Indian Journal of Dermatology
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RESIDENTS PAGE
Year : 2015  |  Volume : 60  |  Issue : 4  |  Page : 378-380
Eyelash trichomegaly


Department of Dermatology, Venereology and Leprology, GGS Medical College and Hospital, Faridkot, Punjab, India

Date of Web Publication10-Jul-2015

Correspondence Address:
Dr. Sandeep Kaur
Skin OPD, OPD block- 1st floor, GGS Medical Hospital, Sadiq Road, Faridkot, Punjab - 151 203
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.160484

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   Abstract 

Eyelash trichomegaly is increased length, curling, pigmentation or thickness of eyelashes. Various causes include congenital syndromes, acquired conditions and drugs. It can manifest at birth or present later in life. It can form a part of spectrum of manifestations of some congenital syndromes. Although it tends to have a benign course, it can lead to psychological disturbances and can result in corneal abrasions and visual disturbances, if trichiasis occurs. This article focuses on its etiology, pathogenesis and brief management.


Keywords: Trichomegaly, HIV, latanoprost


How to cite this article:
Kaur S, Mahajan BB. Eyelash trichomegaly. Indian J Dermatol 2015;60:378-80

How to cite this URL:
Kaur S, Mahajan BB. Eyelash trichomegaly. Indian J Dermatol [serial online] 2015 [cited 2018 Dec 11];60:378-80. Available from: http://www.e-ijd.org/text.asp?2015/60/4/378/160484

What was known?

  1. Causes of trichomegaly.
  2. Management of trichomegaly.



   Introduction Top


Eyelash trichomegaly is defined as increase in length (12 mm or more), curling, pigmentation or thickness of eyelashes. [1],[2] The term "trichomegaly" was first used by Gray in 1944. Various causes of trichomegaly include congenital, familial, acquired and drugs. Eyelash trichomegaly can be psychologically disturbing and may lead to corneal abrasions and visual disturbances, if trichiasis occurs. [3],[4]

Eyelash growth

During embryological development, eyelashes are the first terminal hairs to appear. Their growth cycle lasts approximately 5-6 months, with a very short anagen phase (30 days) and a relatively long telogen phase (approximately 4-5 months). [1] Eyelashes and eyebrows have the lowest ratio of anagen to telogen hair follicles, with approximately 50% of eyelashes in the anagen phase compared with 85-90% of scalp hairs.

The epidermal growth factor receptor appears to play a crucial role in hair growth as evidenced by drugs that inhibit its function. In addition, prostaglandins have been shown to be able to convert the hair follicle from the telogen phase into the anagen phase. [5]

Congenital conditions associated with eyelash trichomegaly

Among various congenital conditions associated with eyelash trichomegaly [Table 1], only two include it as a defining diagnostic feature: Oliver-McFarlane syndrome and Cornelia de Lange syndrome.
Table 1: Congenital conditions associated with eyelash trichomegaly


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Acquired conditions associated with eyelash trichomegaly

In HIV trichomegaly has been observed to occur in association with late-stage disease. Eyelash length has been shown to normalize as patients respond to anti-retroviral therapy. [13] However, no association has been seen between the length of eyelashes and either the severity or prognosis of HIV infection. Acquired conditions associated with eyelash trichomegaly is mentioned in [Table 2].
Table 2: Acquired conditions associated with eyelash trichomegaly


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Drugs associated with eyelash trichomegaly

  1. Prostaglandin analogues like latanoprost, bimatoprost: Most commonly reported cause of eyelash trichomegaly.
  2. Epidermal growth factor receptor inhibitors: cetuximab, [14] Panitumumab; tyrosine kinase inhibitors: erlotinib, [15] gefitinib [16]
  3. Interferon-α2b [17]
  4. Zidovudine
  5. Phenytoin
  6. Diazoxide, minoxidil
  7. Acetazolamide
  8. Cyclosporine, tacrolimus
  9. Topiramate
  10. Psoralens
  11. Corticosteroids
  12. Streptomycin
  13. Penicillamine
Epidermal growth factor receptor inhibitors

Epidermal growth factor receptor inhibitors are used to treat a variety of solid tumors like bladder, breast, colorectal, head and neck, lung, and ovarian cancers. There are two classes of drugs that target the epidermal growth factor receptor: monoclonal antibodies that block the receptor itself (cetuximab, panitumumab) and small molecules that inhibit the tyrosine kinase activity, thereby blocking receptor activation (gefitinib, erlotinib).

