Acquired Localized Hypertrichosis Induced by Rivastigmine

Abstract

Hypertrichosis is the excessive hair growth in any area of the skin surface. Acquired localized hypertrichosis may be secondary to multiple causes and there is a secondary form due to several drugs, which is usually reversible with discontinuation of the causative agent. Rivastigmine is a reversible and competitive inhibitor of acetylcholinesterase and butyrylcholinesterase used for symptomatic treatment of Alzheimer dementia and Parkinson's disease. It has an adequate safety profile and cutaneous side effects are unusual. Irritant contact dermatitis, allergic dermatitis, baboon syndrome, and cutaneous rash due to rivastigmine have been reported. We report on a Caucasian 80-year-old male with personal history of Alzheimer's disease. The patient started therapy with oral rivastigmine one month prior to clinical presentation of localized hypertrichosis on both forearms. Norgalanthamine has been shown to promote hair growth activity via the proliferation of dermal papilla. Acetylcholinesterase inhibitors can induce hair growth.

The muscarinic acetylcholine receptor in dermal papilla cells regulates hair growth

“…For an example in Alzheimer’s patients, 24 out of 62 patients reported hair darkening in the occipital region after using cholinesterase inhibitor for at least 6 months(Chan et al, 2020). In another example, a Caucasian 80-year-old male who received AChE/BChE inhibitor rivastigmine for one month was diagnosed acquired localized hypertrichosis on both forearms(Imbernón-Moya et al, 2016). These findings highlight the potential regulation of hair growth by cholinergic system.…”

“…Several lines of evidence support the notion of ACh playing role in hair biology. Alzheimer’s patients taking oral reversible and competitive acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) inhibitor, rivastigmine, exhibited symptoms of hypertrichosis and hair re-pigmentation(Chan et al, 2020; Imbernón-Moya et al, 2016; Müller, 2007). In DPCs treated with AChE inhibitor, nor-galantamine, a stimulation of anagen’s activating signalling has been identified(Kowal et al, 2018; Prvulovic et al, 2010; Scott & Goa, 2000; Yoon et al, 2019).…”

A network pharmacology-based approach to explore mechanism of action of medicinal herbs for alopecia treatment

“…Neuronal or non-neuronal ACh signaling or both lead to the depletion of stem cell populations in murine hair follicles in a complex neuroectodermal–mesodermal interaction system 32 . AChE has been reported to induce hair growth 34 . The glycerophospholipid metabolic pathway maintains cell membrane stability to confer protection to the cell against hypoxic stress-induced damage by upregulating mRNA, protein, and metabolite levels 35 .…”

Omeprazole‐induced hypertrichosis in two children

“…The cause of acquired generalized hypertrichosis can be idiopathic, iatrogenic, or secondary to systemic diseases such as hypothyroidism, porphyria, celiac disease, dermatomyositis, tumors, or HIV infection . Drugs such as cyclosporin A, corticosteroids, phenytoin, penicillin, spironolactone, acetazolamide, psoralen, diazoxide, and minoxidil can also cause acquired generalized hypertrichosis, with involvement mostly of the scalp, frontal region, trunk, and extremities …”