Tuesday 25 April 2017

Dear Dr Nina: My four-year-old has a very hairy back - should I be worried?

Ask the GP...

Dr Nina Byrnes answers your medical questions
Dr Nina Byrnes answers your medical questions

Nina Byrnes

Ask the GP: Dr Nina Byrnes

Q. I have a daughter who has just turned four. She is a great little girl - bright and funny and is rarely sick. When she was born, she was quite hairy - she had a full head of black hair with lighter hair all down her back. As she got older, her hair got fairer and most of the hair on her back disappeared, but she is still quite hairy from the nape of her neck to her mid back. My husband thinks we need to go to the doctor to get her checked out. What do you think? Is it just one of those things or could it indicate a hormone issue? Should I bring her to the GP for bloods?

A The human body is covered in a coating of hair excluding the palms of our hands and soles of our feet. The colour, texture and density of this differ greatly among people and are subject to strong cultural and genetic factors. Dark hair may seem thicker whereas those with blonde body hair may appear to be almost hair free. Those of Asian and Middle Eastern and African culture often have darker thicker body hair.

Excess hair may be classed according to the type of hair and the underlying cause. Hirsutism refers to excess hair that is subject to male hormone influence. This occurs most commonly post-puberty and can be associated with conditions such as polycystic ovarian syndrome. Hirsutism normally occurs in a male pattern of hair growth. Excess hair is most  notable on the face, genitals, armpits, arms and legs. Polycystic ovarian syndrome is associated with an increased risk of type 2 diabetes.

Hypertrichosis is an increased coating of fine fluffy body hair referred to as Lanugo. At it’s most extreme the excess hair may cover the entire body. A very rare form of congenital hypetrichosis causes excess hair over the whole body and has been referred to as “werewolf syndrome”. This was first reported several centuries ago. It had a strong familial affinity and affected families were viewed with suspicion or subjected to ridicule.

It is most likely that your daughter has a mild form of hypertrichosis — which there are many causes of. One of the most common in infants is prematurity. Babies born early may appear to have more body hair but this normally reduces over time. Genetics are one of the other most common causes. It is worth exploring whether you or your husband or any of your siblings had or have excess body hair as this commonly runs in families.

If there is pigmented skin below the hair this may be a type of congenital mole which could be checked by a dermatologist. Patches of hair at the base of the spine can be associated with spinal cord abnormalities. These patches are normally checked for at post natal check ups so as your daughter got through these checks without concern it’s unlikely to be related. Hypothyroidism may also cause excess hair but again this would have been checked for at birth.

There are a number of rare genetic and metabolic conditions that can be associated with unusual body hair distribution. As your daughter is otherwise healthy this again makes these unlikely, but if you are genuinely concerned you could talk to your GP who may arrange referral to a specialist who could arrange further tests if required.

In an otherwise healthy person excess hair may be cosmetically unacceptable. Girls may become particularly self conscious as they get older reducing their participation in sports such as swimming

There are many treatment options including electrolysis, laser, depilatory creams and waxing. However, I would reserve these treatments for when your daughter is older. What is most likely required is to reassure her she is normal and to enjoy her for the healthy child that she appears to be.

Q My pre-teen caught verrucas at the local swimming pool. How do we get rid of them?

A Verrucas are warts occurring on the soles of the feet. They can be more problematic than other warts as the weight of the body tends to push them into the skin making them a little harder to treat.

Warts are thought to occur in about  in 10 people at any one time. They don’t do any harm, and most will resolve themselves over two years. However, they can be bothersome and so most people seek treatment.

You should not pick, bite or peel a wart. This increases the chance of spreading the virus to your hands or other parts of your feet. If the verruca is not bothering you, it may not need any treatment at all. However, as verrucas can be contagious, it is worth wearing special shoes or covering it in public or shared areas such as showers and pools. Applying duct tape can be an effective treatment. Apply the tape. Leave it for 6 days. Take it off. File the skin then leave it off over night and reapply the next day. Over the counter products containing salicylic acid are an option. This needs to be applied every 24-hours and the dead skin filed off each day before reapplying. Your GP may be able to freeze the wart. This is called cryotherapy. Liquid Nitrogen is sprayed from a short distance directly onto the verrucae until a frozen halo appears. During the thaw the tissue is damaged thus treating the wart. Those who have diabetes or poor circulation shouldn’t have cryotherapy. A healthy immune system will usually eventually clear the virus completely but those who have reduced immunity due to medication, illness or even stress may be more prone to dramatic or recurrent infections and flares.

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