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• W2010070361 abstract "To the Editor: Prostaglandin E1 (PGE1) ointment is used to treat skin ulcers. PGE1 improves ulcers by dilating small vessels and increasing blood flow to the injured site. We present a case of hypertrichosis that developed around a leg ulcer during topical treatment with PGE1 ointment.A 54-year-old woman suffered burns in a traffic accident resulting in ulcers on her left lower leg 2 months before her first visit to our department. Treatment with PGE1 ointment (prostandin ointment [0.003% alprostadil alfadex]; Ono Pharmaceutical, Osaka, Japan) and a basic fibroblast growth factor (bFGF) spray (Fibrast spray [100 μg/mL trafermin]; Kaken Pharmaceutical, Tokyo, Japan) was initiated. The ulcer gradually improved and had almost healed after 2 months, but hypertrichosis gradually developed around the ulcer (Fig 1, A and B). Since then, the patient has not used PGE1 ointment, and the extent of the hypertrichosis has diminished.It has been reported that long term systemic administration of PGE1 to neonates for cyanotic heart diseases causes hypertrichosis,1Nadroo A.M. Shringari S. Garg M. al-Sowailem A.M. Prostaglandin induced cortical hyperostosis in neonates with cyanotic heart disease.J Perinat Med. 2000; 28: 447-452Crossref PubMed Scopus (20) Google Scholar but there has been no previous report of hypertrichosis after treatment with topical PGE1 ointment or topical bFGF. On the contrary, bFGF has been reported to inhibit hair follicle development and hair growth, and therefore to cause hair loss in animal models.2du Cros DL Fibroblast growth factor influences the development and cycling of murine hair follicles.Dev Biol. 1993; 156: 444-453Crossref PubMed Scopus (51) Google Scholar It is known that topical steroids can induce hypertrichosis, but the patient did not use topical steroids. We suspect that the hypertrichosis in our case was induced by PGE1 ointment.Among the PG signaling pathways, PGF2α-FP signaling is known to induce hypertrichosis as evidenced by the fact that the patients with glaucoma who use latanoprost, a stable analog of PGF2α, may develop hypertrichosis around the eye.3Johnstone 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. 1997; 124: 544-547Abstract Full Text PDF PubMed Scopus (209) Google Scholar In addition, topical treatment with latanoprost stimulates hair growth in mice.4Sasaki S. Hozumi Y. Kondo S. Influence of prostaglandin F2alpha and its analogues on hair regrowth and follicular melanogenesis in a murine model.Exp Dermatol. 2005; 14: 323-328Crossref PubMed Scopus (97) Google Scholar PGE1 is known to bind to four kinds of PGE receptors (EP1, EP2, EP3 and EP4) and to the PGI receptor IP, but not to FP. Therefore, it is unlikely that the hypertrichosis in our case was caused by FP signaling; instead, other PG receptors may have been responsible. We previously have reported that EP3 and EP4 mRNA are expressed in the hair bulb region, in the dermal papilla cells and the outer root sheath cells, respectively, during the anagen phase, and that they disappear during the telogen phase but reappear as a result of depilation; this suggests that EP3 and EP4 receptors may be involved in the development and regrowth of hair follicles.5Torii E. Segi E. Sugimoto Y. Takahashi K. Kabashima K. Ikai K. et al.Expression of prostaglandin E(2) receptor subtypes in mouse hair follicles.Biochem Biophys Res Commun. 2002; 290: 696-700Crossref PubMed Scopus (28) Google Scholar Because PGE1 has the highest affinity for EP3, which is also stimulated by latanoprost, EP3 may be the receptor responsible for the hypertrichosis. However, we should mention that hypertrichosis is uncommon during treatment with PGE1 ointment; this suggests that pharmacodynamic effect of PGE1 on hypertrichosis may be more complicated. Further detailed studies about the expression pattern of PG receptors or pharmacologic analysis of PG receptors on hair growth are needed to reveal the mechanism of hypertrichosis by PGE1. To the Editor: Prostaglandin E1 (PGE1) ointment is used to treat skin ulcers. PGE1 