ARTICLE
Auteur(s) : Gita Faghihi, Fateme Andalib, Ali
Asilian
Isfahan university of medical sciences, Department
of Dermatology, Al-Zahra hospital, Isfahan, Iran
accepté le 13 Juin 2009
Latanoprost is an ester analogue of prostaglandin F2α
for glaucoma treatment. Eyelash hypertrichosis has been reported as
a common side effect of intra ocular latanoprost use. It has been
reported that latanoprost increases the length, thickness, and
pigmentation of eyelashes [1, 2], and stimulates eyelash regrowth
as well [2].
In this study the efficacy of topical latanoprost in the
treatment of patients with eyebrow and eyelash alopecia areata (AA)
was evaluated.
Subjects and methods
In this clinical trial, 26 patients with alopecia areata were
studied after approval by the local ethics committee. All the
patients had bilateral alopecia areata of eyelashes and eyebrows.
These patients were visited in the dermatology clinics of Noor and
Al-Zahra hospitals, Isfahan, Iran. Patients were of both genders,
10 to 50 years old, with good general health. All the patients had
a minimum disease duration of three months and more than 50% loss
of eyelashes and eyebrows on each side. None of the patients had
used any topical or systemic medication for their disease in the
last three months.
Patients with severe systemic disorders, immunosuppressed
states, known allergy to latanoprost, those who were using
corticosteroids at the same time, pregnant and breast-feeding
women, patients who were unable to follow instructions or periodic
visits and patients who did not consent to participate in the study
were excluded.
Eyebrow and eyelash alopecia areata of one side was treated with
topical latanoprost 0.005%, and alopecia areata of the other side
was not treated with any drug. Eyebrows and lashes treated with
latanoprost were considered as the case group, and the others (not
treated) were assigned as the control group.
The duration of treatment was four months. Patients were
instructed to apply one drop of the solutions on each part
(eyebrows, upper and lower eyelids) once a day, using a
cotton-tipped applicator. The photographs taken before, in the
middle, and at the end of the treatment period were compared. At
each visit, changes were recorded as absent (0-25%), partial
(26-75%), and complete (76-100%) hair growth.
Finally, the established changes in the case and control groups
were compared. P-value ≤ 0.05 was considered statistically
significant.
Results
This study included 26 patients; 14 males (53.8%) and 12 females
(46.2%) with a mean age of 22.5 ± 7.6 years old (ranging from 11 to
40). The patients studied were affected by alopecia areata for a
mean time of 6.6 ± 6.3 years (ranging from 3 months to 24 years).
They were also affected by bilateral alopecia areata of the eyebrow
and eyelash for a mean time of 3.5 ± 3.7 years (ranging from 3
months to 14 years).
All the patients completed the study. No adverse effect was
reported, except a case of non-enduring headache. In the case group
(treated side), partial hair regrowth was observed only in one case
(3.85%), whereas there was no report of hair regrowth in the
control group (not treated side). Using the Fisher test, no
statistically significant difference was seen between the cases and
controls (P = 1).
Discussion
Johnstone reported hypertrichosis and increased pigmentation of
eyelashes associated with intraocular latanoprost use by applying
unilateral latanoprost for 43 patients with glaucoma [3]. Some
other cases of hypertrichosis and pigmentation of eyelashes in
patients treated with latanoprost have also been reported [4, 5].
Chiba et al. reported that the incidence of eyelash change was
0% at 1 month, 33.8% at 3 months, 44.4% at 6 months, and 46.2% at
12 months of intraocular latanoprost use [6]. Also, Sugimoto
et al. studied seventeen patients with glaucoma and finally
concluded that latanoprost significantly increases the eyelash
length [7]. Uno et al. studied eight monkeys. They showed that
treatment with 50 μg/mL of latanoprost daily over 5 months
caused minimal hair growth, whereas 500 μg/mL daily over 3
months induced moderate-to-marked hair regrowth [8].
The mechanism of the latanoprost-induced lash growth is unclear.
Several experimental studies support the stimulating effects of
prostaglandin analogues on hair growth. Furthermore, if the
proposed mechanism of minoxidil action is through its stimulating
effect of prostaglandin E2 synthesis, it is predictable
that the direct use of prostaglandin analogues may have even more
powerful and longer-lasting effects [9]. Also, prostaglandin
analogues may not only stimulate human hair growth, but may also
exert an inhibitory effect on the pathomechanism of alopecia areata
(AA) and, therefore, could be invaluable agents for this condition
[10].
The results of our study showed that hair regrowth was seen only
in one case. Ross et al. studied 7 patients and applied
topical latanoprost (3 μg, daily) for their lesions. They
found that latanoprost had no significant effect on hair regrowth
after 12 weeks [11]. Akhyani et al. studied 10 patients with
AA of the eyelash and eyebrow and applied topical latanoprost
(5 μg, daily) and placebo and found no significant difference
[12]. Roseborough et al. applied topical unilateral
latanoprost or bimatoprost in 11 patients with eyelash AA and
compared the results with the non-treated side, they also reported
no significant differences [13].
It is reported that intraocular use of latanoprost causes hair
growth, however its topical use on bald areas has not been
effective. Some of the factors leading to the negative outcome, may
include insufficient penetration of the drug to the follicular bulb
and its lower systemic absorption. Of course it must also be noted
that a drug which prolongs anagen does not necessarily affect
alopecia areata, for instance topical minoxidil, which produces
hair growth, does not improve alopecia areata in most cases.
Therefore, lack of efficacy is probably not related to poor
penetration.
Acknowledgements
Financial support: none. Conflict of interest: none.
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