Paraneoplastic Changes of the Hair

Abstract

Reviews dealing with cutaneous paraneoplastic syndromes (CPS) present varying classification schemes, some of which refer merely to symptoms of the underlying tumor. For example, hypertrichosis accompanying tumor-induced Cushing’s disease is classified either as an endocrinologic paraneoplasia or as a symptom of the underlying malignancy. The same holds true for hirsutism, observed in cases of androgen-synthetizing tumor of the adrenal glands. The present paper is limited to those types of CPS which are not disputed, such as hypertrichosis lanuginosa acquisita (HLA), porphyria cutanea tarda acquisita (PCTA) due to neoplasia, and symptomatic alopecia mucinosa (SAM). We also discuss briefly hair changes occurring in ACTH-producing nonendocrine tumors, including similarly acting polypeptides. A discussion of scarring alopecia over bone metastases of breast, lung, and urogenital cancer and of alopecia in erysipelas-like cancer is not discussed here. Since 1967, we have accepted Delacretaz’ definition of the paraneoplastic syndrome: a nonmetastatic manifestation caused by a visceral malignancy, regardless of its origin. The close relationship between the tumor and the otherwise incurable dermatosis exists because CPS should regress spontaneously whenever the tumor is treated by surgical removal, X-ray therapy, or chemotherapy. Its reappearance then signifies relapse or late metastasis.