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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The synthetic phenyl-substituted analog of prostaglandin F<span class="elsevierStyleInf">2</span> alpha &#40;PGF<span class="elsevierStyleInf">2</span>-&#945;&#41;&#44; latanoprost&#44; is an intraocular pressure-lowering drug for use in patients with primary open-angle glaucoma and ocular hypertension&#46; Hypertrichosis of the eyelashes is a common reported adverse effect of this drug and of prostaglandin analogs in general since their introduction in the late 1990s&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Here we present a case of poliosis and bilateral hypertrichosis of the malar vellus hairs that occurred during use of ophthalmic latanoprost solution for glaucoma treatment&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 64-year-old woman presented at our department complaining of excessive hair growth in both malar areas&#46; The problem had started 6 months earlier and the hairs had progressively grown in number and diameter since then&#46; Examination revealed hypertrichosis and poliosis of the eyelashes in addition to hypertrichosis of the malar areas&#46; The whitened eyelashes were interspersed among normal-appearing eyelashes in both eyes &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; There were no signs of hypertrichosis on any other parts of the body&#46; The patient had had bilateral glaucoma for 4 years&#44; and had been using latanoprost eye drops since diagnosis&#46; She had a history of hypertension and diabetes mellitus and had been taking amlodipine tablets and oral acarbose for the treatment of these diseases for about 8 years&#46; She had no other cutaneous or systemic disorders and the results of routine biochemical and hormonal tests were within normal limits&#46; She denied use of any topicals creams&#44; including sunscreens or corticosteroids&#44; on her face&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Hypertrichosis is the growth of hair that is considered excessive for the age&#44; sex&#44; and race of an individual&#46; It can occur all over the body or be isolated to small patches&#46; PGF<span class="elsevierStyleInf">2</span>-&#945; analogs have been observed to promote hair growth and may have hypertrichotic effects&#46; The mechanisms by which prostaglandins trigger hair growth&#44; however&#44; are not clear&#46; It has been suggested that hypertrichosis of the eyelashes following administration of prostaglandin analogs for glaucoma treatment is probably a result of the induction of the anagen phase in telogen-phase eyelash follicles&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> These analogs may also prolong the anagen phase of eyelashes&#44; leading to an increase in eyelash length&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Eyelash hypertrichosis has been reported as a common adverse effect of ophthalmic latanoprost treatment&#44; with frequency rates as high as 77&#37;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and 50&#46;5&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Even brief exposure to an ophthalmic prostaglandin analog appears to be associated with eyelash changes&#46; In one study&#44; very brief exposure to latanoprost &#40;&#60;22 days&#41; was reported to produce hypertrichosis similar to that seen with sustained exposure&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Our patient reported hypertrichosis of the vellus hairs of the malar area after 3&#46;5 years of treatment&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Changes in the appearance of hairs other than eyelashes have been reported in a few papers&#46; Reports of hypertrichosis of the vellus hairs of the eyelids&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;5</span></a> inner canthus&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> upper cheek&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and malar regions<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#8211;10</span></a> can be found in the literature&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Chen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> reported poliosis in a series of 7 patients using different PGF<span class="elsevierStyleInf">2</span>-&#945; analogs for primary open-angle glaucoma&#46; The affected lashes were interspersed with normally pigmented lashes&#46; Whole affected lashes were observed to be new&#44; implying that the effect may result from failure of pigmentation in newly stimulated eyelash growth or from stimulated growth of previously inconspicuous white lashes&#46; Our patient did not complain about her white eyelashes as she considered them to be normal age-related changes&#46; It is&#44; however&#44; known that eyelashes do not generally turn white with age&#44; and if they do&#44; they normally only do so at a very late stage&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Other local adverse effects of PGF<span class="elsevierStyleInf">2</span>-&#945; analogs are iris pigmentation&#44; conjunctival hyperemia&#44; increased pigmentation of the periocular skin&#44; deepening of the eyelid sulcus&#44; periorbital fat atrophy and relative enophthalmos&#44; anterior uveitis&#44; and an increased risk of herpes simplex viral infection recurrence&#46; There have also been some reports of systemic adverse effects&#44; such as symptoms of common cold and upper respiratory tract infection&#44; headache&#44; abnormal liver function tests&#44; asthenia and hirsutism&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">We thought it might be interesting to report this infrequently observed case to highlight the importance of considering topical PGF<span class="elsevierStyleInf">2</span>-&#945; analog therapy as a possible cause of poliosis and hypertrichosis of the vellus hairs around eyes&#46;</p></span>"
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Case and research letter
Hypertrichosis of the malar areas and poliosis of the eyelashes caused by latanoprost
Hipertricosis de las Áreas Malares y Poliosis de las Pestañas Causados por Latanoprost
S. Özyurta,
Autor para correspondencia
ozyurtselcuk@yahoo.com

Corresponding author.
