Localized Hypertrichosis of Eyelashes and Eyebrows
Photo Quiz
Self-Test Your Diagnostic Acumen
CASE: This 60-year-old man presents for a routine dermatologic exam. An incidental finding is bilateral hypertrichosis of the eyelashes and eyebrows.
What do you suspect caused the excessive hair growth?
ANSWER: Misapplication of bimatoprost 0.03% for treatment of glaucoma
The curious distribution of the hypertrichosis and the awareness of cosmetic use of bimatoprost 0.03% raised suspicion of an iatrogenic etiology. Upon questioning, the patient admitted to the use of bimatoprost 0.03% for glaucoma and reported that he had difficulty in applying the eye drops properly. This accounted for the side effect of localized hypertrichosis of the eyelashes and eyebrows.
Bimatoprost 0.03%, a prostaglandin analog, is among the commercial drugs that are available for the treatment of glaucoma. Outside of their designated use as intraocular hypotensive agents, prostanoids have clinically known side effects, including iris and eyelid pigmentation, eyelash growth, and conjunctival hyperemia.1 Noticeable changes in adnexal hair have also been described.2-4 For this reason, bimatoprost 0.03% has also been marketed and FDA-approved for cosmetic purposes that are popular among women.
Most patients with glaucoma are elderly, and inappropriate use of topical prostaglandin analogs is not uncommon. Age-related complications, such as visual impairments and other pathologies, can result in the application of drops outside the eye or use of an excessive amount of medication. With such patients, it is important for physicians to be aware of the aforementioned changes in appearance.
It has been proposed that prostanoid-related dermatologic changes are likely due to alterations of the phase transitions of the hair cycle.5 Minimizing direct contact with prostaglandin analogs appears to reduce hypertrichosis of the eyelashes and hyperpigmentation of the skin in the periocular region.n
REFERENCES:
1. Ortiz-Perez S, Olver JM. Hypertrichosis of the upper cheek area associated with travoprost treatment of glaucoma. Opthal Plast Reconstr Surg. 2010;26:
376-377.
2. Johnstone MA, Albert DM. Prostaglandin-induced hair growth. Surv Ophthalmol. 2002;47:185-202.
3. Elgin U, Batman A, Berker N, Ilhan B. The comparison of eyelash lengthening effect of latanoprost therapy in adults and children. Eur J Ophthalmol. 2006;
16:247-250.
4. Doshi M, Edward DP, Osmanovic S. Clinical course of bimatoprost-induced periocular skin changes in Caucasians. Ophthalmology. 2006;113:
1961-1967.
5. Centofanti M, Oddone F, Tanga L, Manni G. Prevention of dermatologic side effects of bimatoprost 0.03% topical therapy. Am J Opthal. 2006;142:
1059-1060.