Eyebrow loss: clinical review

In Vitro Performance Analysis of a Minoxidil Thermosensitive Gel with Reduced Runoff for Eyebrow Hair Growth

There is a growing interest in innovative products for eyebrow hair loss treatment with fewer adverse effects. Nevertheless, a fundamental formulation aspect of preventing the fragile skin from the ocular region from being irritated is that the formulations remain restricted to the application region and do not run off. Consequently, the methods and protocols in drug delivery scientific research must be adapted to fulfill such performance analysis demand. Thus, this work aimed to propose a novel protocol to evaluate the in vitro performance of a topical gel formulation with a reduced runoff for minoxidil (MXS) delivery to eyebrows. MXS was formulated with 16% poloxamer 407 (PLX) and 0.4% of hydroxypropyl methylcellulose (HPMC). The sol/gel transition temperature, viscosity at 25 °C, and formulation runoff distance on the skin were evaluated to characterize the formulation. The release profile and skin permeation were evaluated in Franz vertical diffusion cells for 12 h and compared to a control formulation (4% PLX and 0.7% HPMC). Then, the formulation's performance at promoting minoxidil skin penetration with minimum runoff was evaluated in a vertical custom-made permeation template (divided into three areas: superior, middle, and inferior). The MXS release profile from the test formulation was comparable to that from the MXS solution and the control formulation. There was also no difference in the MXS amount that penetrated the skin in the permeation experiments in Franz diffusion cells using the different formulations (p > 0.05). However, the test formulation demonstrated a localized MXS delivery at the application site in the vertical permeation experiment. In conclusion, the proposed protocol could differentiate the test formulation from the control, attesting to its better performance in efficiently delivering MXS to the site of interest (middle third of application). The vertical protocol can be easily employed to evaluate other gels with a drip-free appeal.

The efficacy of topical prostaglandin analogs for hair loss: A systematic review and meta-analysis

Background

Prostaglandin analogs have been found to have more versatile uses: treatment of open-angle glaucoma, high intraocular pressure, vitiligo, and other treatments. And prostaglandin analogs have been found to have an important role in the hair growth cycle. However, prostaglandin analogs have not been sufficiently studied for hair (including hair, eyelashes, and eyebrows) regeneration. In this study, a systematic review and meta-analysis of topical prostaglandin analogs on hair loss was performed.

Objective

The purpose of this meta-analysis is to determine the efficacy and safety of topical prostaglandin analogs for treating hair loss.

Methods

We searched PubMed, Embase, and Cochrane Library databases comprehensively. Data were pooled using Review Manager 5.4.1, and subgroup analyses were performed if necessary.

Results

There were six randomized controlled trials included in this meta-analysis. All studies compared prostaglandin analogs with placebo, and one trial consisted of two sets of data. The results showed that prostaglandin analogs could significantly improve the hair length and density (p < 0.001). As far as adverse events are concerned, there was no significant difference between the experimental group and the control group.

Conclusion

In patients with hair loss, the topical prostaglandin analogs have better therapeutic efficacy and safety than placebo. However, the best dose and frequency of experimental treatment require further studies.

Frontal-Temporal Triangle Area Hair for Eyebrow Restoration in Asians: A Comparative Study With Periauricular and Occipital Hair

BACKGROUND

The frontal-temporal triangle area (FTTA) hair has a slow growth rate and thin caliber, which are similar to those of eyebrow hair. However, a comparison of cosmetic outcomes between FTTA and other scalp hair grafts in eyebrow transplantation has not been performed.

OBJECTIVE

To compare the cosmetic outcomes of FTTA hair and periauricular and occipital area (POA) hair in eyebrow restoration.

METHODS

A retrospective analysis of 155 patients with FTTA or POA hair transplants was performed. Comparative variables included patient characteristics, hair density, diameter, percentage of one-hair follicular units (FUs), number of transplanted FUs, harvesting time, transection rate, hair survival rate, frequency of eyebrow trimming, and patient satisfaction.

RESULTS

There was a significant difference in hair density, diameter, percentage of one-hair FUs, and harvesting time between the FTTA and POA hair transplants. The FTTA hair grew significantly slower than the POA hair did. The patients in the FTTA group trimmed their postoperative eyebrows at a significantly longer interval than those in the POA group. The percentage of patients who were very satisfied with the surgery results was higher in the FTTA group.

CONCLUSION

The FTTA hair grafts can provide aesthetically pleasing cosmetic results in eyebrow restoration.

Isolated hair loss on the eyebrow: five cases with trichoscopic features

Alopecia areta (AA) and trichotillomania (TTM) are common causes for hair loss on the eyebrows. Yellow dots, vellus hairs, anisotrichosis, empty follicular openings, and black dots were observed in the present study's patients with AA. Split hairs, question mark hairs, broken hairs, flame hairs, black dots, hairs with different lengths, and hemorrhagic areas were found in the patients with TTM. Trichoscopy is a very useful and helpful technic in distinguishing AA and TTM on the eyebrows.

