Comparative study of the efficacy and safety of topical minoxidil 2% versus topical bimatoprost 0.01% versus topical bimatoprost 0.03% in treatment of eyebrow hypotrichosis: a randomized controlled trial.

Eyebrows are an important feature of facial identity and communications in human beings as well as an important eye defense shield from dust and foreign bodies. To compare the efficacy and safety between 0.01%, 0.03% bimatoprost and minoxidil 2% in gel formulations for eyebrow enhancement. Sixty eligible subjects were female or male, aged 18 years or older with eyebrow hypotrichosis, defined as either a Grade 1 or 2 on the Global Eyebrow Assessment (GEBA) scale. Patients were randomized into 3 groups using block randomization. Group a (20 patients) applied topical 0.03% bimatoprost gel once daily onto both eyebrows, group b (20 patients) applied topical 0.01% bimatoprost gel once daily onto both eyebrows while group c (20 patients) applied topical minoxidil 2% gel once daily onto both eyebrows. A significant improvement in GEBA score was reported in all the three groups after treatment (P ≤ 0.001); however, there was no statistically significant difference between the three groups (P1 = 0.091; P2 = 0.102; P3 = 0.663). Bimatoprost is equally efficacious as minoxidil in enhancement of eyebrows with a more favorable response produced by the 0.03% concentration.

Successful treatment of hereditary hypotrichosis simplex by platelet rich plasma injection with topical minoxidil 2.

Background: Hereditary hypotrichosis simplex is a rare genetic hair disease that affects the scalp. Failure to grow normal hair in terms of length and density is the main complaint of patients. Diagnosis usually established by exclusion of other congenital hair and other ectodermal disorders. Till now, no satisfactory treatment was used for the condition.Report: A 14 year old patient with hypotrichosis simplex was treated with combined platelet rich plasma injection and topical minoxidil 2% with marked improvement.Conclusion: While no satisfactory treatment presents for this condition, the use of platelet rich plasma injection can add new hope for hypotrichosis simplex patients.

Botanical extracts in combination improve autosomal recessive woolly hair/hypotrichosis caused by LIPH mutations.

BACKGROUND: Mutation in the lipase H (LIPH) gene is a main reason for autosomal recessive woolly hair (ARWH)/hypotrichosis. Although some studies reported that topical minoxidil could improve ARWH, an effective treatment method for this disease is still lacking. AIM: We attempt to explore potential treatment options for ARWH. MATERIALS & METHODS: A female 6-year-old child was diagnosed with ARWH/hypotrichosis caused by LIPH mutations. And she was treated with combined treatment of botanical extracts. RESULTS: After 6 months of treatment, the patient's hair grew remarkably. After 4 years of treatment, the patient's hair remained dense. DISCUSSION: After the combination treatment, the patient saw a favorable clinical effect. However, the specific mechanisms of action for botanical extracts require further validation. In addition, some regenerative strategies may be considered as potential treatment options for ARWH. We should actively attempt treatment for ARWH patients and encourage prenatal diagnosis due to the great impact of hair loss. CONCLUSION: The combined therapy of botanical extracts may improve ARWH long-term with a sustainable therapeutic effect.

Revisiting the Safety of Prostaglandin Analog Eyelash Growth Products.

BACKGROUND: The FDA approved bimatoprost ophthalmic solution 0.03% for treatment of eyelash hypotrichosis in 2008. Consumer concern persists regarding potential side effects of this product. OBJECTIVE: To identify gaps in the safety information associated with the use of prostaglandin eyelash growth products. MATERIALS AND METHODS: Literature searches were performed using PubMed, Embase, and Nexis Uni databases without restriction to publication date, language, or study setting. RESULTS: The literature pertaining to bimatoprost for treatment of eyelash hypotrichosis is dominated by industry-sponsored clinical trials. Study design choices create gaps in our understanding of the clinical safety of these products. CONCLUSION: Because of study design choice, clinical trials of bimatoprost for eyelash growth may have systematically underreported the incidence of drug application discomfort and prostaglandin-associated periorbitopathy. The risk of increased iris pigmentation remains inadequately investigated. Consequently, there is an ongoing need to educate and monitor patients who choose to use these products.

