Unwanted hair growth in undesirable areas is not an unheard-of physiological grievance. Hair between the brows or on the chin in the case of women can be done away with picking. But what if the unwanted growth is within one's mouth? According to a new report by doctors from the University of Campania Luigi Vanvitelli in Italy, a 25-year-old woman was found to have this exact problem.
The young woman was diagnosed with an extremely rare condition what the doctors call 'recurrent gingival hirsutism', which led to the growth of hair inside her mouth. As of now, only five such cases have been reported the physicians pointed out. "The occurrence of hairs in the oral cavity is an extremely rare finding. The etiology is still unknown," wrote the researchers.
Diagnosis of Polycystic ovary syndrome(PCOS)
The woman approached the doctor for the first time in 2009, when she was a 19-year-old, with hair growing in her gums. Upon examination, the doctors discovered that the sexual hormone levels were high in her body, especially, testosterone and luteinizing hormone. The condition is known as hirsutism and often leads to the growth of hair on the back, chest and face in a woman. In her case, the mouth, which the researchers addressed as 'oral hirsutism'
Further examination revealed the existence of numerous cysts on her ovaries, leading to the diagnosis of Polycystic ovary syndrome (PCOS). PCOS is a hormonal disorder found among women of reproductive age. The hair and associated soft tissue were surgically removed. She received systemic therapy using an oral contraceptive and was treated by an endocrinologist thereafter. The treatment seemed to be successful.
"Significant systemic benefits were achieved after 4 months of therapy, including no relapse in the occurrence of oral hairs. Since then, the patient has not been further examined at our facility," the authors wrote.
Relapse of oral hair growth
Six years after the first intervention, the now 25-year-old woman reported to the doctors with a relapse. They conducted an extraoral facial examination—of external areas surrounding the mouth—and found hair growth in the neck and chin regions. An intraoral examination—within the mouth—showed the growth of brown eyelash-like hair in the gums. They were removed.
Histological analysis of the underlying tissue collected through incisional biopsy at the level of sulcus—space between the gum and the teeth—was carried out. The doctors found hair within different cross-sections of the sample, and the woman was referred to an endocrinologist and asked to return for a follow-up examination three months later.
But to the surprise of the doctors, the woman returned one year later with even more growth of oral hair on both the arches of her gums. Further examination revealed that there was growth on the gums as well as between some of her teeth. However, no growth of hair was not found in any other part of the oral cavity.
Touching upon the technicalities of the aggravated condition, the doctors wrote, "Clinical examination showed more numerous hairs coming out in correspondence of the sulcus between the free gingiva and many teeth, including the maxillary and mandibular incisors and premolars. No other sites in the oral cavity were involved."
What is the underlying reason?
The re-growth of oral hair six years after the first intervention suggests that it is not an occasional finding. Taking into consideration the initial dormancy of the woman's condition and its expression followed by the diagnosis of PCOS suggest that its manifestation was a result of a combination of factors.
"This led to our understanding that this was not an occasional finding but that it was probably a structural defect and hormonal imbalance that persisted, giving rise to this phenomenon," noted the authors.
Extremely rare with only 5 known cases
According to the researchers, the condition is extremely rare, and during the course of the literature review for the report, the researchers found only five cases. "A literature review found only 5 cases, most of which described a single hair localized in various sites of the oral cavity," the researchers wrote.
One of the earliest cases mentioned was the discovery of a similar growth during the autopsy of a 57-year-old white man from the UK in 1960. A 13-year-old Polish boy who had been suffering from alopecia areata since the age of three, reported to the Pedodontic Department of the Institute of Stomatology, Medical Academy in Lublin in 1986, with the growth of hair in his mouth. Black hair with a thickness slightly lower than scalp hair was observed.
An 11-year-old boy from Iran examined by doctors from the Department of Oral Medicine, School of Dentistry, Tehran University of Medical Sciences in 2007 was another case mentioned by the researchers. Much like the previous case of the Polish boy, dark hair was found growing between his gums.
Another case mentioned is that of a 45-year-old white man who was examined at the Gainesville Veteran's Administration Hospital Dental Clinic during a regular dental check-up in 2005. A single brown hair was found growing out of his gum, which the patient claimed existed since his teenage. The most recent case, other than one discussed in the study, was that of a 30-year-old French man who was found to have growth of hair in the middle of his tongue in 2016. It was surgically removed later.