improves ulcers by dilating small vessels and increasing blood flow to the injured site. We present a case of hypertrichosis that developed around a leg ulcer during topical treatment with PGE1 ointment. A 54-year-old woman suffered burns in a traffic accident resulting in ulcers on her left lower leg 2 months before her first visit to our department. Treatment with PGE1 ointment (prostandin ointment [0.003% alprostadil alfadex]; Ono Pharmaceutical, Osaka, Japan) and a basic fibroblast growth factor (bFGF) spray (Fibrast spray [100 μg/mL trafermin]; Kaken Pharmaceutical, Tokyo, Japan) was initiated. The ulcer gradually improved and had almost healed after 2 months, but hypertrichosis gradually developed around the ulcer (Fig 1, A and B). Since then, the patient has not used PGE1 ointment, and the extent of the hypertrichosis has diminished. It has been reported that long term systemic administration of PGE1 to neonates for cyanotic heart diseases causes hypertrichosis,1Nadroo A.M. Shringari S. Garg M. al-Sowailem A.M. Prostaglandin induced cortical hyperostosis in neonates with cyanotic heart disease.J Perinat Med. 2000; 28: 447-452Crossref PubMed Scopus (20) Google Scholar but there has been no previous report of hypertrichosis after treatment with topical PGE1 ointment or topical bFGF. On the contrary, bFGF has been reported to inhibit hair follicle development and hair growth, and therefore to cause hair loss in animal models.2du Cros DL Fibroblast growth factor influences the development and cycling of murine hair follicles.Dev Biol. 1993; 156: 444-453Crossref PubMed Scopus (51) Google Scholar It is known that topical steroids can induce hypertrichosis, but the patient did not use topical steroids. We suspect that the hypertrichosis in our case was induced by PGE1 ointment. Among the PG signaling pathways, PGF2α-FP signaling is known to induce hypertrichosis as evidenced by the fact that the patients with glaucoma who use latanoprost, a stable analog of PGF2α, may develop hypertrichosis around the eye.3Johnstone 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. 1997; 124: 544-547Abstract Full Text PDF PubMed Scopus (209) Google Scholar In addition, topical treatment with latanoprost stimulates hair growth in mice.4Sasaki S. Hozumi Y. Kondo S. Influence of prostaglandin F2alpha and its analogues on hair regrowth and follicular melanogenesis in a murine model.Exp Dermatol. 2005; 14: 323-328Crossref PubMed Scopus (97) Google Scholar PGE1 is known to bind to four kinds of PGE receptors (EP1, EP2, EP3 and EP4) and to the PGI receptor IP, but not to FP. Therefore, it is unlikely that the hypertrichosis in our case was caused by FP signaling; instead, other PG receptors may have been responsible. We previously have reported that EP3 and EP4 mRNA are expressed in the hair bulb region, in the dermal papilla cells and the outer root sheath cells, respectively, during the anagen phase, and that they disappear during the telogen phase but reappear as a result of depilation; this suggests that EP3 and EP4 receptors may be involved in the development and regrowth of hair follicles.5Torii E. Segi E. Sugimoto Y. Takahashi K. Kabashima K. Ikai K. et al.Expression of prostaglandin E(2) receptor subtypes in mouse hair follicles.Biochem Biophys Res Commun. 2002; 290: 696-700Crossref PubMed Scopus (28) Google Scholar Because PGE1 has the highest affinity for EP3, which is also stimulated by latanoprost, EP3 may be the receptor responsible for the hypertrichosis. However, we should mention that hypertrichosis is uncommon during treatment with PGE1 ointment; this suggests that pharmacodynamic effect of PGE1 on hypertrichosis may be more complicated. Further detailed studies about the expression pattern of PG receptors or pharmacologic analysis of PG receptors on hair growth are needed to reveal the mechanism of hypertrichosis by PGE1." @default.
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• W2010070361 title "Hypertrichosis around a leg ulcer being treated with prostaglandin E1 ointment" @default.
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