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Cited by 6Hair Growth and Disordersmelanin and skin pigmentationChemotherapy-related skin toxicity

Comparative study of the efficacy and safety of topical minoxidil 2% versus topical bimatoprost 0.01% versus topical bimatoprost 0.03% in treatment of eyebrow hypotrichosis: a randomized controlled trial

Open access
Zaky, Mohamed S., Hashem, Osama A., Mahfouz, Sara M., Elsaie, Mohamed L.·2023·Archives of Dermatological Research
DOI 10.1007/s00403-023-02679-2PMC PMC10514173
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Abstract

Eyebrows are an important feature of facial identity and communications in human beings as well as an important eye defense shield from dust and foreign bodies. To compare the efficacy and safety between 0.01%, 0.03% bimatoprost and minoxidil 2% in gel formulations for eyebrow enhancement. Sixty eligible subjects were female or male, aged 18 years or older with eyebrow hypotrichosis, defined as either a Grade 1 or 2 on the Global Eyebrow Assessment (GEBA) scale. Patients were randomized into 3 groups using block randomization. Group a (20 patients) applied topical 0.03% bimatoprost gel once daily onto both eyebrows, group b (20 patients) applied topical 0.01% bimatoprost gel once daily onto both eyebrows while group c (20 patients) applied topical minoxidil 2% gel once daily onto both eyebrows. A significant improvement in GEBA score was reported in all the three groups after treatment (P ≤ 0.001); however, there was no statistically significant difference between the three groups (P1 = 0.091; P2 = 0.102; P3 = 0.663). Bimatoprost is equally efficacious as minoxidil in enhancement of eyebrows with a more favorable response produced by the 0.03% concentration.

AI snapshot

Written from the paper’s full text.

TL;DR

In 60 adults with eyebrow hypotrichosis, once-daily topical bimatoprost 0.03%, bimatoprost 0.01%, and minoxidil 2% gels all significantly improved Global Eyebrow Assessment (GEBA) scores over 16 weeks, with no statistically significant between-group differences. Bimatoprost 0.03% showed numerically more favorable response and significantly higher patient satisfaction than the other two groups.

Key findings

  • After 4 months, at least a 1-grade GEBA improvement occurred in 100% of the bimatoprost 0.03% group versus 80% in both bimatoprost 0.01% and minoxidil 2% groups. All three groups improved significantly from baseline (P ≤ 0.001), but between-group differences were not significant (P1 = 0.091; P2 = 0.102; P3 = 0.663).
  • Eyebrow hair diameter and count increased significantly from baseline in all three groups. Mean change in diameter was 4.23 ± 1.41 μm for bimatoprost 0.03%, 4.07 ± 1.02 μm for bimatoprost 0.01%, and 3.98 ± 3.18 μm for minoxidil 2%; mean change in number was 5.97 ± 5.67, 5.45 ± 3.97, and 4.96 ± 3.24, respectively. Between-group differences were not significant.
  • On the 7-point rating scale, all groups improved significantly (P ≤ 0.05), with a more favorable response in the bimatoprost 0.03% group; average rating scores were 2.3, 1.8, and 2.0 for bimatoprost 0.03%, bimatoprost 0.01%, and minoxidil 2%, respectively.
  • Patient satisfaction was significantly higher with bimatoprost 0.03% (8.0 ± 0.65) than bimatoprost 0.01% (6.80 ± 0.62) and minoxidil 2% (6.60 ± 0.50) (p1 ≤ 0.01; p2 ≤ 0.01). Adverse events were negligible and not statistically significant among groups; one minoxidil user had contact dermatitis, and two cases had pruritus and mild erythema that resolved spontaneously.

Methods

  • Randomized, triple-armed, single-blinded study of 60 eligible female or male subjects aged 18 years or older with eyebrow hypotrichosis defined as Grade 1 or 2 on the GEBA scale. Patients were randomized by block randomization into three groups of 20: topical bimatoprost 0.03% gel, topical bimatoprost 0.01% gel, or topical minoxidil 2% gel, applied once daily onto both eyebrows for 16 weeks.
  • Outcomes included GEBA evaluated from standard photographs by two blinded dermatologists, a 7-point rating scale, folliscope hair count and diameter, trichoscopic eyebrow assessment, and a 1–10 satisfaction scale. Sample size was calculated from a previous Thai comparative study with 5% significance and 90% power; minimum calculated subjects was 50, and 60 were recruited considering dropout.
  • All included patients were female and completed the study. Statistical tests reported included chi-square, Monte Carlo, Stewart Maxwell, and one-way ANOVA.

