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Eyelash Trichomegaly Associated With Systemic Tacrolimus

Eyelash Trichomegaly Associated With Systemic Tacrolimus Report of a Case A 35-year-old woman with hepatitis B underwent orthotopic heart transplantation for congestive heart failure secondary to congenital heart defects. Postoperative immunosuppression included treatment with tacrolimus, mycophenolate mofetil, and prednisone. Of note, the patient did not receive cyclosporine. Ten weeks after transplantation, the patient was seen by the dermatology service for an allergic contact dermatitis reaction to tape. At that time, the patient was noted to have eyelash trichomegaly (eyelashes measuring approximately 1.3 cm) that she noted about 8 weeks after receiving the transplant and starting immunosuppressant therapy (Figure). We propose that the eyelash trichomegaly was induced by tacrolimus. Figure. View LargeDownload Eyelash trichomegaly: approximate eyelash length,1.3 cm. Comment Tacrolimus and cyclosporine have a similar mechanism of action, namely, inhibition of T-lymphocyte activation via calcineurin inhibition. The 2 drugs also induce some of the same adverse effects, including nephrotoxic and neurotoxic effects, increased serum uric acid levels, increased risk of lymphoproliferative disorders, and a higher rate of infections. Hypertrichosis is a well-established adverse effect of cyclosporine but is reported less frequently in association with tacrolimus. Eyelash trichomegaly has also been reported with cyclosporine, but to our knowledge this is the first case of eyelash trichomegaly associated with tacrolimus.1 They are likely associated in this case given the timing of the initiation of tacrolimus therapy and the onset of trichomegaly. Furthermore, given its similar mechanism of action to cyclosporine, tacrolimus is the most likely of the patient's immunosuppressant medications to have induced the trichomegaly. In medication-associated trichomegaly, the increased lash length is typically noted several months after initiation of treatment with the causative drug. In addition to cyclosporine, reported precipitating medications include interferon alfa, zidovudine, topical latanoprost, and cetuximab.2,3 It is notable that many of these medications have mechanisms of action that involve modulation of the immune system. Defined by its Greek roots, trichomegaly literally means “large hair.” In the present context, the term refers to eyelashes that are abnormally long, defined by some as lashes longer than 12 mm.3 Eyelash trichomegaly may be seen in the context of generalized hypertrichosis but is more often an isolated finding. Eyelash trichomegaly can be congenital but is usually acquired. Theories to explain the mechanism of acquired trichomegaly include immune dysregulation, abnormal induction of the anagen phase, and stimulation of growth by viral proteins.3 The differential diagnosis of acquired trichomegaly includes medications, infections, malignancy, and chronic diseases. Human immunodeficiency virus (HIV) is a well-reported cause, but there is some debate regarding whether the presence of trichomegaly in patients with HIV signifies a poor prognosis. Interestingly, a recent study of 204 patients with HIV showed no association between eyelash length and CD4 count or viral load.3 More unusual causes of acquired trichomegaly include Kala-azar, malnutrition, malignancies, and dermatomyositis.3-5 In summary, we report the first known case of eyelash trichomegaly induced by tacrolimus. This medication should be included in the differential diagnosis of acquired trichomegaly. Although the mechanism of acquired trichomegaly is unknown, many of the associated diseases and medications cause alterations in the immune system. Therefore, in a patient without a known precipitating systemic or pharmacologic cause of long eyelashes, the dermatologist should be suspicious of an abnormality in immunity. Back to top Article Information Correspondence: Dr Grossman, 12 Greenridge Ave, Suite 403, White Plains, NY 10605 (MarcMEG9@aol.com). Financial Disclosure: None. References 1. Cather JC, Abramovits W, Menter A. Cyclosporine and tacrolimus in dermatology. Dermatol Clin. 2001;19:119-137. PubMedGoogle ScholarCrossref 2. Dueland S, Sauer T, Lund-Johansen F, et al. Epidermal growth factor receptor inhibition induces trichomegaly. Acta Oncol. 2003;42:345-346. PubMedGoogle ScholarCrossref 3. Almagro M, del Pozo J, Garcia-Silva J, et al. Eyelash length in HIV-infected patients. AIDS. 2003;17:1695-1696. PubMedGoogle ScholarCrossref 4. Velez A, Kindelan JM, Garcia-Herola A, et al. Acquired trichomegaly and hypertrichosis in metastatic adenocarcinoma. Clin Exp Dermatol. 1995;20:237-239. PubMedGoogle ScholarCrossref 5. Sharma RC, Mahajan VK, Sharma NL, et al. Trichomegaly of the eyelashes in dermatomyositis. Dermatology. 2002;205:305. PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Eyelash Trichomegaly Associated With Systemic Tacrolimus