Eyebrow growth pattern analysis in patients with eyebrow hypotrichosis after receiving topical treatment: A retrospective study.

BACKGROUND: Differences in growth patterns among the various parts of the eyebrow have been observed. AIMS: We aimed to investigate changes in the hair density and diameter and analyze the eyebrow growth pattern of each eyebrow part (head, body, and tail) in patients with eyebrow hypotrichosis over a 24-week course of topical treatment. PATIENTS/METHODS: A retrospective study of 48 patients who received treatment with bimatoprost 0.01% was conducted. Patient demographic data were collected; measurements of hair density and diameter in the different parts of the eyebrow were collected and statistically evaluated. RESULTS: The tail of the eyebrow revealed the lowest baseline eyebrow density and diameter. Significant changes in eyebrow density (P = .01) and diameter (P = .01) were first detected in the tail at 4 and 16 weeks of treatment, respectively. The head and body showed a comparable growth pattern. CONCLUSIONS: This study confirms the previous observations that hair density, diameter, pattern of growth, and hair growth cycle vary according to their anatomical location within the eyebrow. A better understanding of eyebrow growth pattern could provide the precise pathomechanism of eyebrow hypotrichosis leading to a standardized treatment protocol.

Cooccurrence of Two Different Genetic Diseases: A Case of Valproic Acid Hepatotoxicity in Nicolaides-Baraitser Syndrome (SMARCA2 Mutation)-Due to a POLG1-Related Effect?

Nicolaides-Baraitser syndrome (NCBRS) is a rare disease caused by a mutation in the SMARCA2 gene. Clinical features include craniofacial dysmorphia and abnormalities of the limbs, as well as intellectual disorder and often epilepsy. Hepatotoxicity is a rare complication of the therapy with valproic acid (VPA) and a mutation of the polymerase γ (POLG) might lead to a higher sensitivity for liver hepatotoxicity. We present a patient with the coincidence of two rare diseases, the NCBRS and additionally a POLG1 mutation in combination with a liver hepatotoxicity. The co-occurrence in children for two different genetic diseases is discussed with the help of literature review.

Comparison of the efficacy and safety of using 0.01% versus 0.03% bimatoprost for the treatment of eyebrow hypotrichosis: A randomized, double-blind, split-face, comparative study.

BACKGROUND: Previous studies have proven the efficacy and safety of 0.01% and 0.03% bimatoprost for the treatment of eyebrow hypotrichosis; however, there is no comparison study between both concentrations. AIMS: To compare the efficacy and safety between 0.01% and 0.03% bimatoprost for the treatment of eyebrow hypotrichosis. PATIENTS/METHODS: This prospective, randomized, double-blind, split-face clinical study was conducted in 30 patients with eyebrow hypotrichosis. Each side of eyebrow of individual patients was randomly assigned for 0.01% and 0.03% bimatoprost, applied on each eyebrow once daily. Eyebrow density, diameter, the Global Eyebrow Assessment scale, 7-point rating scale, and patient satisfaction were evaluated. Side effects were also recorded. RESULTS: Both 0.01% and 0.03% bimatoprost significantly improved eyebrow density and diameter (P < .05), although there were no statistically significant differences in changes in eyebrow density and diameter from baseline between both concentrations (P = .96 and .84, respectively). Additionally, patients significantly preferred 0.03% bimatoprost in terms of clinical improvement and satisfaction (P = .04 and .003, respectively). CONCLUSIONS: Both 0.01% and 0.03% bimatoprost are effective and safe for the treatment of eyebrow hypotrichosis. Bimatoprost 0.03% is superior to its 0.01% counterpart, albeit without statistical significance.

