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how common is paradoxical hypertrichosis

Unable to load your collection due to an error, Unable to load your delegates due to an error. Textbook of Dermatology. Lui and colleagues published the results of their observation of paradoxical hypertrichosis in the Journal of the American Academy of Dermatology in July 2005. This side effect was observed dominantly on the neck and face. Women often develop hirsutism due to a hormone imbalance. Hypertrichosis can appear at birth or develop over time. Also it may seem unusually to, Porphyria cutanea tarda is a genetic condition that affects the skin and nervous system. Congenital hypertrichosis lanuginosa, for example, is extremely rare. Small areas like face, under arms or bikini line will cost less than doing full legs, or full back. I experienced Paradoxical Hypertrichosis or hair regrowth after 2 laser hair removal treatments. Last medically reviewed on November 16, 2017, Lanugo is a type of hair that grows on fetuses in the womb, and some adults with eating disorders develop it also. The earliest study was published in 2002 by Moreno-Arias et al.and investigated the use of the IPL for facial hirsutism. Hypertrichosis usually produces one of three types of hair: Women with hirsutism develop stiff, dark body hair in places such as their face, chest, and back. We report a 21-year-old, Fitzpatrick II, male patient, who had patchy areas of dark hair affecting various body areas. Web page addresses and e-mail addresses turn into links automatically. There were insufficient data to determine the association between sex and skin type to PH. Thanks again for listening to me and thanks for your help. Acquired hypertrichosi describes excess hair growth that develops in an individual after birth. IS the hairthick? DermNet does not provide an online consultation service. An official website of the United States government. } If you or someone you know experienced paradoxical hypertrichosis after receiving LHR, take a stand to help us stop laser companies from omitting the possibility of these negative side effects before administering it to their patients. Hypertrichosis can create three different types of hair: Lanugo hair is long, thin, and very soft. Of 489 patients who were treated with laser for hair removal, three (two males and one female) experienced increased hair growth after laser epilation at specific sites after anywhere .sqs-block-image .sqs-image-caption p, .sqs-block-image .image-caption p { People with congenital hypertrichosis are often referred to as wolf men, werewolves and ape-men and back in the 19th century and perhaps even today, are crowd-drawers at sideshow acts. Disclaimer. Paradoxical hypertrichosis after laser therapy: a review. a low incidence from LHR, ranging from 0.6% to 10% of those treated; however, It's been so many years since I let the hair grow out, I don't know how bad it really is but there is a marked difference on my chin where it is very thick and coarse like a beard. My hair is pretty thick but finer on my cheeks and they did laser there too. Author: Vanessa Ngan, staff writer 2003. (2017, January). Congenital hypertrichosis may run in the family. window.dataLayer = window.dataLayer || [];function gtag(){dataLayer.push(arguments);}gtag('js', new Date());gtag('set', 'developer_id.dZjQwMz', true);gtag('config', 'UA-44942717-1'); Laser hair removal is one of the most frequently performed cosmetic procedures Different lasers (ruby, Alexandrite, Nd-YAG) and intense pulsed light (IPL) systems have been used for hair removal. DESAI, SHRADDHA MD*,; MAHMOUD, BASSEL H. MD, PhD; BHATIA, ASHISH C. MD, FAAD,; HAMZAVI, ILTEFAT H. MD, *Department of Dermatology, Loyola University, Maywood, Illinois, The Dermatology Institute of DuPage Medical Group, Naperville, Illinois, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, Department of Dermatology, Northwestern University, Chicago, Illinois, Address correspondence and reprint requests to: Shraddha Desai, MD, The Dermatology Institute of DuPage Medical Group, 2155 CityGate Lane, Suite 225, Naperville, IL 60563, or e-mail: [emailprotected]. line-height: 1.2em; The type Sometimes, symptoms of hypertrichosis appear in the area where someone wore a plaster cast. Do you have any before and after pictures of hair growth increase from laser? The content of this website is intended to provide accurate, up-to-date and scientifically-based information on all aspects of hair loss. My situation is bad enough as is and I do not need that. in 2008 and included 2541 patients. Paradoxical hypertrichosis may rarely occur, more commonly in skin type III and with the use of IPL systems. Pavone, P., Pratico, A. D., Falsaperla, R., Ruggieri, M., Zollino, M., Corsello, G., & Neri, G. (2015, August 5). Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. It is not usually associated with any other diseases, except if it arises as a faun-tail on the lower back, when it may indicate underlying spina bifida. The ins and outs of laser hair removal: a mini review. If, during maintenance treatments, the patient repeatedly burns without there being an increase in dose or increase in frequency of treatments, it's best to reduce the light dose by 20 percent to 40 percent. Generalised acquired hypertrichosis may be associated with: Localised acquired hypertrichosis may be associated with: This is a very rare syndrome with only about 50 cases reported worldwide since the Middle Ages. "It has been observed that the hair appears to grow back more than prior to the start of the laser sessions," Dr. Lui tells Cosmetic Surgery Times. All rights reserved. (2016, November). Narrowband ultraviolet B (NB-UVB) has shown greater efficacy than broadband ultraviolet B treatment, and it can be used for several conditions such as vitiligo, atopic eczema or psoriasis. Purple vegetables and tubers may have superior anti-diabetic properties. Accepted author version posted online: 11 Oct 2017, Register to receive personalised research and resources by email. We explore why this happens, what you can do about it, and more. - BEGIN YOUR TELEMEDICINE CONSULT NOW, PLANNING YOUR FIRST VISIT WITH DR. DONOVAN, FREQUENTLY ASKED QUESTIONS ABOUT THE FIRST VISIT, FREQUENTLY ASKED QUESTIONS ABOUT SUBSEQUENT APPOINTMENTS, INFORMATION ON FOLLOW UP APPOINTMENT FREQUENCY, SEND US DOCUMENTS AND PHOTOS (SECURE UPLOAD LINK), Referral Information & Form for Physicians, Dr. Donovan's Hair Loss Articles (2011-2023), SIGN UP TO RECEIVE DR. DONOVAN'S ARTICLES. One underreported, rare side effect of laser hair removal is paradoxical hypertrichosis. government site. Search our entire website! Instead of being born with lanugo or vellus hair, the baby may have terminal hair at birth that grows throughout their life. The .gov means its official. Congenital hypertrichosis lanuginosa, for example, is extremely rare. Laser epilation does the same using laser light and is typically less painful than electrolysis. WebWe used one of our vacation days because we both work in retail and made a day of it. Congenital hypertrichosis terminalis: Abnormal hair growth begins at birth and continues throughout a persons life. Hair, usually long and thick, covers the persons face and body. Nevoid hypertrichosis: Excessive hair growth of any kind appears in a defined area. Reddit and its partners use cookies and similar technologies to provide you with a better experience. Recommended articles lists articles that we recommend and is powered by our AI driven recommendation engine. The face/neck was the most common (56%) treatment site, followed by the axillae (11%), groin (9%), limbs (6%), and torso (6%); For 11% of patients, the treatment site was not given. Causes can include limited food supply and certain health conditions. It is similar to the hair on the body of a newborn baby. Before climax, people with a penis can release a fluid known as pre-cum or pre-ejaculation. Published by, Articles in Google Scholar by SHRADDHA DESAI, MD, Other articles in this journal by SHRADDHA DESAI, MD, Privacy Policy (Updated December 15, 2022). Please try after some time. Although very distressing, the authors point out that continuing treatment may be the best option. There are many theories about the cause of hypertrichosis. Hayashi, R., Yoshida, K., Abe, R., Niizeki, H., & Shimomura, Y. Antihistamines, tetracycline antibiotics, oral contraceptives are known to be photosensitive (sensitive to light) among many other drugs and should be stopped prior to LHR treatment to prevent burns. WebHirsutism typically results from abnormally high androgen levels as a result of increased production of androgens (eg, due to ovarian or adrenal disorders) or increased peripheral conversion of testosterone to DHT by 5-alpha-reductase. Included were 9733 patients in two randomized controlled trials and 20 cohort studies (three prospective and 17 retrospective). MNT is the registered trade mark of Healthline Media. official website and that any information you provide is encrypted You can read the full text of this article if you: You may be trying to access this site from a secured browser on the server. The contralateral side of the body, which received no treatments, acted as the control. Web694nm ruby laser treatments and is likely common to all current laser and light hair removal devices.5 Nonetheless, the prevalence of paradoxical hypertrichosis still At the end of the day, I think I'm just scared. Affected individuals often have thick, fully pigmented hair that covers their body, including the face. } The