Limitations

  • The paper states the study was limited by relatively small sample size, inclusion of only female sex subjects, short study and follow-up durations, and failure to correlate hypotrichosis duration to treatment response.
  • Evident from the text: there was no vehicle or placebo control arm, the design was single-blinded rather than double-blind, and all enrolled completers were female despite male/female eligibility. Between-group comparisons were mostly non-significant, limiting conclusions about superiority among the three formulations.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1007/s00403-023-02679-2

Cites

24 of 24 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

1 of 19 cited sources checked · 0 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    No standard evidence-based treatment exists for eyebrow hypotrichosis apart from topical medications, intralesional injections, surgical transplantation, camouflage, and microblading.

    “No standard evidence-based treatment exists for eybrow hypotrichosis apart from topical medications, intralesional injections, surgical transplantation as well as camouflage and microblading [3].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [3] Riahi RR, Cohen PR (2018) Topical treatment of eyebrow hypotrichosis with bimatoprost 0.03% solution: case report and literature review. Cureus. 10(5):e2666 source

      The Discussion (page unavailable) lists topical bimatoprost and minoxidil and hair transplantation as options, while the Conclusions say treatment modalities are limited and further studies are needed. The paper does not state that no standard evidence-based treatment exists, and it does not mention intralesional injections, camouflage, or microblading. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
  • Findingown data

    The investigators' 7-point rating scale revealed a significant improvement in all three treatment groups (P ≤ 0.05).

    “This was in accordance with the investigators 7 point rating scale that revealed a significant improvement in all three groups (P ≤ 0.05);”
    Quote in the paperNot a substantial claim
  • Findingown data

    At the end of the study, 100% of patients in all three groups reported improvement in their eyebrow appearance on self-evaluation with the 7-point rating scale.

    “At the end of the study, 100% of patients in all three groups reported improvement in their eyebrow appearance on the self-evaluation with 7-point rating scale.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The observed improvements from baseline in all three groups are attributable to the active treatments rather than to placebo effect, natural course, or measurement variability.
  • Findingown data

    In patients with eyebrow hypotrichosis, treatment with topical bimatoprost 0.03%, bimatoprost 0.01%, or minoxidil 2% gel for 16 weeks produced a significant improvement in GEBA score in all three groups (P ≤ 0.001).

    “A significant improvement in GEBA score was reported in all the three groups after treatment (P ≤ 0.001);”
    • Also stated in: § Abstract · plain
      “A significant improvement in GEBA score was reported in all the three groups after treatment (P ≤ 0.001); however, there was no statistically significant difference between the three groups (P1 = 0.091; P2 = 0.102; P3 = 0.663).”
    • Also stated in: § Discussion · plain
      “In the current study a significant improvement in GEBA score was reported in all the three groups after treatment (P ≤ 0.001);”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The observed improvements from baseline in all three groups are attributable to the active treatments rather than to placebo effect, natural course, or measurement variability.
    • Rests on an assumption: The GEBA assessments by two blinded dermatologists were reliable and consistent.
  • Findingown data

    At 16 weeks of treatment, a statistically significant change in hair diameter was observed in all three treatment groups.

    “At 16 weeks of treatment, a statistically significant change in hair diameter was observed in all 3 groups.”
    • Also stated in: § Discussion · plain
      “At 16 weeks of treatment, a statistically significant change in hair diameter was observed in all 3 groups.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The observed improvements from baseline in all three groups are attributable to the active treatments rather than to placebo effect, natural course, or measurement variability.
  • May combine two claims. 14
  • The quote only partly states this claim. 1
  • Classified as probably not a substantial claim. 11

  • May combine two claims.

    Findingown data

    Hair diameter and number were superiorly but not significantly increased in the bimatoprost 0.03% group compared to the other two groups.

    “Hair diameter and number were superiorly but none significantly increased in the bimatoprost 0.03 group when compared to the other two groups Table 3.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    A single case of contact dermatitis was reported by a minoxidil user, while two cases complained of pruritis and mild erythema that resolved spontaneously.

    “A single case of contact dermatitis was reported by a minoxidil user while two cases complained of pruritis and mild erythema that resolved spontaneously without any complaints.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Safety evaluation in terms of adverse events was negligible and of no statistical significance among all groups.

    “Safety evaluation in terms of adverse events were negligible and of no statistical significance among all groups.”
    • Also stated in: § Discussion · plain
      “In the current study very minimal side effects were reported.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The 7-point rating scale improvement was more favorable in the bimatoprost 0.03% group, although this difference was not statistically significant.

    “which was more favorable in the bimatoprost 0.03% group Table 2; Figs. 1, 2, and 3.”
    • Also stated in: § Discussion · hedged
      “with a more non-significantly favorable response demonstrated by the bimatoprost 0.03% group.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Interpretationown data

    Bimatoprost 0.03% produces a more favorable response than the other treatments.

