Novel Treatment of Female-Pattern Androgenetic Alopecia With Injected Bimatoprost 0.03% Solution
July 2011 | Volume 10 | Issue 7 | Case Report | 795 | Copyright © 2011
Jason J. Emer MD, Mary L. Stevenson MD, Orit Markowitz MD
Mount Sinai School of Medicine, Department of Dermatology, New York, NY
Female-pattern androgenetic alopecia is a very common disorder that has been associated with extreme psychological morbidity. Few treatments have documented utility and many physicians are often overwhelmed with how little is pharmacologically available to treat this condition. Novel treatments that are effective, safe, less costly and simple are in high demand. We report a case of female-pattern androgenetic alopecia that failed to respond to a novel treatment with injected bimatoprost solution. Hypothetically, the treatment should have been effective and although we did not have success, this report suggests critical points to consider in the future of prostaglandin analogs, as well as other therapies being considered for the treatment of female-pattern hair loss.
J Drugs Dermatol. 2011;10(7):795-798.
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A 59-year-old post-menopausal Hispanic female with no significant past medical history presented with a complaint of a three-year history of gradual “thinning” of her hair over the central and frontal scalp. The hair loss was refractory to over-the-counter vitamin supplementation and minoxidil foam. Recently, the hair loss had become more cosmetically displeasing and concerning. On examination, the patient had diffuse thinning of the entire part-width with maintenance of the frontal and temporal hairline (i.e., Ludwig Scale I–II) without evidence of inflammation or scarring (Figure 1). A review of systems was non-contributory and the patient specifically denied any recent changes in medication, known exposures or stressors, changes in dietary habits, or signs of virilization (e.g., acne, hirsutism, clitoral enlargement, or deepening of voice). She also denied any family history of hair loss. Extensive laboratory analyses including thyroid studies (thyroid-stimulating hormone, triiodothyronine (T3), and thyroxine (T4)), free and bound testosterone, dehydroepiandrosterone (DHEA) sulfate, complete blood count (CBC) with differential, iron studies (e.g., total iron binding capacity, iron and ferritin), folate, vitamin B-12 and a complete metabolic panel (CMP) were unremarkable. Rapid plasma reagin (RPR) and anti-nuclear antibody (ANA) tests were also within normal limits. A diagnosis of androgenetic alopecia (AGA; femalepattern) was made based upon the patient history, physical examination with detailed clinical assessments and extensive laboratory analyses. The patient requested a novel therapy as she was unsatisfied with previous topical therapies and was hesitant to begin any systemic therapies such as finasteride, spironolactone, or contraceptives.
Bimatoprost 0.03% solution (Latisse, Allergan) was injected (30 g needle on a 1 cc syringe) with perpendicular injections depositing 0.1 ml aliquots 1 cm apart across a chosen target area of the anterior part-width on the frontal scalp weekly for 12 weeks and then twice weekly for an additional four weeks (Figure 2). Injection was chosen over topical application in anticipation of increased medication absorption and more direct medication delivery to the target site. Each injection had the total weekly concentration of bimatoprost that would be used as determined per package insert for eyelash growth to limit the number of injection sessions per week, as typical application of bimatoprost for hypotrichosis is nightly application to the skin of the upper eyelid margin with the accompanying applicator. No significant improvement in hair density or hair darkening was noted in the treatment target area after four months of therapy (Figure 3). A decision to begin alternative combination therapy with oral spironolactone, topical minoxidil foam and vitamin B complex injection supplementation was made given the clinical response was not as robust as anticipated. Of note, there was no evidence or patient report of local injection site reactions and the treatments were well tolerated without any evidence of adverse events.