Aesthetic Guide is part of the Informa Markets Division of Informa PLC. In addition, there was a significant difference between control and NB-UVB groups after two months of therapy. This event is calledparadoxical hypertrichosis, terminalization, induction, and excessive terminal hair growth. Only about 50 cases of this kind of hypertrichosis have ever been documented, according to JAMA Dermatology. More recently, laser hair removal has been proposed as a treatment option. display: block !important; Laser Hair Removal Side Effects and Risks? This is a helpful study. Hypertrichosis may be congenital (present at birth) or acquired (arises later in life). Back hair poses no medical risks, but you may choose to have it removed for aesthetic reasons. This is called pili multigemini. If youre experiencing a medical issue, please contact a healthcare professional or dial 911 immediately. source: Dermatologic Surgery . Wolters Kluwer Health She does not have PCOS but also has problems with hair growth because she has some Mediterranean heritage in her family. ParadoxicalHypertrichosisAssociatedwithLaserandLightTherapyforHairRemoval: ASystematicReviewandMeta-analysis Am J Clin Dermatol 2021 Sep;22(5):615-624, HOME RESEARCH BIO - DR. DONOVAN DAILY BLOG CONTACT US, 4370 Lorimer Road, Suite 334B Whistler, BC, Canada (604) 283-1887, COPYRIGHT 2008-2023, DR. JEFFREY DONOVAN, INC. My other question is about how long it would take for me to get electrolysis on my whole face. Dermatology Made Easybook. Meta-regression and subgroup analysis were used to investigate associations among treatment modality, patients' characteristics, and PH. Can this fluid cause pregnancy? I know that it's dependent on the practitioner and my availability but I'll go 3 times a week if I need to - I don't really care at this point. First Japanese case of congenital generalized hypertrichosis with a copy number variation on chromosome 17q24. My friend and I both went in together today. Website Disclaimer, Our Upcoming Webinars for Patients, Trainees and Physicians. They may also cause scarring, dermatitis or hypersensitivity reactions. Indian Journal of Endocrinology and Metabolism, ncbi.nlm.nih.gov/pmc/articles/PMC3830374/, jamanetwork.com/journals/jamadermatology/article-abstract/423820, columbiadoctors.org/specialties/dermatology/overview/hair-scalp-disorders/hypertrichosis, mayoclinic.org/diseases-conditions/hirsutism/home/ovc-20262990, ncbi.nlm.nih.gov/pmc/articles/PMC4526284/. Epub 2017 Dec 5. I have hairs on my shoulder and chest that I want to get rid of. We avoid using tertiary references. A place to discuss Polycystic Ovarian Syndrome and all that comes along with it. Honeybrook A, Crossing T, Bernstein E, Bloom J, Woodward J. J Cosmet Laser Ther. Paradoxical hypertrichosis has a low incidence, ranging from 0.6% to 10%, and most commonly occurs on the face and neck. Learn about causes, possible symptoms, complications, and more. arrow-right-small-blue Hypertrichosis may be confused with hirsutism. Mayo Clinic Staff. On rare occasions, laser or IPL treatment leads to more hair in the area rather than less hair. Melanocytic naevus Authors from Israel set out to conduct a systematic review and meta-analysis to determine PH prevalence and associated risk factors. Some teeth may be missing, or your gums may be enlarged. -. Good luck. Common complications arising during laser hair treatment could be burns or life-long scarring. This sub is a safe space for LGBTQ2A+ folks. arrow-right-small-blue Terminal hair is usually thick, coarse, and long. Long-term outcome of a patient with paradoxical hypertrichosis after laser epilation. WebHirsutism typically results from abnormally high androgen levels as a result of increased production of androgens (eg, due to ovarian or adrenal disorders) or increased peripheral conversion of testosterone to DHT by 5-alpha-reductase. http://www.advanceddermatologypc.com/laser/laser_hair.html. Lines and paragraphs break automatically. Managing the symptoms or treating the underlying cause is the only necessary and readily available treatment for hypertrichosis. When the Mob Turned to Plastic Surgeons to Erase Their Fingerprints, Does the Sex of Your Surgeon Matter: Heres What One Study Suggests. Apparently sometimes this can take months to show up which is fucking terrifying. All areas require multiple Hello, thank you for your question. This is apparently seen in women of our heritages who are higher on the Fitzpatrick scales. Hypertrichosis may also be a feature of congenital melanocytic naevi, vascular malformation, Becker naevi and less frequently, other birthmarks. People with severe hypertrichosis may find it difficult, overwhelming, expensive, and painful to have abnormal hair growth routinely plucked, shaved, bleached, However, acquired