Trichomegaly Induced by Erlotinib

Abstract

Erlotinib (Tarceva, Roche) is a chemotherapeutic agent used in the management of advanced non-small cell lung cancer and other malignancies. We present the case of a patient who developed excessive eyelash growth, called trichomegaly, a rare ocular side effect of this drug.

Follow-up of erlotinib related uveitis

“…Ocular side effects are rare and include conjunctivitis, trichomegaly and keratoconjunctivitis 2–5. A recent addition to this list is non-granulomatous uveitis 1.…”

Cetuximab-Associated Elongation of the Eyelashes

“…[8,12,15,16,19] Mucocutaneous reactions to EGFR inhibitors are summarized in table I. [1][2][3][4][5][6]9,11,14,15,17,19,20,[22][23][24][25][26][27][28][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] These include not only increased (hypertrichosis) and decreased (alopecia) Acral fissures Fissures occur on the hands and feet, fingers (tips and interphalangeal joints), and toes. [8,15,26] Indeed, the papulopustular eruption has been associated with favorable tumor response, lengthening of time to progression, and improved overall survival.…”

“…[33] Similar to our patient, eyelash trichomegaly has been described in other individuals receiving cetuximab. [25,39] In addition, elongated eyelashes have occurred in patients receiving therapy with tyrosine kinase inhibitors such as erlotinib [5,6,11,15,19,24,[31][32][33][34][35]39] and gefitinib. [1,4,5,36,38] Trichomegaly of the eyelashes has also been reported in patients treated with other monoclonal antibodies to EGFR such as panitumumab.…”

“…[19,22,39,42,45] Since these agents inhibit the EGFR via different mechanisms, the resultant eyelash trichomegaly probably results from a downstream effect secondary to the receptor inhibition. [11,36,38] Eyelash trichomegaly has occurred most commonly in patients with colorectal carcinoma [1,2,4,5,[36][37][38] and lung cancer [5,6,19,22,31,[33][34][35]42] who have been treated with EGFR inhibitors; cetuximab-induced long eyelashes have also been observed in individual patients with either oropharyngeal squamous cell carcinoma [3] or porocarcinoma. It has been postulated that premature maturation of the hair follicle epithelium cells with subsequent terminal differentiation results from dysregulated keratin gene expression secondary to the inhibition of the EGFR by the drugs.…”

Erlotinib-related bilateral anterior uveitis

“…Known ocular side effects are ocular surface disorders, conjunctivitis, trichomegaly and keratoconjunctivitis 2–4. The drug is reported to be associated with trichomegaly and corneal epithelial defects.…”