Trichomegaly induced by EGFR inhibitors, a result of enhanced terminal differentiation, usually occurs after 2-5 months of treatment, and can be associated with hypertrichosis in other areas.

The cutaneous adverse effects of these agents have been grouped into a condition known as PRIDE (papulopustules and/or paronychia, regulatory abnormalities of hair growth, itching, and dryness due to epidermal growth factor receptor inhibitors) syndrome. [18]

The authors postulated that, in a similar way that the presence of erlotinib-induced rash has been correlated with tumor response, the presence of eyelash trichomegaly might also be used as a useful clinical tool to assess for antineoplastic therapy success. [19]

Interferon alpha

The first report of interferon-associated eyelash trichomegaly was in two patients with B-cell lymphoma treated with interferon. [20] After 4 months of treatment, both patients began to note that their eyelashes had thickened, curled, and reached lengths of 20-65 mm.

Prostaglandins

Acquired eyelash trichomegaly has been reported with topical use of latanoprost. The effects of prostaglandin F2-alpha and latanoprost have been found to stimulate not only murine hair follicles and follicular melanocytes but also the conversion from telogen to anagen phase. This side effect has also been tried for cosmetic effects. The Food and Drug Administration approved bimatoprost 0.03% solution for treatment of patients with hypotrichosis of the eyelashes in December 2009. [21]

Approach to the patient with eyelash trichomegaly

This should include an overall evaluation of the patient's history and other concurrent medical problems.

The onset of eyelash trichomegaly is an important point for delineating a specific etiology. If present from birth, one should look for other hair anomalies or facial features that may be present (such as alopecia, synophrys) and may suggest one of the congenital syndromes described earlier.

If onset is in later life, one should focus on medications or topical products and a risk assessment for HIV or hepatitis virus should be made.

Treatment

The main treatment of eyelash hypertrichosis involves regular trimming of the eyelashes if they cause symptoms. [22] Sometimes antibiotics and artificial tears may be necessary for local irritation or  Meibomitis More Details. [23]


   Conclusion Top


Eyelash trichomegaly, an uncommon finding, has been reported in association with a wide variety of conditions. Its clinical significance and underlying pathophysiology is yet to be discovered, but factors such as prostaglandins, immune system regulation, and epidermal growth factor receptors appear to be involved. The prognostic value of eyelash trichomegaly in oncology remains to be confirmed; some investigators suggest that the long eyelashes represent a clinical marker associated with a positive response to antineoplastic therapy.

In the future, drugs such as the prostaglandin analogs and epidermal growth factor receptor inhibitors that are associated with eyelash trichomegaly may represent potential for novel treatments of various types of hair loss.



 
   References Top

1.
Santmyire-Rosenberger BR, Albert M. Acquired trichomegaly with topiramate. J Am Acad Dermatol 2005;53:362-3.  Back to cited text no. 1
[PUBMED]    
2.
Jayamanne DG, Dayan MR, Porter R. Cyclosporin induced trichomegaly of accessory lashes as a cause of ocular irritation. Nephrol Dial Transplant 1996;11:1159-61.  Back to cited text no. 2
    
3.
Manjunatha NP, Gnanaraj L. Isolated trichomegaly causing mechanical ptosis. J Pediatr Ophthalmol Strabismus 2008;45:384.  Back to cited text no. 3
[PUBMED]    
4.
Woo TL, Francis IC. Intermittent blurred vision and trichomegaly due to latanoprost. Clin Experiment Ophthalmol 2001;29:272-3.  Back to cited text no. 4
[PUBMED]    
5.
Sasaki S, Hozumi Y, Kondo S. Influence of prostaglandin F2alpha and its analogues on hair regrowth and follicular melanogenesis in a murine model. Exp Dermatol 2005;14:323-8.  Back to cited text no. 5
    
6.
Nazareth MR, Bunimovich O, Rothman IL. Trichomegaly in a 3-year-old girl with alopecia areata. Pediatr Dermatol 2009;26:188-93.  Back to cited text no. 6
    