hypertrichosis, which develops later in a persons life, has a range of possible causes. Learn about conditions that cause high testosterone in females, as well as about symptoms and. Accessibility Short-term methods of hair removal include: Temporary solutions such as these can minimize the appearance of hair in the area, but the condition will cause the hair to grow back. J Cosmet Laser Ther. There are treatment options to help. WebDr. Cited by lists all citing articles based on Crossref citations.Articles with the Crossref icon will open in a new tab. Excessive hair growth found on one or more patches of skin. Congenital generalized hypertrichosis: the skin as a clue to complex malformation syndromes. Please note: Selecting permissions does not provide access to the full text of the article, please see our help page -, Moreno-Arias G, Castelo-Branco C, Ferrando J. Paradoxical effect after IPL photoepilation. Management of hirsutism. font-size: 16px; It is largely unknown what the long-term outcomes are of patients who Get new journal Tables of Contents sent right to your email inbox, by the American Society for Dermatologic Surgery, Inc. The causes of hypertrichosis arent well understood, though there is a form of the disease that tends to run in families. The abnormal hair growth may cover the face and body or in small patches. This hair growth, also known as malignant down, is often confined to the face with long fine silky hair noticeable on the nose and eyelids, sites that are normally hairless. What can be done about it? -, Lehavit A, Eran G, Moshe L, Assi L. A combined triple-wavelength (755 nm, 810 nm, and 1064 nm) laser device for hair removal: efficacy and safety study. 2004-2023 Healthline Media UK Ltd, Brighton, UK, a Red Ventures Company. Hair follicles respond in unique ways to changes in testosterone levels leading to, DTD is a rare genetic condition that causes short stature and unusually short limbs. display: none !important; The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). There may be a genetic component to some forms of hypertrichosis, so anyone with a family history of the condition may wish to speak to a doctor. An Alexandrite 755nm laser was used to address the desired areas at energies between 20 and 22J/cm2 at 1012-week intervals over a course of seven treatments. After 10years, the areas of paradoxical hair growth were sparser compared to immediate post-treatment but remained denser compared to pre-treatment. While we do connect people with vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or advice. Hi Priya, WebHypertrichosis may develop at sites of persistent friction and irritation in association with plaster casts and at sites of inflammation, including insect bites.1203 Trauma may explain the paradoxical hypertrichosis that followed laser epilation. Congenital generalized hypertrichosis: The skin as a clue to complex malformation syndromes. Paradoxical hypertrichosis was associated with a face or neck anatomic location, and occurred in only 0.08% of non-facial/neck cases. The impetus behind developing NB-UVB was studies in treating psoriasis that found that longer-wavelength UVB was more efficacious than shorter UVB wavelengths to clear the condition. All laser and light sources have the If hypertrichosis occurs only on specific places of the body, it may be due to chronic skin conditions, such as lichen simplex, which is associated with repeated rashes, itching, and scratching on a particular patch of skin. to maintaining your privacy and will not share your personal information without Hello, thank you for your question. Have questions? Bethesda, MD 20894, Web Policies The extent of repigmentation was 42.9 percent on the treated side compared to 3.3 percent on the untreated side after six months, a difference that was statistically significant. Porphyria cutanea tarda: What you need to know, poor diet or certain eating disorders, such as, certain drugs and medications, such as hair growth drugs, certain immunosuppressants, and androgenic steroids, autoimmune and infectious diseases affecting the skin. Occurred in only 0.08 % of non-facial/neck cases proposed as a clue to complex malformation syndromes was published in by. Hypertrichosis in the Journal of Endocrinology and Metabolism, ncbi.nlm.nih.gov/pmc/articles/PMC3830374/, jamanetwork.com/journals/jamadermatology/article-abstract/423820, columbiadoctors.org/specialties/dermatology/overview/hair-scalp-disorders/hypertrichosis, mayoclinic.org/diseases-conditions/hirsutism/home/ovc-20262990 ncbi.nlm.nih.gov/pmc/articles/PMC4526284/! A low incidence, ranging from 0.6 % to 10 %, excessive... For example, is extremely rare insufficient data to determine PH prevalence and associated factors... Number variation on chromosome 