Treatment of hereditary hypotrichosis simplex of the scalp with topical gentamicin.

BACKGROUND: Hypotrichosis simplex of the scalp (HSS) is characterized by progressive loss of scalp hair that results in almost complete baldness at a young age. HSS is often caused by dominant nonsense mutations in CDSN encoding corneodesmosin, leading to the formation of an amyloid-like material, which interferes with normal hair follicle cycle. OBJECTIVES: As gentamicin has been shown to mediate ribosomal read-through, we aimed to ascertain its therapeutic efficacy in a small series of patients carrying a recurrent mutation in CDSN . METHODS: We used a green fluorescence reporter assay system, confocal microscopy and Western blot analysis to ascertain in vitro the ability of gentamicin to induce translational read-through across a causative CDSN mutation. RESULTS: Using a reporter assay, we initially showed that gentamicin induces read-through activity across an HSS-causing nonsense mutation. Gentamicin was further shown to rescue corneodesmosin translation in primary keratinocytes obtained from a patient with HSS. To validate the in vitro data, we conducted a pilot clinical trial where the scalp of four patients was treated topically with gentamicin for 6 months, demonstrating significant improvement as ascertained by the Severity of Alopecia Tool score. CONCLUSIONS: Our findings indicate that topical gentamicin should be considered as a potential therapeutic modality in HSS. What's already known about this topic? Hypotrichosis simplex of the scalp (HSS) is caused by nonsense mutations in CDSN encoding corneodesmosin. The mutant corneodesmosin has been hypothesized to be toxic to the hair follicles, leading to hypotrichosis. Disorders caused by nonsense mutations are amenable to ribosomal read-through using gentamicin. What does this study add? Gentamicin enhanced read-through activity and promoted full-length corneodesmosin synthesis in primary keratinocytes derived from patients carrying a nonsense mutation in CDSN. Topical treatment with gentamicin was found to rescue the hypotrichosis phenotype partially in four patients with HSS. What is the translational message? Topical gentamicin should be considered as a potential treatment for HSS.

Successful use of topical minoxidil in the treatment of hypotrichosis associated with desmoplakin mutations.

Syndromes associated with desmosomal protein mutations such as desmoplakin can result in hair abnormalities including congenital alopecia and hypotrichosis. Herein, we present an 8-year-old boy, with a combination of two heterozygous mutations in the DSP gene encoding desmoplakin associated with congenital alopecia and long-standing hypotrichosis, who was treated with off-label use of topical minoxidil 5% foam once daily with dramatic growth after 2 months of therapy and sustained results at 1 year. Topical minoxidil may be effective in management of congenital alopecia and hypotrichosis associated with desmoplakin mutations.

R-propranolol is a small molecule inhibitor of the SOX18 transcription factor in a rare vascular syndrome and hemangioma.

Propranolol is an approved non-selective ß-adrenergic blocker that is first line therapy for infantile hemangioma. Despite the clinical benefit of propranolol therapy in hemangioma, the mechanistic understanding of what drives this outcome is limited. Here, we report successful treatment of pericardial edema with propranolol in a patient with Hypotrichosis-Lymphedema-Telangiectasia and Renal (HLTRS) syndrome, caused by a mutation in SOX18. Using a mouse pre-clinical model of HLTRS, we show that propranolol treatment rescues its corneal neo-vascularisation phenotype. Dissection of the molecular mechanism identified the R(+)-propranolol enantiomer as a small molecule inhibitor of the SOX18 transcription factor, independent of any anti-adrenergic effect. Lastly, in a patient-derived in vitro model of infantile hemangioma and pre-clinical model of HLTRS we demonstrate the therapeutic potential of the R(+) enantiomer. Our work emphasizes the importance of SOX18 etiological role in vascular neoplasms, and suggests R(+)-propranolol repurposing to numerous indications ranging from vascular diseases to metastatic cancer.

