A case of acquired trichomegaly following treatment with erlotinib

Abstract

A woman on erlotinib treatment for lung cancer presented with a corneal ulcer from aberrant eyelash touch. She developed coarse, hyperpigmented and irregular eyelash and eyebrow growth a few months following treatment. She was treated successfully with epilation, eyelash trimming, lid hygiene and intensive topical lubrication. This is the first case report in the UK of trichomegaly with associated corneal ulceration. Erlotinib is an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor that has recently been approved for use as a chemotherapeutic agent by the National Institute for Health and Clinical Excellence. Ophthalmologists and oncologists should be aware of the adnexal and ocular surface changes that can occur, and that simple interventions may be used to manage them.

Erlotinib Associated Trichomegaly In A Patient With Chronic Latanoprost Use

“…14,15,16,17,18,19,20,21 Medications associated with this pattern of eyelash growth include: Cyclosporine, EGFRI, Interferon alpha, Prostaglandin analogues, Tacrolimus, and Topiramate. 22,23,24,25,26,27 This patient was using two medications shown to cause trichomegaly; Erlotinib (an EGFRI), and Latanoprost (a prostaglandin analogue). According to one large series, 94% of patients developing trichomegaly from prostaglandin analogue eye drops within the first year of use develop symptoms in the first 6 months of treatment (44.6% in 6 months versus 46.2% in 1 year).…”

“…2 Though most chemotherapeutic agents would be expected to cause hair loss, EGFRI drugs such as Erlotinib have been shown to cause a paradoxical trichomegaly (increased length, thickness, and pigmentation) of the eyelashes due to a dysregulation of this process. 3,4,5 Interestingly, prostaglandin F2α receptors have been shown to be expressed predominately during the anagen phase in the inner root sheath of the bulb and stem of eyelashes. 6…”