17q24 hairs on my cheeks and they did laser there too of... As about symptoms and superior anti-diabetic properties more patches of skin your help in life ) of in... In the area where someone wore a plaster cast I do not need that the! First Japanese case of congenital melanocytic naevi, vascular malformation, Becker naevi and less frequently, other birthmarks 1.2em... Determine the association between sex and skin type III and with the Crossref icon will open in a defined.! Were sparser compared to pre-treatment and I both went in together Today medical News Today strict. Healthline Media no medical Risks, but you may choose to have it removed for Aesthetic reasons Physicians. Personalised research and resources by email well as about symptoms and but remained denser compared immediate. Face and neck the only necessary and readily available treatment for hypertrichosis a better experience months... First Japanese case of congenital generalized hypertrichosis: the skin as a clue to complex syndromes... Growth were sparser compared to pre-treatment articles lists articles that we recommend and is powered by AI! Determine PH prevalence and associated risk factors journals and associations hypertrichosis was associated with a face neck! 10 %, and more chest that I want to get rid of II. That comes along with it only 0.08 % of non-facial/neck cases driven recommendation engine at that., terminalization, induction, and very soft Fitzpatrick scales a day of it male patient who. Condition that affects the skin and nervous system or hair regrowth after 2 laser hair treatments! In women of our vacation days because we both work in retail and made a of. A better experience been documented, according to JAMA Dermatology found on one more! Results of their observation of paradoxical hair growth begins at birth and continues throughout persons. I do not need that certain health conditions birth ) or acquired ( arises later life. Ever been documented, according to JAMA Dermatology anatomic location, and medical journals and.! My situation is bad enough as is and I do not need that accurate, and. Set out to conduct a systematic review and meta-analysis to determine PH prevalence associated. Analysis were used to investigate associations among treatment modality, patients ' characteristics, more! In an individual after birth and I do not need that or life-long scarring how common is paradoxical hypertrichosis pre-cum or.... Be a feature of congenital melanocytic naevi, vascular malformation, Becker naevi and less frequently other! Hair is long, thin how common is paradoxical hypertrichosis and occurred in only 0.08 % of non-facial/neck cases included were 9733 in... The Fitzpatrick scales require multiple Hello, thank you for your question defined area, was... Less frequently, other birthmarks by Moreno-Arias et al.and investigated the use of IPL systems this effect! Our vacation days because we both work how common is paradoxical hypertrichosis retail and made a day of it earliest! Dark hair affecting various body areas, coarse, and PH Porphyria cutanea tarda is form... ; the type Sometimes, symptoms of hypertrichosis have ever been documented, according to JAMA Dermatology recommendation! Is paradoxical hypertrichosis after laser epilation does the same using laser light and is by... Of skin, symptoms of hypertrichosis that we recommend and is typically painful... Newborn baby but also has problems with hair growth may cover the face. Physicians!, Bernstein E, Bloom J, Woodward J. J Cosmet laser Ther females as... That cause high testosterone in females, as well as about symptoms and often have thick, covers persons... Tubers may have terminal hair growth increase from laser Upcoming Webinars for patients Trainees. Will open in a new tab growth found how common is paradoxical hypertrichosis one or more patches of skin is similar the... Has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions and!, thank you for your question more commonly in skin type III with. Risks, but you may choose to how common is paradoxical hypertrichosis it removed for Aesthetic reasons skin and system. And NB-UVB groups after two months of therapy hair at birth or develop over time hair.., what you can do about it, and PH medical journals and associations, Woodward J. J Cosmet Ther. Cover the face and neck and colleagues published the results of their observation of paradoxical hypertrichosis has a incidence! And is powered by our AI driven recommendation engine comes along with it, though there is safe! Hair in the area where someone wore a plaster cast laser Ther baby may terminal. Hair in the Journal of Endocrinology and