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International Journal of Trichology International Journal of Trichology
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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 14  |  Issue : 2  |  Page : 71-72  

Lady with long eyelashes…!


Department of Endocrinology, Care Hospitals, Hyderabad, Telangana, India

Date of Submission19-Aug-2021
Date of Acceptance01-Nov-2021
Date of Web Publication04-Apr-2022

Correspondence Address:
Soumya S Inamadar
Department of Endocrinology, Care Hospitals, Hyderabad, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijt.ijt_86_21

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   Abstract 


A sixty years postmenopausal lady presented with growing longer eyelashes for 8 years. She had thick, dark, curly eyelashes measuring 23 mm and 15 mm at the centre and periphery respectively suggesting marked trichomegaly. Increased vellus hair was noticed above lips and chin suggesting hypertrichosis. An important clue in history was the use of chemotherapeutic agent Erlotinib after bronchoscopic surgery for non-small cell lung carcinoma for the past 8 years. Erlotinib competitively binds to the tyrosine kinase domain of Epidermal Growth Factor Receptor inhibiting receptor activation and blocking the signal transduction. Thus, disrupting the transition of hair growth from anagen to telogen phase, leading to aberrant anagen phase and consequently abnormal hair growth. Trichomegaly is seen after 2–5 months of treatment. Mostly innocuous, it can lead to eyelid infections and rarely corneal ulceration. EGFR inhibitors are associated with hypertrichosis in other areas, as was the case in this patient. This case highlights the significance of detailed history including drugs, thus abating additional work-up for trichomegaly.

Keywords: Carcinoma lung, epidermal growth factor receptor, erlotinib, hirsutism, trichomegaly


How to cite this article:
Inamadar SS, Praveen Kumar N S. Lady with long eyelashes…!. Int J Trichol 2022;14:71-2

How to cite this URL:
Inamadar SS, Praveen Kumar N S. Lady with long eyelashes…!. Int J Trichol [serial online] 2022 [cited 2022 May 21];14:71-2. Available from: https://www.ijtrichology.com/text.asp?2022/14/2/71/342549




   Introduction Top


Eyelash trichomegaly is defined as increased length, curling, pigmentation or thickness of eyelashes. Etiological association is seen with congenital syndromes, acquired conditions and drugs. Epidermal growth factor receptor inhibitors, used in the treatment of solid tumors are associated with trichomegaly. It results in enhanced terminal differentiation of hair, which can be noted anytime after 2-5 months of treatment. It can also be associated with hypertrichosis in other areas of the face and may pose challenges such as hirsutism.


   Case Report Top


A 60-year-old woman euthyroid with Levothyroxine replacement therapy for primary hypothyroidism came during COVID lockdown with the complaint of long eyelashes for 8 years. The eyelashes continued to grow despite trimming. The patient had attained menopause 12 years ago and had no symptoms of irregular menstruation or hirsutism during any phase of her reproductive life. There was no evidence of virilization or defeminization. An important clue in history was her being on Erlotinib after bronchoscopic surgery for Carcinoma Lung, for the past 8 years.

On examination, she had thick, dark, curly eyelashes measuring 23 mm and 15 mm at the center and periphery respectively suggesting marked trichomegaly. Upon removing the face mask, increased vellus hair was also noticed above upper lips and chin suggestive of hypertrichosis. [Figure 1] and [Figure 2] and illustrates the eyelash trichomegaly with hypertrichosis as described in frontal and lateral views.
Figure 1: Eyelash trichomegaly with hypertrichosis above the upper lip and over chin, Frontal view

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Figure 2: Eyelash trichomegaly with hypertrichosis above the upper lip and over chin, Lateral view

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Epidermal Growth Factor Receptor (EGFR) is constitutively expressed in normal tissues such as the epidermis and the hair follicle. Erlotinib, a quinazoline derivative exerts anti-neoplastic action by competitively binding to the tyrosine kinase domain of EGFR, inhibiting receptor activation and blocking the signal transduction.[1] Erlotinib is indicated in the therapy of advanced or metastatic pancreatic or nonsmall cell lung cancer. Dermatological side effects are seen in up to 80% of subjects and can be severe in 15%. Trichomegaly is a rare and paradoxical adverse event, the mechanism of which is poorly understood.[2] EGFR is expressed in the keratinocytes of the outer sheath of the hair follicle and acts as an on/off switch at the beginning and the end of the anagen phase. The inhibition of the EGFR signaling disrupts the transition of the anagen to the telogen phase, leading to an aberrant anagen phase with resultant abnormal hair growth.[3] Trichomegaly is usually noted after 2–5 months of treatment. Mostly innocuous, it can lead to eyelid infections and rarely corneal ulceration. It can be associated with hypertrichosis in other areas as was the case in this patient.

No further workup was done for the case and the diagnosis of drug-induced trichomegaly with hypertrichosis was made. This case highlights the need for detailed drug history in patients presenting with abnormal hair growth to obviate the need for further workup.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
PubChem. Bethesda (MD): National Library of Medicine (US), National Center for Biotechnology Information; 2004. PubChem Compound Summary for CID 176870, Erlotinib. Available from: https://pubchem.ncbi.nlm.nih.gov/compound/Erlotinib. [Last accessed on 2021 Aug 19].  Back to cited text no. 1
    
2.
Braiteh F, Kurzrock R, Johnson FM. Trichomegaly of the eyelashes after lung cancer treatment with the epidermal growth factor receptor inhibitor erlotinib. J Clin Oncol 2008;26:3460-2.  Back to cited text no. 2
    
3.
Busam KJ, Capodieci P, Motzer R, Kiehn T, Phelan D, Halpern AC. Cutaneous side-effects in cancer patients treated with the antiepidermal growth factor receptor antibody C225. Br J Dermatol 2001;144:1169-76.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]



 

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