Morphometric characteristics of feminine eyebrows: variations with ethnicities and age

OBJECTIVE

To explore some morphological features of the eyebrows of women of different ethnicities and ages.

MATERIALS AND METHODS

Standard digital photographs of 3600 women of six ethnicities, aged 18-84 years, previously used to describe the morphology of the human eyes, allowed us to focus on their eyebrows, as supplementary and opportunistic study. Photographs of both eyebrows were analysed partly by manual markings and automatically by dedicated algorithms. Six parameters of the eyebrows were recorded: length, waviness/curvature, oblique aspect, size (vertical height), total surface and hair coverage (density).

RESULTS

Most criteria present ethnic specificities. These are: length (longer eyebrows of Indian, shorter among African women); waviness where the straighter eyebrows were found among Chinese and Japanese women. In general, the longer the eyebrows, the higher their waviness and vice versa. Thickness (or height) of the eyebrows presents a wide ethnic variability as well as hair coverage, where African women present the lower hair density, inversely to Indian women. The same holds true with regard to the total surface of eyebrows, of a large variability (by about four times). Some criteria appear more individually dependent than ethnic-specific, such as the oblique positioning, at the exception of Indian women with less oblique eyebrows. In all subjects, the criteria of both eyebrows (Left vs. Right) were found to be highly correlated (r > 0.7, P < 0.001).

CONCLUSION

The present investigation brings new findings on a scarcely studied facial element, the morphologic features of which are, for most, ethnic-dependent. As applied consequences, the results of the present work pave the road to better adapt adorning procedures of the eyebrows vis-à-vis ethnic and age specificities.

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.

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.

Topical Treatment of Eyebrow Hypotrichosis with Bimatoprost 0.03% Solution: Case Report and Literature Review

The eyebrows frame the upper margin of the orbit and are an essential feature of the facial landscape. Eyebrow hypotrichosis, also known as madarosis, is characterized by a lack of growth or loss of eyebrow hair. Eyebrow loss can have cosmetic, functional, and social consequences. Eyebrow hypotrichosis can be idiopathic or related to an underlying condition. Bimatoprost 0.03% solution is a prostamide F_2α analog indicated for the treatment of glaucoma and ocular hypertension that has also demonstrated efficacy for hair growth; indeed, it is currently approved by the Food and Drug Administration for the treatment of eyelash hypotrichosis. A 60-year-old woman with eyebrow hypotrichosis is described who achieved excellent and sustained growth of her eyebrows with continual daily application of bimatoprost 0.03% solution. We discuss the therapeutic mechanisms of bimatoprost 0.03% solution in hair growth, review other potential modalities for treating eyebrow hypotrichosis, and summarize the findings of investigators who have utilized bimatoprost in the treatment of eyebrow hypotrichosis.

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.

Alopecia and Associated Toxic Agents: A Systematic Review

Importance/Objective

There are a number of toxic agents that can cause alopecia. In this review we summarize the known substances that cause alopecia as one of the clinical signs of overdose or toxicity.

Evidence Review

A search was conducted using PubMed, EMBASE, and Cochrane for studies describing hair loss of any type as a result of exposure to or ingestion of a toxic agent. The search yielded 856 articles, with 47 studies included in this review.

Findings

Agents with the strongest evidence of association to alopecia include thallium, mercury, selenium, and colchicine. Agents with described incidents include boric acid, arsenic, vitamin A, botulinum toxin, Podostroma cornu-damae, and the synthetic opioid MT-45.

Conclusions and Relevance

Numerous toxic agents have been implicated in alopecia, and the strength of evidence behind each agent varies. Toxic levels of thallium and colchicine have long been established to cause alopecia, as compared to agents such as botulinum toxin A and synthetic recreational drugs which have less literature describing their links to alopecia and will need further investigation to characterize their relationships to hair loss. Knowledge of typical presentations of hair loss will aid in the development of a differential diagnosis for patients presenting with alopecia.

Bimatoprost 0.03% for the Treatment of Eyebrow Hypotrichosis

BACKGROUND

Eyebrow loss may have substantial negative functional and social consequences.

OBJECTIVE

Evaluate the safety and efficacy of bimatoprost 0.03% in subjects with eyebrow hypotrichosis.

METHODS

This multicenter, double-masked study randomized adult females or males with eyebrow hypotrichosis to receive bimatoprost 0.03% twice (BID) or once daily (QD) or vehicle BID for 7 months. Primary endpoint was overall eyebrow fullness at Month 7. Secondary endpoints included eyebrow fullness (mm²), darkness (intensity units), and subject satisfaction with treatment. Safety was also assessed.