Efficacy and Safety of Bimatoprost 0.01% for the Treatment of Eyebrow Hypotrichosis: A Randomized, Double-Blind, Vehicle-Controlled Study.

BACKGROUND: Eyebrow hypotrichosis is an important dermatological problem. However, there is no standard treatment. OBJECTIVE: To study the efficacy and safety of bimatoprost 0.01% for the treatment of eyebrow hypotrichosis. MATERIALS AND METHODS: Although bimatoprost 0.03% has been studied previously, this is the first study to evaluate the efficacy and safety of bimatoprost 0.01% for the treatment of eyebrow hypotrichosis. A randomized, double-blinded, vehicle-controlled trial was conducted in 40 patients. All patients were randomized to receive bimatoprost 0.01% or placebo vehicle, once daily, for 6 months. The primary outcome was improvement in eyebrow density and diameter. Additional outcomes were the improvement in clinical assessments and safety evaluation. RESULTS: Compared to the vehicle group, bimatoprost 0.01% significantly increased mean eyebrow hair density, eyebrow hair diameter, and clinical assessments (p < .001) in the drug group. Patients' satisfaction score was higher for the drug group than the vehicle group (p < .05). Adverse effects of the treatment were minimal and similar between the 2 groups. CONCLUSION: Bimatoprost 0.01% was found to be superior to a placebo for eyebrow enhancement. Bimatoprost 0.01% can be considered effective, safe, and well-tolerated for the treatment of eyebrow hypotrichosis.

15 keto fluprostenol isopropyl ester (80 µgr/mL) gel for cosmetic eyelash growth and enhancement.

BACKGROUND: Eyelashes have both a protective and an aesthetic function. Hypotrichosis of the eyelashes may negatively influence an individual's self-perception. OBJECTIVE: To evaluate efficacy and safety of topical administration of a new cosmetic preparation containing 15 keto fluprostenol isopropyl ester (80 µgr/mL) for the treatment of idiopathic hypotrichosis of the eyelashes. METHODS: This is a monocentric, double-blind, vehicle-controlled study. Forty patients (18 years) with idiopathic hypotrichosis (GEA 1 or 2), who also exhibit feelings of low confidence, based on the ESQ score, were divided into two groups. Group 1: twenty women treated with once-daily 15 keto fluprostenol isopropyl ester gel and Group 2: twenty women treated only with the vehicle gel. RESULTS: Group 1: The average difference in eyelash length measured at the midpoint of palpebral margins between T0 and T2 for Group 1 was 1633 mm and for Group B was 0.25 (P < 0.0001). Comparing the ESQ questionnaires of Groups 1 and 2 from T0 to T2, only the 80% of the patients of Group 1 declared to dedicate less time to the application of cosmetic mascara, having longer and darker lashes at T2 vs patients of Group 2, of which only 20% reported longer and darker eyelashes at T2. About safety, only one patient of Group 1 experienced sensation of ocular sensation heaviness and headache. No other side effects were referred. CONCLUSIONS: 15 keto fluprostenol isopropyl ester gel was effective in enhancing eyelash growth, with an excellent safety profile.

Therapeutic potential of bimatoprost for the treatment of eyebrow hypotrichosis.

Eyebrows serve as a key feature of the face and have many roles, including cosmetic appearance and social communication. Eyebrow hypotrichosis, which refers to reduction or absence of the eyebrow hair, could be a major problem that leads to negative functional, psychological, and social consequences. Bimatoprost is an ophthalmic prostamide analog that is approved by the United States Food and Drug Administration for the treatment of eyelash hypotrichosis. Its proposed mechanism is stimulation of the prostaglandin receptor in dermal papilla and melanocyte, thus leading to a prolonged anagen phase and increased melanogenesis. The hair follicle then increases in thickness, length, and darkness. The efficacy of bimatoprost for the treatment of eyebrow hypotrichosis has been supported by well-controlled studies. Bimatoprost, which is noninvasive, effective, and well tolerated, is worth considering as a treatment option for eyebrow hypotrichosis.