, G. Seyman Çetinkayab
a Dermatology Clinic, İzmir Atatürk Education and Research Hospital, İzmir, Turkey
b Internal Medicine Clinic, İzmir Atatürk Education and Research Hospital, İzmir, Turkey
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The synthetic phenyl-substituted analog of prostaglandin F<span class="elsevierStyleInf">2</span> alpha &#40;PGF<span class="elsevierStyleInf">2</span>-&#945;&#41;&#44; latanoprost&#44; is an intraocular pressure-lowering drug for use in patients with primary open-angle glaucoma and ocular hypertension&#46; Hypertrichosis of the eyelashes is a common reported adverse effect of this drug and of prostaglandin analogs in general since their introduction in the late 1990s&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Here we present a case of poliosis and bilateral hypertrichosis of the malar vellus hairs that occurred during use of ophthalmic latanoprost solution for glaucoma treatment&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 64-year-old woman presented at our department complaining of excessive hair growth in both malar areas&#46; The problem had started 6 months earlier and the hairs had progressively grown in number and diameter since then&#46; Examination revealed hypertrichosis and poliosis of the eyelashes in addition to hypertrichosis of the malar areas&#46; The whitened eyelashes were interspersed among normal-appearing eyelashes in both eyes &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; There were no signs of hypertrichosis on any other parts of the body&#46; The patient had had bilateral glaucoma for 4 years&#44; and had been using latanoprost eye drops since diagnosis&#46; She had a history of hypertension and diabetes mellitus and had been taking amlodipine tablets and oral acarbose for the treatment of these diseases for about 8 years&#46; She had no other cutaneous or systemic disorders and the results of routine biochemical and hormonal tests were within normal limits&#46; She denied use of any topicals creams&#44; including sunscreens or corticosteroids&#44; on her face&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Hypertrichosis is the growth of hair that is considered excessive for the age&#44; sex&#44; and race of an individual&#46; It can occur all over the body or be isolated to small patches&#46; PGF<span class="elsevierStyleInf">2</span>-&#945; analogs have been observed to promote hair growth and may have hypertrichotic effects&#46; The mechanisms by which prostaglandins trigger hair growth&#44; however&#44; are not clear&#46; It has been suggested that hypertrichosis of the eyelashes following administration of prostaglandin analogs for glaucoma treatment is probably a result of the induction of the anagen phase in telogen-phase eyelash follicles&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> These analogs may also prolong the anagen phase of eyelashes&#44; leading to an increase in eyelash length&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Eyelash hypertrichosis has been reported as a common adverse effect of ophthalmic latanoprost treatment&#44; with frequency rates as high as 77&#37;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and 50&#46;5&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Even brief exposure to an ophthalmic prostaglandin analog appears to be associated with eyelash changes&#46; In one study&#44; very brief exposure to latanoprost &#40;&#60;22 days&#41; was reported to produce hypertrichosis similar to that seen with sustained exposure&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Our patient reported hypertrichosis of the vellus hairs of the malar area after 3&#46;5 years of treatment&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Changes in the appearance of hairs other than eyelashes have been reported in a few papers&#46; Reports of hypertrichosis of the vellus hairs of the eyelids&#44;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;5</span></a> inner canthus&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> upper cheek&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and malar regions<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#8211;10</span></a> can be found in the literature&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Chen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> reported poliosis in a series of 7 patients using different PGF<span class="elsevierStyleInf">2</span>-&#945; analogs for primary open-angle glaucoma&#46; The affected lashes were interspersed with normally pigmented lashes&#46; Whole affected lashes were observed to be new&#44; implying that the effect may result from failure of pigmentation in newly stimulated eyelash growth or from stimulated growth of previously inconspicuous white lashes&#46; Our patient did not complain about her white eyelashes as she considered them to be normal age-related changes&#46; It is&#44; however&#44; known that eyelashes do not generally turn white with age&#44; and if they do&#44; they normally only do so at a very late stage&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Other local adverse effects of PGF<span class="elsevierStyleInf">2</span>-&#945; analogs are iris pigmentation&#44; conjunctival hyperemia&#44; increased pigmentation of the periocular skin&#44; deepening of the eyelid sulcus&#44; periorbital fat atrophy and relative enophthalmos&#44; anterior uveitis&#44; and an increased risk of herpes simplex viral infection recurrence&#46; There have also been some reports of systemic adverse effects&#44; such as symptoms of common cold and upper respiratory tract infection&#44; headache&#44; abnormal liver function tests&#44; asthenia and hirsutism&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">We thought it might be interesting to report this infrequently observed case to highlight the importance of considering topical PGF<span class="elsevierStyleInf">2</span>-&#945; analog therapy as a possible cause of poliosis and hypertrichosis of the vellus hairs around eyes&#46;</p></span>"
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