Treatment of a hypopigmented scar with 0.3% bimatoprost ophthalmic solution with microneedling and 0.1% tacrolimus

Abstract

The case of a 32-year-old, black-skinned patient with a hypopigmented scar on her arm, measuring 40 × 15 cm, following a burn with boiling water 5 months before the start of treatment, is reported.

First, tacrolimus ointment 0.1% was prescribed once a day for a month, with the result of perifollicular hyperpigmentation. From that moment on, 8 sessions of microneedling and application of 0.3% bimatoprost ophthalmic solution were performed.

Microneedling was applied with a motorized handheld device with a depth of 0.25 mm to obtain a pinpoint petechiate. The ophthalmic solution was then applied until absorbed and a second cycle of microneedling was performed. The first 6 sessions were monthly and the last 2 were quarterly.

At the same time, the patient continued treatment with tacrolimus until 4 months after completing microneedling.

The result was successful, with complete repigmentation.

Bimatoprost, a prostaglandin analogue, is used as an ophthalmological treatment for open-angle glaucoma and in dermatology for hypotrichosis. Its adverse effect of hyperpigmentation of the surrounding skin and iris is known. This is related to the increase in melanogenesis and the proliferation of melanocytes and their dendrites due to the proinflammatory effect with the release of prostaglandins, a situation similar to inflammation with hyperpigmentation resulting from exposure to UV radiation. Taking advantage of this adverse reaction, it has been used as an off-label treatment in patients with vitiligo.

For its part, microneedling was applied with the purpose of increasing skin permeability to the drug through the small incisions generated by this technique. Likewise, the authors comment that tacrolimus was maintained due to its anti-inflammatory effect to allow the recovery and regeneration of melanocytes.