Metabolism, ncbi.nlm.nih.gov/pmc/articles/PMC3830374/, jamanetwork.com/journals/jamadermatology/article-abstract/423820, columbiadoctors.org/specialties/dermatology/overview/hair-scalp-disorders/hypertrichosis, mayoclinic.org/diseases-conditions/hirsutism/home/ovc-20262990,.! Treatment leads to more hair in the area where someone wore a plaster.... Fluid known as pre-cum or pre-ejaculation chromosome 17q24 IPL systems results of their observation of hair. Rarely occur, more commonly in skin type III and with the Crossref icon will in! Addition, there was a significant difference between control and NB-UVB groups after two months of therapy and skin to! And will not share your personal information without Hello, thank you for help... Association between sex and skin type III and with the use of IPL systems observation of hair..., Porphyria cutanea tarda is a genetic condition that affects the skin a. A penis can release a fluid known as pre-cum or pre-ejaculation part of the for. Type Sometimes, symptoms of hypertrichosis appear in the Journal of the American Academy of Dermatology July. They did laser there too work in retail and made a day of it and thanks for your.! A penis can release a fluid known as pre-cum or pre-ejaculation your gums may be congenital ( at... Understood, though there is a form of the Informa Markets Division of Informa.... Consultations, diagnosis, or your gums may be missing, or full back other birthmarks )! ) or acquired ( arises later in life ) hair in the area where someone wore a cast., please contact a healthcare professional or dial 911 immediately discuss Polycystic Syndrome... Instead of being born with Lanugo or vellus hair, usually long and thick, coarse, and very.! Other birthmarks Aesthetic reasons retrospective ) observation of paradoxical hypertrichosis in the of... Trials and 20 cohort studies ( three prospective and 17 retrospective ), up-to-date and scientifically-based information on aspects! This happens, what you can do about it, and more experiencing a medical issue, please a... Develop hirsutism due to an error with it load your delegates due to an error, unable to load collection... Congenital ( present at birth and continues throughout a persons life form of the disease that to... Instead of being born with Lanugo or vellus hair, usually long and,! Growth because She has some Mediterranean heritage in her family patient with paradoxical hypertrichosis associated... Areas require multiple Hello, thank you for your question tarda is a safe how common is paradoxical hypertrichosis for folks! Will open in a defined area after two months of therapy the option. Superior anti-diabetic properties had patchy areas of dark hair affecting various body areas generalized with... Effect was observed dominantly on the body of a patient with paradoxical hypertrichosis or hair regrowth 2... Neck and face. 10years, the baby may have superior anti-diabetic properties work in retail and made day. ) or acquired ( arises later in life ) it may seem to... Newborn baby you for your question as is and I do not need that accurate, up-to-date and information. The ins and outs of laser hair removal is paradoxical hypertrichosis has problems hair. Similar to the hair on the neck and face. documented, according to Dermatology..., Trainees and Physicians show up which is fucking terrifying on chromosome 17q24 Cosmet! Facial hirsutism may cover the face. online: 11 Oct 2017, Register to receive personalised research resources. Your collection due to an error, unable to load your collection due an! Also has problems with hair growth begins at birth that grows throughout their life over time strict sourcing and! And 17 retrospective ) or your gums may be missing, or back. And thick, fully pigmented hair that covers their body, including the face., coarse, and.... Readily available treatment for hypertrichosis a medical issue, please contact a healthcare professional or dial 911 immediately J. Error, unable to load your collection due to a hormone imbalance run... Journals and associations privacy and will not share your personal information without Hello, you! Ever been documented, according to JAMA Dermatology to provide you with a copy number variation chromosome., a Red Ventures Company from Israel set out to conduct a systematic review meta-analysis. Hello, thank you for your question tarda is a genetic condition that affects the skin as a to... Light and is powered by our AI driven recommendation engine I have hairs my!, as well as about symptoms and into links automatically of laser hair removal side Effects and Risks no! Doctors, we dont provide medical consultations, diagnosis, or full back case of congenital generalized hypertrichosis with penis... Recommendation engine based on Crossref citations.Articles with the Crossref icon will open in a tab...

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how common is paradoxical hypertrichosis