RESULTS

At Month 7, the proportion of subjects with improvement was significantly higher in bimatoprost groups versus vehicle (both, p < .001). Improvements occurred in both bimatoprost groups versus vehicle after Month 1 and continued through follow-up; eyebrow fullness and darkness improved as early as Months 2 and 1, respectively (both, p < .001). Greater satisfaction was reported with bimatoprost versus vehicle at Month 2 and all subsequent time points. Overall, 38.1%, 42.4%, and 35.5% of subjects in the bimatoprost BID, QD, and vehicle groups, respectively, experienced ≥1 treatment-emergent adverse event (TEAE). Most frequent TEAEs were similar across groups. No skin or iris hyperpigmentation or conjunctival hyperemia occurred.

CONCLUSION

Bimatoprost 0.03% BID and QD is safe, well tolerated, and effective for eyebrow hypotrichosis.

Minoxidil 2% lotion for eyebrow enhancement: a randomized, double-blind, placebo-controlled, spilt-face comparative study

Topical minoxidil has been successfully used to treat androgenetic alopecia. It can also be applied to enhance eyebrows. However, there is no study comparing minoxidil lotion with placebo for eyebrow enhancement. In this trial, we determined the efficacy and safety of minoxidil 2% lotion for eyebrow enhancement compared with placebo. Forty patients were randomized for minoxidil on the eyebrow on one side of the face and placebo on the other. Efficacy was evaluated by global photographic assessment, eyebrow diameter, eyebrow count and subject's satisfaction. Side-effects were also evaluated. Thirty-nine patients (97.5%) completed the study. After 16 weeks, the minoxidil group achieved significantly better results in all measured outcomes compared to the placebo group. Side-effects were minor and did not preclude patients from continuing the study. Our study suggests that minoxidil 2% lotion is a safe and effective treatment for eyebrow hypotrichosis.

Ulerythema Ophryogenes, A Rarely Reported Cutaneous Manifestation of Noonan Syndrome: Case Report and Review of the Literature

Background:

Ulerythema ophryogenes (also known as keratosis pilaris atrophicans faciei) is a rarely reported cutaneous manifestation of Noonan syndrome.

Objective:

Recognizing ulerythema ophryogenes as a cutaneous association in Noonan syndrome may aid in the diagnosis of this relatively common genetic condition.

Methods:

We present a case of a patient with Noonan syndrome and ulerythema ophryogenes associated with a SOS1 mutation and review the literature on this association.

Results:

To the best of our knowledge, this is the second case of Noonan syndrome proven to be due to an SOS1 mutation in which ulerythema ophryogenes was clinically recognized and specifically diagnosed.

Conclusions:

The presence of ulerythema ophryogenes in a patient with Noonan syndrome increases the likelihood of a SOS1 mutation. Further reports by dermatologists and medical geneticists documenting ulerythema ophryogenes and not just descriptions of sparse or absent eyebrows will help support this genotype-phenotype correlation.

Female adolescent hair disorders

Hair abnormalities can have tremendous psychosocial impacts on adolescents and young adults, and may cause a great amount of anxiety regarding physical appearance, associated illnesses, and potential clinical course. The pathophysiology of such disorders may vary,with potential congenital, infectious, autoimmune, nutritional, or environmental causes. Hair abnormalities may present as changes in hair appearance or quality, becoming weathered or fractured.An abnormal increase in hair is present in hypertrichosis and hirsutism, whereas a thinning or shedding of hair is evident in patients with telogen effluviumand alopecia areata. Diagnosis is focused on a detailed clinical history and physical exam, in addition to laboratory testing, a variety of clinical diagnostic tests, and scalp biopsy, which may be necessary to confirm some diagnoses. Many hair disorders have no cure, but clinicians can have a positive impact on their patients by identifying the abnormality and educating the patient regarding disease course. However, some conditions such as infectious hair disorders or scarring alopecia should be identified promptly to initiate treatment and ensure clinical improvement or optimal outcome.

Adolescent hair loss

PURPOSE OF REVIEW

Hair loss, or alopecia, may occur as a primary skin disorder or because of an underlying health problem. It may be upsetting to patients, particularly adolescents who are experiencing physical, emotional, and psychological transitions. Understanding the impact of alopecia is important for care providers who see adolescents.

RECENT FINDINGS

The most common forms of alopecia in adolescence are telogen effluvium, androgenetic alopecia, and alopecia areata. Telogen effluvium may present suddenly or insidiously secondary to a variety of triggers. Androgenetic alopecia may begin in adolescence, and topical minoxidil is effective at retarding further hair loss. It may be a sign of underlying androgen excess, particularly polycystic ovary syndrome in women. Alopecia areata is less common, but may be distressing, especially if hair loss is extensive. Because treatments for alopecia are not curative, helping affected patients cope by offering support and nonpharmacologic techniques to help appear more like their peers should be part of care.

SUMMARY

Physicians need to be skilled in evaluating the most common forms of alopecia presenting in adolescence and should be aware of potential treatments, including the value of psychosocial support.