Eyelash Trichomegaly Associated With Systemic Tacrolimus

Abstract

Report of a Case A 35-year-old woman with hepatitis B underwent orthotopic heart transplantation for congestive heart failure secondary to congenital heart defects. Postoperative immunosuppression included treatment with tacrolimus, mycophenolate mofetil, and prednisone. Of note, the patient did not receive cyclosporine. Ten weeks after transplantation, the patient was seen by the dermatology service for an allergic contact dermatitis reaction to tape. At that time, the patient was noted to...
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Publisher
American Medical Association
Copyright
Copyright © 2006 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.142.2.248
Publisher site
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Abstract

Report of a Case A 35-year-old woman with hepatitis B underwent orthotopic heart transplantation for congestive heart failure secondary to congenital heart defects. Postoperative immunosuppression included treatment with tacrolimus, mycophenolate mofetil, and prednisone. Of note, the patient did not receive cyclosporine. Ten weeks after transplantation, the patient was seen by the dermatology service for an allergic contact dermatitis reaction to tape. At that time, the patient was noted to have eyelash trichomegaly (eyelashes measuring approximately 1.3 cm) that she noted about 8 weeks after receiving the transplant and starting immunosuppressant therapy (Figure). We propose that the eyelash trichomegaly was induced by tacrolimus. Figure. View LargeDownload Eyelash trichomegaly: approximate eyelash length,1.3 cm. Comment Tacrolimus and cyclosporine have a similar mechanism of action, namely, inhibition of T-lymphocyte activation via calcineurin inhibition. The 2 drugs also induce some of the same adverse effects, including nephrotoxic and neurotoxic effects, increased serum uric acid levels, increased risk of lymphoproliferative disorders, and a higher rate of infections. Hypertrichosis is a well-established adverse effect of cyclosporine but is reported less frequently in association with tacrolimus. Eyelash trichomegaly has also been reported with cyclosporine, but to our knowledge this is the first case of eyelash trichomegaly associated with tacrolimus.1 They are likely associated in this case given the timing of the initiation of tacrolimus therapy and the onset of trichomegaly. Furthermore, given its similar mechanism of action to cyclosporine, tacrolimus is the most likely of the patient's immunosuppressant medications to have induced the trichomegaly. In medication-associated trichomegaly, the increased lash length is typically noted several months after initiation of treatment with the causative drug. In addition to cyclosporine, reported precipitating medications include interferon alfa, zidovudine, topical latanoprost, and cetuximab.2,3 It is notable that many of these medications have mechanisms of action that involve modulation of the immune system. Defined by its Greek roots, trichomegaly literally means “large hair.” In the present context, the term refers to eyelashes that are abnormally long, defined by some as lashes longer than 12 mm.3 Eyelash trichomegaly may be seen in the context of generalized hypertrichosis but is more often an isolated finding. Eyelash trichomegaly can be congenital but is usually acquired. Theories to explain the mechanism of acquired trichomegaly include immune dysregulation, abnormal induction of the anagen phase, and stimulation of growth by viral proteins.3 The differential diagnosis of acquired trichomegaly includes medications, infections, malignancy, and chronic diseases. Human immunodeficiency virus (HIV) is a well-reported cause, but there is some debate regarding whether the presence of trichomegaly in patients with HIV signifies a poor prognosis. Interestingly, a recent study of 204 patients with HIV showed no association between eyelash length and CD4 count or viral load.3 More unusual causes of acquired trichomegaly include Kala-azar, malnutrition, malignancies, and dermatomyositis.3-5 In summary, we report the first known case of eyelash trichomegaly induced by tacrolimus. This medication should be included in the differential diagnosis of acquired trichomegaly. Although the mechanism of acquired trichomegaly is unknown, many of the associated diseases and medications cause alterations in the immune system. Therefore, in a patient without a known precipitating systemic or pharmacologic cause of long eyelashes, the dermatologist should be suspicious of an abnormality in immunity. Back to top Article Information Correspondence: Dr Grossman, 12 Greenridge Ave, Suite 403, White Plains, NY 10605 (MarcMEG9@aol.com). Financial Disclosure: None. References 1. Cather JC, Abramovits W, Menter A. Cyclosporine and tacrolimus in dermatology. Dermatol Clin. 2001;19:119-137. PubMedGoogle ScholarCrossref 2. Dueland S, Sauer T, Lund-Johansen F, et al. Epidermal growth factor receptor inhibition induces trichomegaly. Acta Oncol. 2003;42:345-346. PubMedGoogle ScholarCrossref 3. Almagro M, del Pozo J, Garcia-Silva J, et al. Eyelash length in HIV-infected patients. AIDS. 2003;17:1695-1696. PubMedGoogle ScholarCrossref 4. Velez A, Kindelan JM, Garcia-Herola A, et al. Acquired trichomegaly and hypertrichosis in metastatic adenocarcinoma. Clin Exp Dermatol. 1995;20:237-239. PubMedGoogle ScholarCrossref 5. Sharma RC, Mahajan VK, Sharma NL, et al. Trichomegaly of the eyelashes in dermatomyositis. Dermatology. 2002;205:305. PubMedGoogle ScholarCrossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Feb 1, 2006

Keywords: eyelashes,tacrolimus

References