7.
Sharma RC, Mahajan VK, Sharma NL, Sharma A. Trichomegaly of the eyelashes in dermatomyositis. Dermatology 2002;205:305.  Back to cited text no. 7
[PUBMED]    
8.
Santiago M, Travassos AC, Rocha MC, Souza S. Hypertrichosis in systemic lupus erythematosus (SLE). Clin Rheumatol 2000;19:245-6.  Back to cited text no. 8
    
9.
Marks MB. Recognizing the allergic person. Am Fam Physician 1977;16:72-9.  Back to cited text no. 9
[PUBMED]    
10.
Grossman MC, Cohen PR, Grossman ME. Acquired eyelash trichomegaly and alopecia areata in a human immunodeficiency virus-infected patient. Dermatology 1996;193:52-3.  Back to cited text no. 10
    
11.
Patrizi A, Neri I, Trestini D, Landi C, Ricci G, Masi M. Acquired trichomegaly of the eyelashes in a child with human immunodeficiency virus infection. J Eur Acad Dermatol Venereol 1998;11:89-91.  Back to cited text no. 11
[PUBMED]    
12.
Vélez A, Kindelán JM, García-Herola A, García-Lázaro M, Sánchez-Guijo P. Acquired trichomegaly and hypertrichosis in metastatic adenocarcinoma. Clin Exp Dermatol 1995;20:237-9.  Back to cited text no. 12
    
13.
Almagro M, del Pozo J, García-Silva J, Martínez W, Castro A, Fonseca E. Eyelash length in HIV-infected patients. AIDS 2003;17:1695-6.  Back to cited text no. 13
    
14.
Bouché O, Brixi-Benmansour H, Bertin A, Perceau G, Lagarde S. Trichomegaly of the eyelashes following treatment with cetuximab. Ann Oncol 2005;16:1711-2.  Back to cited text no. 14
    
15.
Papadopoulos R, Chasapi V, Bachariou A. Trichomegaly induced by erlotinib. Orbit 2008;27:329-30.  Back to cited text no. 15
    
16.
Pascual JC, Bañuls J, Belinchon I, Blanes M, Massuti B. Trichomegaly following treatment with gefitinib (ZD1839). Br J Dermatol 2004;151:1111-2.  Back to cited text no. 16
    
17.
Goksugur N, Karabay O. Eyelash and eyebrow trichomegaly induced by interferon-alfa 2a. Clin Exp Dermatol 2007;32:583-4.  Back to cited text no. 17
[PUBMED]    
18.
Lacouture ME, Lai SE. The PRIDE (Papulopustules and/or paronychia, Regulatory abnormalities of hair growth, Itching, and Dryness due to Epidermal growth factor receptor inhibitors) syndrome. Br J Dermatol 2006;155:852-4.  Back to cited text no. 18
[PUBMED]    
19.
Carser JE, Summers YJ. Trichomegaly of the eyelashes after treatment with erlotinib in non-small cell lung cancer. J Thorac Oncol 2006;1:1040-1.  Back to cited text no. 19
    
20.
Foon KA, Dougher G. Increased growth of eyelashes in a patient given leukocyte a interferon. N Engl J Med 1984;311:1259.  Back to cited text no. 20
[PUBMED]    
21.
Mechcatie E. Bimatoprost approved for eyelash lengthening. Skin Allergy News 2009;40:10.  Back to cited text no. 21
    
22.
Dueland S, Sauer T, Lund-Johansen F, Ostenstad B, Tveit KM. Epidermal growth factor receptor inhibition induces trichomegaly. Acta Oncol 2003;42:345-6.  Back to cited text no. 22
    
23.
Zhang G, Basti S, Jampol LM. Acquired trichomegaly and symptomatic external ocular changes in patients receiving epidermal growth factor receptor inhibitors: Case reports and a review of literature. Cornea 2007;26:858-60.  Back to cited text no. 23
    

What is new?

  1. Trichomegaly is not only the increase in length of hair; but also refers to increased pigmentation, curling or thickness of hair.
  2. Detailed list of causes of trichomegaly has been incorporated in this article including the newer drugs associated with trichomegaly.
  3. Underlying pathophysiology of trichomegaly is included in this discussion.
  4. Drugs with side effect of trichomegaly such as latanoprost approved for hypotrichosis of eyelashes.



 
 
    Tables

  [Table 1], [Table 2]



 

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