Lash or Brow Growth Enhancing Serums & Tattooing

This article is not intended to advocate the use of, or discuss the pros and cons of the various hair growth products but rather to shed some light on the potential complications of providing cosmetic tattoo services to a client that is using lash or brow growth promoters and what precautions might be required.

Background

The Cosmetic Europe Personal Care Association estimated the European cosmetics market in 2014 to be worth around 72.5 billion Euros¹ the USA market came in a close second at 49 billion Euros and the total global market at around 198 billion Euros, the cosmetics industry is BIG business with consumers hungry for new products that will enhance their appearance. In 2005 Allergan estimated that Eye makeup, (eye shadow, eye liner, and mascara) represented 15% of global cosmetics and toiletries market and was the fastest growing category of colour cosmetics for the USA being over 6% in 2005².

With so much money actively looking for eye enhancement products it is hardly surprising that the cosmetic and pharmaceutical companies would turn their attention to hair growth enhancers for the lash and brows, after all women in particular have been avid consumers of products and services that will conceal their hypotrichosis.

Eyelash Growth Cycle

Compared to scalp hair eyelashes have an extremely short growth cycle typically the Anagen growth phase lasts about 1-2 months³ the Catagen degenerative phase lasts about 25 days³ and Telogen the resting phase lasts between 4-9 months^4,5.

In comparison the complete growth cycle for scalp hair can last several years with Anagen alone lasting as long as 6-7 years^4,5, also compared to scalp hairs (5-15%) a higher percentage of eyelash follicles (~50%) are in the Telogen resting phase at any given time^3,4.

Old dormant hair shafts are expelled (Exogen) as the Telogen phase of the cycle transitions to Anagen⁶. It is the short growth cycle of eyelash hair and the fact that they only tend to grow in length at about 0.15 mm/day⁵ (about half the length of scalp hairs) which imposes hard limits upon the length and density of the lash hairs. Fortunately the hair growth cycle in humans is asynchronous therefore at any given time our hair follicles are in varying stages of the growth cycle³, or else we may have an all or nothing situation with rotation of our hair growth cycle!

Lash & Brow Growth Enhancers

A fairly brief inquiry into the products claiming to have eyelash/eyebrow growth promotion effects uncovered close to 40 commercially available products on the market;
 

There is an incredible variety of ingredients disclosed in the product literature of the hair growth serums, some of the ingredients would best be described as conditioning treatments (cocktails of vitamins and oils), some may fall into the area of wishful thinking (plant stem cells and sterols), others may have more scientific support due to their capacity to influence intracellular signalling (e.g. prostaglandin analogues).
 

Prostaglandin Analogues

Prostaglandins are found in a wide variety of bodily tissues, most of our cells with a nucleus are capable of making prostaglandins via the use of enzymatic action on lipids, prostaglandins are probably best described as 'active lipid compounds' which bind with prostaglandin cell receptors and activate intracellular signalling (trigger changes in cell behaviour), in this regard they are very similar to a hormone playing an important role in initiating changes in cellular functioning such as increasing permeability of cells walls, affecting vasodilation/vasoconstriction of blood vessels in their immediate vicinity.

Prostaglandin Analogues are synthetically produced prostaglandins that mimic the effects of naturally occurring prostaglandins and some are used for medical purposes, for example Bimatoprost / Latanoprost may be prescribed by an ophthalmologist to a patient with glaucoma to assist with reducing intraocular pressure^7,8. It is due to the past medical use of some of the prostaglandin analogues in eye drops that it was discovered there were some unusual side effects such as hypertrichosis (overgrowth of hairs) of both the lashes and the vellus hairs of the face^3,9.

The exact mechanism that some of the prostaglandin analogues have in affecting lash/brow hair growth is unknown, however it is suggested that they may increase the percentage of follicles in the Anagen growth phase by prolonging Anagen and stimulating the transfer from Telogen to Anagen³. It is well established that length of hair is directly proportional to the duration of Anagen¹⁰, by increasing the duration of Anagen and stimulating more follicles from Telogen to Anagen it is possible to affect both the length and density of hairs.

Some of prostaglandin analogues that may be present either in prescription or over the counter commercial products that may be marketed or prescribed for lash/brow growth enhancement (or an off label use of a pharmaceutical approved for another purpose);

• Bimatoprost
   
• Isopropanol Phenylhydroxypentene Dihydroxycyclopentylheptenate
   
• Dechloro Dehydroxy Difluoro Ethylcloprostenolamide
   
• Methylamido Dihydro Noralfaprostal (an analogue closely related to Bimatoprost)
   
• 17-Phenyl Trinor Prostaglandin E2 Serinol Amide
   
• Latanoprost

The Medical Products Agency (MPA) is the Swedish national authority responsible for regulation and surveillance of the development manufacturing and marketing of drugs and other medicinal products available on the Swedish market, the MPA is a similar agency to the USA Food and Drug Administration or the Australian Therapeutic Goods Administration. In 2013 the MPA published results of their testing of 26 different eyelash serums that were commercially available at that time. The published results of their laboratory testing found that 9 (34.6%) of the products tested contained prostaglandins and notably 3 of the products that they tested were found to contain prostaglandins that were not declared on their list of ingredients¹¹, the MPA concluded their report by warning about the risk of 'spiked serum' and advising against their use for cosmetic purposes due to the risk of side effects.

Due to regional regulatory restrictions the ingredients within lash growth enhancers may differ depending on the country in which they are released, and companies may also change formulations from time to time. With an increasing number of people shopping on the internet we feel that it is difficult to have certainty, when a cosmetic tattoo client informs that they are using a lash growth enhancer, if it contains prostaglandins or not.