Retrospective Evaluation of Topical Bimatoprost and Iris Pigmentation Change.

BACKGROUND: Topical bimatoprost is a topical prostaglandin analog originally used to treat glaucoma and more recently used to cosmetically induce hypertrichosis of the eyelashes. Iris pigmentation change has been noted in the treatment of glaucoma but has not been assessed with the cosmetic periorbital application of bimatoprost. OBJECTIVE: To evaluate for iris pigmentation change with the long-term cosmetic use of topical bimatoprost. MATERIALS AND METHODS: A retrospective chart review in a cosmetic dermatology practice of women (N = 50) who consistently purchased topical bimatoprost over an average of 4.59 years was compared with that of age-matched non-bimatoprost patients (N = 50). A blinded evaluator assessed each patient for iris pigmentary change. RESULTS: No iris pigmentation change was noted with the cutaneous application of bimatoprost. CONCLUSION: The cutaneous application of bimatoprost appears to be safe with minimal risk for iris pigmentation change.

Bimatoprost for the treatment of eyelash, eyebrow and scalp alopecia.

INTRODUCTION: Alopecia is a common condition observed among people of all ages. It is a disorder that can involve only the scalp as observed in androgenetic alopecia or scalp and body as in alopecia areata or patients under chemotherapy treatment. There are several treatment options with different safety and efficacy outcomes. Bimatoprost, a synthetic prostamide F2α analog originally approved for the treatment of ocular hypertension and open-angle glaucoma, is now FDA approved as a 0.03%, solution to be applied once daily to increase eyelashes growth. Areas covered: In this review, the authors evaluate the role of bimatoprost in idiopathic hypotrichosis of the eyelashes, in hypotrichosis of the eyelashes associated to chemotherapy, in alopecia areata of the eyelashes and eyebrows and in androgenetic alopecia. In addition, pharmacokinetics, pharmacodynamics, safety and tolerability of bimatoprost are discussed. Expert opinion: Bimatoprost will likely be the third FDA approved weapon in the fight against hair loss. Prostaglandin analogs are the only possible treatment for hypotrichosis and alopecia of the eyelashes regardless of its etiology. Eyebrow hypotrichosis due to alopecia areata or frontal fibrosis alopecia can also possibly benefit of these medications.

Effects of LATISSE (bimatoprost 0.03 per cent topical solution) on the ocular surface.

PURPOSE: LATISSE is marketed for the treatment of hypotrichosis (loss of eyelashes), using a prostamide analogue and preserved with benzalkonium chloride, which is an effective preservative; however, it also causes irritation to the ocular surface. LATISSE is applied to the lid margin; however, with the blink, some solution may fall onto the ocular surface. The objective of this study was to assess the effects of LATISSE on the ocular surface over two months. METHODS: Non-dry eye participants interested in eyelash lengthening were invited to a prospective uncontrolled, open-label clinical study using LATISSE for two months. Eyelash length, subjective symptoms, tear film stability, osmolarity, ocular redness and intraocular pressure were evaluated at baseline (T0) and at one (T1) and two months (T2). RESULTS: Twenty-eight women (ages 18 to 29) entered the study. Fifteen completed the study with five who discontinued due to burning upon instillation and eight were lost to follow-up. Average eyelash length increased at each time (p < 0.001). Dryness, burning and grittiness remained low (less than 25/100) throughout the trial with dryness showing a significant change between T0 and T1 (p = 0.04), but not between T1 and T2 (p > 0.05). No difference (p > 0.05) was noted for the non-invasive break-up time, photochromametry or tear osmolarity. Intraocular pressure showed a decrease with time but translated to only a one to two mmHg change, which was not clinically relevant. CONCLUSIONS: LATISSE increases eyelash length within a short time (less than two months). Patients seeking eyelash enhancement options should be educated as to the use, precautions and any secondary effects, including the potential for discomfort upon instillation.