AR: Reversal of baldness in patient receiving
4. 5. 6. 7. 8. 9. 10. 1i.
minoxidil for hypertension. N Engl J Med 303:14801481, 1980. Burton JL, Marshall A: Hypertrichosis due to minoxidil. Br J Dermatol 101:593-595, 1979. Mehta PK, Bashir M, Shansky RM, Sakharam DM, Dunea G: Severe hypertension--treatment with minoxidil. JAMA 233:249-252, 1975. Jacomb RG, Brunnberg FJ: The use of minoxidiI in the treatment of severe essential hypertension--a report on 100 patients. Clin Sci 51:579S-581S, 1976. Earhart RN, Ball J, Nuss DD, Aeling JL: Minoxidilinduced hypertrichosis--treatment with calcium thloglycolate depilatory. South Med J 70:442-443, 1977. Humphrey SJ, Wilson E, Zins GR: Whole body tissue blood flow in conscious dogs treated with minoxidil. Fed Proc 33:583, 1974. Burton JL, Schutt WH, Caldwell IW: Hypertrichosis due to diazoxide. Br J Dermatol 93:707-711, 1975. Ressmann AC, Butterworth T: Localized acquired hypertriehosis. Arch Dermatol Syph 65:458-463, 1952, Rook A: In Rook A, Wilkinson DS, Ebling FJG, editors: Textbook of dermatology, ed. 2. Oxford, 1972, Blackwell Scientific Publications, vol 2, p. 1580.
Nail growth revisited To the Editor: A smattering of genetics permits any reader to know that "one cannot conceive of a normal nail atop an anomalous ungual phalanx. ,,1 The best example can be given by the Coffin-Siris syndrome, which includes absence of the nails of the fifth fingers and toes and absent terminal phalanges of the fifth fingers and toes. There is just one possible exception in the literature concerning a normal nail growing above an absent phalanx: Ohya's case, reported by Kikuchi et al, 2 which presented an ectopic nail "attached to the skin on the palmar aspect of the right t h u m b . . . It had a free margin, a nail plate, and a lunula." Alas! no mention of any proximal nail fold and the excellent photograph of the patient's condition, published in a famous French textbook, fails to reveal it. z
Robert Baran, M.D. Le Grand Palais 42, Rue des Serbes 06400 Cannes, France
REFERENCES 1. Kelikian H: Congenital deformities of the hand and the forearm. Philadelphia, 1974, W. B. Saunders Co., p. 210. 2. Kikuchi I, Ono T, Ogata K: Ectopic nail. Case reports. Plast Reconstr Surg 61:781-783, 1978. 3. Milian G: Nouvelle pratique dermatologique. Paris, 1936, Masson & Cie, vol 7, p. 320.
Journal of the American Academy of Dermatology
Correspondence
not suggesting a mechanism of androgenic stimulation. The true incidence and accurate descriptions of hypertrichosis are probably inadequately reported in the literature since most investigators have been nondermatologists. A calcium thioglycolate standard depilatory has been effective in managing the hypertrichosis 7 H a i r regrowth. Although other peripheral vasodilators (such as diazoxide) are said to increase cutaneous blood flow and may produce hypertrichosis, it appears that minoxidil most significantly enhances cutaneous blood flow. At a dose of 1 mg/kg intravenously in dogs, blood flow increases 62.5% in the skin (0.8 m m / m i n / g m tissue control vs 1.3 m m / m i n / g m tissue with minoxidil). 8 Minoxidil does not reduce the blood pressure of normotensive individuals. The mechanism of minoxidil-induced hypertrichosis is unknown. Burton et aP also described diazoxide hypertrichosis. Burton and his associates postulated increased cutaneous perfusion as the possible mechanism for hypertrichosis with potent peripheral vasodilators. Localized hypertrichosis has been suspected to be associated with increased cutaneous blood flow in some cutaneous inflammatory conditions, as well as in association with arteriovenous aneurysms, t0,11 Earhart et al 7 evaluated a possible systemic androgen effect by finding normal plasma testosterone and normal excretion of urinary hydroxysteroids and ketosteroids in patients treated with oral minoxidil. Local changes in dihydrotestosterone or the reductase enzyme have not been reported. Cutaneous receptor effects have not been reported.
Virginia C. Weiss, M.D. Dennis P. West, M.S. Catherine E. Mueller, B.S. Department of Dermatology, Abraham Lincoln School of Medicine, and the Department of Pharmacy Practice, College of Pharmacy University of [Uinois at the Medical Center P.O. Box 6998 Chicago, [L 60680
REFERENCES 1. Dargie HJ, Dollery CT, Daniel J: Minoxidil in resistant hypertension. Lancet 2:515-518, 1977. 2. Devine BL, Fife R, Trust PM: Minoxidil for severe hypertension after failure of other hypotensive drugs. Br Med J 2:667-669, 1977. 3. Zappacosta AR: Reversal of baldness in patient receiving
4. 5. 6. 7. 8. 9. 10. 1i.
minoxidil for hypertension. N Engl J Med 303:14801481, 1980. Burton JL, Marshall A: Hypertrichosis due to minoxidil. Br J Dermatol 101:593-595, 1979. Mehta PK, Bashir M, Shansky RM, Sakharam DM, Dunea G: Severe hypertension--treatment with minoxidil. JAMA 233:249-252, 1975. Jacomb RG, Brunnberg FJ: The use of minoxidiI in the treatment of severe essential hypertension--a report on 100 patients. Clin Sci 51:579S-581S, 1976. Earhart RN, Ball J, Nuss DD, Aeling JL: Minoxidilinduced hypertrichosis--treatment with calcium thloglycolate depilatory. South Med J 70:442-443, 1977. Humphrey SJ, Wilson E, Zins GR: Whole body tissue blood flow in conscious dogs treated with minoxidil. Fed Proc 33:583, 1974. Burton JL, Schutt WH, Caldwell IW: Hypertrichosis due to diazoxide. Br J Dermatol 93:707-711, 1975. Ressmann AC, Butterworth T: Localized acquired hypertriehosis. Arch Dermatol Syph 65:458-463, 1952, Rook A: In Rook A, Wilkinson DS, Ebling FJG, editors: Textbook of dermatology, ed. 2. Oxford, 1972, Blackwell Scientific Publications, vol 2, p. 1580.
Nail growth revisited To the Editor: A smattering of genetics permits any reader to know that "one cannot conceive of a normal nail atop an anomalous ungual phalanx. ,,1 The best example can be given by the Coffin-Siris syndrome, which includes absence of the nails of the fifth fingers and toes and absent terminal phalanges of the fifth fingers and toes. There is just one possible exception in the literature concerning a normal nail growing above an absent phalanx: Ohya's case, reported by Kikuchi et al, 2 which presented an ectopic nail "attached to the skin on the palmar aspect of the right t h u m b . . . It had a free margin, a nail plate, and a lunula." Alas! no mention of any proximal nail fold and the excellent photograph of the patient's condition, published in a famous French textbook, fails to reveal it. z
Robert Baran, M.D. Le Grand Palais 42, Rue des Serbes 06400 Cannes, France
REFERENCES 1. Kelikian H: Congenital deformities of the hand and the forearm. Philadelphia, 1974, W. B. Saunders Co., p. 210. 2. Kikuchi I, Ono T, Ogata K: Ectopic nail. Case reports. Plast Reconstr Surg 61:781-783, 1978. 3. Milian G: Nouvelle pratique dermatologique. Paris, 1936, Masson & Cie, vol 7, p. 320.