Adverse Side Effects

Some of the potential adverse side effects associated with the use of lash enhancement products that contain prostaglandin analogues may include¹²;

• Pigmentation of iris (likely to be permanent)
  
  
• Pruritus, conjunctival hyperemia (incidence approximately 3-4%)
  
  
• Eyelid skin hyperpigmentation (incidence approximately 6.1%)
  
  
• Hair growth outside the treatment area
  
  
• Intraocular inflammation (e.g. uveitis)
  
  
• Macular edema
  
  
• Dry eye symptoms
  
  
• Periorbital erythema
  
  
• Sensitivities to preservatives (e.g. benzalkonium chloride)
  
  
• Discolouration of contact lenses by preservatives
   
• Corneal Alterations¹³
  
  

Implications of Providing Eyeliner/Eyebrow Tattooing Services
To Clients Using Lash/Brow Growth Enhancers

Some of the prostaglandin analogues such as Bimatoprost and Latanoprost are known to be capable of inducing melanogenesis⁹ and atypical melanocytes¹⁴ resulting in hyperpigmentation of the skin around the treatment area, this has potential implications relating to unexpected colour change subsequent to tattooing and or triggering melanin hyper-pigmentary halos around the site of tattooing.

We have seen some claims by some Cosmetic Tattoo technicians and trainers that Bimatoprost can cause changes in the actual colour of tattoo pigments, we suspect that this is probably a misunderstanding in regards to increased melanin production rather than an actual tattoo pigment colour change. Tattooing skin that has hyperactive melanocytes may be inclined to trigger post inflammatory hyper-pigmentation affecting the final healed result of tattooing which could be misinterpreted as a change in the colour of the tattoo pigment.

There have also been some concerns by technicians about the potential for prostaglandin analogues to cause excessive bleeding during tattoo treatments; prostaglandin analogues are known to cause conjunctival hyperemia in some patients¹² and there are some animal studies that showed that Bimatoprost ophthalmic solution (or possibly its preservative) can cause ocular vasodilation¹⁵ therefore it seems at least plausible that lash growth serums containing prostaglandin analogues might be capable of causing vasodilation of blood vessels and result excessive bleeding during an eyeliner or eyebrow procedure.

Recommendations

Given results of testing conducted by the MPA it may be prudent to assume that any client using a lash or brow growth serum (prescription or not) might be using a product potentially containing a prostaglandin analogue. In addition there is such a wide variety of formulations in the growth enhancing serums that it is advisable not to provide cosmetic tattoo services to clients using these products as the outcome from tattooing may be completely unpredictable.

In order to minimise the risk of complications we suggest that clients cease using growth enhancing serums for at least 4-6 weeks prior to tattooing and do not recommence reuse of growth serums until at least 4 weeks after the last date of any cosmetic tattooing (near the growth serum treatment area).

NB. patients who are prescribed prostaglandin analogues for medical reasons should not be encouraged cease use of their medicines unless advised to do so by their treating doctors as it may have serious consequences (particularly with conditions such as glaucoma).
 

References

1. Cosmetic Europe Personal Care Association Activity Report 2014
2. Enhanced Eyelashes: Prescription and Over-the-Counter Options. D. Jones. Aesthetic Plast Surg. 2011 Feb; 35(1): 116–121
3. Johnstone MA, Albert DM (2002) Prostaglandin-induced hair growth. Surv Ophthalmol 47:S185–S202
4. Elder MJ (1997) Anatomy and physiology of eyelash follicles: relevance to lash ablation procedures. Ophthalmic Plast Reconstr Surg 13:21–25
5. Na JI, Kwon OS, Kim BJ, Park WS, Oh JK, Kim KH, Cho KH, Eun HC (2006) Ethnic characteristics of eyelashes: a comparative analysis in Asian and Caucasian females. Br J Dermatol 155:1170–1176
6. Randall VA (2007) Hormonal regulation of hair follicles exhibits a biological paradox. Semin Cell Dev Biol 18:274–285
7. Camras CB, Wax MB, Ritch R, et al: Latanoprost treatment for glaucoma: effects of treating for 1 year and of switching from timolol. United States Latanoprost Study Group. Am J Ophthalmol 126:390–9, 1998
8. Williams RD, Cohen JS, Gross RL, Liu C-C, Safyan E, Batoosingh AL, for the Bimatoprost Study Group (2008) Long-term efficacy and safety of bimatoprost for intraocular pressure lowering in glaucoma and ocular hypertension: year 4. Br J Ophthalmol 92:1387–1392
9. Johnstone MA: Hypertrichosis and increased pigmentation of eyelashes and adjacent hair in the region of the ipsilateral eyelids of patients treated with unilateral topical latanoprost. Am J Ophthalmol 124:544–7, 1997
10. Paus R, Cotsarelis G: The biology of hair follicles. N Engl J Med 341:491–7, 1999
11. Pharmaceutical ingredients in one out of three eyelash serums. Swedish Medical Products Agency 15/04/2013
12. LATISSE Prescriber Information Insert. Revised: 9/2014
13. Chen W, Dong N, Huang C, Zhang Z, Hu J, Xie H, Pan J, Liu Z. Corneal alterations induced by topical application of commercial latanoprost, travoprost and bimatoprost in rabbit. PLoS One. 2014 Mar 14
14. Kapur R, Osmanovic S, Toyran S, Edward DP (2005) Bimatoprost-induced periocular skin hyperpigmentation: histopathological study. Arch Ophthalmol 123:1541–1546
15. Abayomi B Ogundele, David Earnest, Marsha A McLaughlin. In vivo comparative study of ocular vasodilation, a relative indicator of hyperemia, in guinea pigs following treatment with bimatoprost ophthalmic solutions 0.01% and 0.03%. Clinical Ophthalmology 19/06/2010