Eyelash lengthening through prostaglandin analogues

When applied locally, prostaglandin analogues are able to stimulate eyelashes to grow significantly. This has been proven for about 2 decades by numerous randomized, double-blind, reproducible therapy studies on this topic (see literature). The growth effects were proven in healthy Caucasian as well as in Asian women. Therapeutic approaches also exist for alopecia of the eyebrows and capillitium (Vergilis-Kalner IJ 2014).

Good effects have also been demonstrated for chemotherapeutically induced eyelash loss (Ahluwalia GS 2013). However, post-chemotherapy patients have to expect higher side effects than healthy ones.

Prostaglandin analogues extend the growth phase of the lashes, so that more lashes are in the growth phase at the same time and the lashes become both longer and thicker. The number of applied hair follicles is not affected. Prostaglandin analogues also stimulate melanin synthesis; this effect can lead to hyperpigmentation of the eyelids. Studies on the effect of Latanoprost in androgenetic alopecia have shown a significant increase in hair density. In addition, an increased pigmentation of the hair was observed. The molecular mechanism of action of PG analogues on the growth cycle of the eyelashes is not yet known (BfR Commission: 21st meeting of the BfR Commission on Cosmetic Products, protocol of 18 April 2018).

The following prostaglandin analogues are the most commonly offered and used:

• Bimatoprost, Latanoprost
• Isopropyl cloprostenates (Miralash®, FaceEvolution Hairplus®)
• Dechloro-dihydroxy-difluoro-ethylcloprostenolamides (Nanolash®, RevitaLash®)
• Methylamido-Dihydro-Noralfaprostal (M2 Eyelash Activating Serum®)
• Active ingredient from the coral Plexaura Homomalla (RefectoCil®, BeautyLash®)

The side effects of prostaglandin in cosmetic products vary greatly. Known are: conjunctival hyperemia, itching and erythema of the eyelids, melanotic pigmentation of the iris, periocular skin pigmentation, keratitis punctata, iris cysts, cystoid macular edema (Makri OE et al. 2017), anterior uveitis, iritis, reactivation of keratitis herpetica.

Many publications regarding the side effects of the eyelash sera refer to the active ingredient Latanoprost, because it has been used for the longest time for this indication (Alm A et al. 2008).

Most of the side effects occurred already in an early therapy phase and were apparently reversible after interruption of the treatment. With the rather rare occurrence of serious side effects, side effects that have been known for this group of drugs in the treatment of glaucoma for a long time must also be considered (Horsely MB et al. 2011). This serious spectrum of side effects seriously questions the "eyelash serums" as "unproblematic cosmetics".

Dermatological case report: After application of an isopropylcloprostenate-containing eyelash serum, a periorbital, interfollicular whitish colour change developed within a short time, which was also detectable around capillary vessels of the skin. The changes were reversible (Horvath O et al. 2017).

In 2008, the first company launched an eyelash serum on the market, there are now over 20 different serums (cosmetics). According to the manufacturers, these serums significantly stimulate the growth of the eyelashes within a short period of time. Applied daily, first successes should be visible from about 4-6 weeks. The patients discovered by chance that these substances stimulate the growth of the eyelashes when they received prostaglandin-containing eye drops for glaucoma.

1. Ahluwalia GS (2013) Safety and efficacy of bimatoprost solution 0.03% topical application in patients with chemotherapy-induced eyelash loss. J Investig Dermatol Symp Proc 16:73-76.
2. Alm A et al (2008) Side effects associated with prostaglandin analog therapy. Surv Ophthalmol 53 Suppl1: 93-105.

3. BfR-Commission: 21st meeting of the BfR-Commission for Cosmetic Products, protocol of 18 April 2018. Prostaglandin-A

4. Glaser DA et al (2015) Long-term safety and efficacy of bimatoprost solution 0-03% application to the eyelid margin for the treatment of idiopathic and chemotherapy-induced eyelash hypotrichosis: a randomized controlled trial. Br J Dermatol 172:1384-1394.
5. Fagien S et al (2013) Patient-reported outcomes of bimatoprost for eyelash growth: results from a randomized, double-masked, vehicle-controlled, parallel-group study. Aesthet Surgery J 33:789-798.
6. Giannico AT et al (2013) Eyelash growth induced by topical prostaglandin analogues, bimatoprost, tafluprost, travoprost, and latanoprost in rabbits. J Ocul Pharmacol Ther 29(9):817-820.
7. Harii K et al (2014) Bimatoprost for eyelash growth in Japanese subjects: two multicenter controlled studies. Aesthetic Plast Surgery 38:451-460.
8. Horsley MB et al (2011) The use of prostaglandin analogues in the uveitic patient. Seminar Ophthalmol 26:285-289.
9. Horváth O et al (2017) Periocular discoloration after using a prostaglandin analog for eyelash enhancement: evaluation with reflectance confocal microscopy. J Cosmet Dermatol 16:18-20.
10. Khidhir KG et al (2013) The prostamide-related glaucoma therapy, bimatoprost, offers a novel approach for treating scalp alopecias. FASEB J 27:557-567.
11. Kwon O et al (2014) Long-term utility and durability of the therapeutic effects of bimatoprost 0.03% for eyelash augmentation in healthy Asian subjects. Dermatology 229:222-229.
12. Makri OE et al (2017) Cystoid macular edema associated with preservative-free latanoprost after uncomplicated cataract surgery: case report and review of the literature.
    BMC Res Notes 10:127.
13. Vergilis-Kalner IJ (2014) Application of bimatoprost ophthalmic solution 0.03% for the treatment of eyebrow hypotrichosis: series of ten cases. Dermatol Online J 20.
14. Wirta D et al.(2015) Bimatoprost 0.03% for the treatment of Eyelash Hypotrichosis: A Pooled Safety Analysis of Six Randomized, Double-masked Clinical Trials. J Clin Aesthet Dermatol 8:17-29.