    “with a more favorable response produced by the 0.03% concentration.”
    • Also stated in: § Discussion · hedged
      “with a more insignificantly favorable response demonstrated by the bimatoprost 0.03% group.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The study was single-blinded.

    “This was a randomized, triple armed single blinded randomized study to compare the efficacy and safety of topical 0.01% and 0.03% bimatoprost versus topical 2% minoxidil.”
    • Also stated in: § Patients and methods · plain
      “For outcomes, the GEBA scale was evaluated from standard photographs by two blinded dermatologists as subjective parameter in every visit.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Sixty patients, all females, were included and completed the study till the end.

    “Sixty patients; all females were included and completed the study till the end.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The efficacy of bimatoprost 0.03% for the treatment of eyelash hypotrichosis was proven by many randomized controlled trials and was approved by the FDA in 2008.

    “The efficacy of bimatoprost 0.03% for the treatment of eyelash hypotrichosis was proven by many randomized, controlled trials and was approved by the FDA in 2008 [18].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] Cohen JL (2010) Enhancing the growth of natural eyelashes: the mechanism of bimatoprost-induced eyelash growth. Dermatol Surg 36:1361–1371 source

  • May combine two claims.

    Interpretationnone given

    The study was limited by relatively small sample size, only female sex subjects, short study and follow-up durations, and failure to correlate hypotrichosis duration to treatment response.

    “The study was limited by the relatively small sample size; only female sex subjects, the short study and follow-up durations as well as failure of correlating hypotrichosis duration to treatment response.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The sample size was calculated based on data from a previous comparative study in a Thai population, with a 5% significance level and 90% power; the calculated minimum was 50 subjects, and 60 were recruited considering dropout.

    “The sample size was calculated based on data from a previous comparative study in a Thai population, with a 5% significance level and 90% power. The calculated minimum number of subjects was 50. Considering dropout, we recruited a total of 60 subjects.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Bimatoprost has been shown in mouse models to increase hair bulb and papillae diameters and increase melanogenesis, resulting in increased hair thickness and pigmentation.

    “Furthermore, bimatoprost had been shown in mouse models to increase the hair bulb and papillae diameters as well as increase melanogenesis which results in increased hair thickness and pigmentation [11, 12].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [11] Sasaki S, Hozumi Y, Kondo S (2005) Influence of prostaglandin F2alpha and its analogues on hair regrowth and follicular melanogenesis in a murine model. Exp Dermatol 14:323–328 source
    • cites [12] Uno H, Zimbric ML, Albert DM, Stjernschantz J (2002) Effect of latanoprost on hair growth in the bald scalp of the stump-tailed macacque: a pilot study. Acta Derm Venereol 82:7–12 source

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The study was randomized.

    “This was a randomized, triple armed single blinded randomized study to compare the efficacy and safety of topical 0.01% and 0.03% bimatoprost versus topical 2% minoxidil.”
    • Also stated in: § Abstract · plain
      “Patients were randomized into 3 groups using block randomization.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Among side effects reported with bimatoprost solution for ophthalmic conditions and eyelash hypotrichosis, conjunctival hyperemia, eye irritation, iris pigmentation, periorbital pigmentation, and fat atrophy were the most frequently reported.

    “Among side effects reported with the use of bimatoprost solution for ophthalmic conditions and eyelash hypotrichosis; conjuctival hyperemia, eye irritation, iris pigmentation, periorbital pigmentation and fat atrophy were the most frequently reported [25].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] Yoelin S, Walt JG, Earl M (2010) Safety, effectiveness, and subjective experience with topical bimatoprost 0.03% for eyelash growth. Dermatol Surg 36(5):638–649 source

  • May combine two claims.

    Premisecitation

    Earlier case reports demonstrated good response to eyebrow thinning with the use of bimatoprost 0.03% for 16 weeks and with no side effects reported.

    “Earlier case reports demonstrated good response to eyebrow thinning with the use of bimatoprost 0.03% for 16 weeks and with no side effects reported [8, 9].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [8] Elias MJ, Weiss J, Weiss E (2011) Bimatoprost ophthalmic solution 0.03% for eyebrow growth. Dermatol Surg 37:1057–1059 source
    • cites [9] Schweiger ES, Pinchover L, Bernstein RM (2012) Topical bimatoprost for the treatment of eyebrow hypotrichosis. J Drugs Dermatol 11:106–108

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The GEBA scale was evaluated from standard photographs by two blinded dermatologists as a subjective parameter at every visit.

    “For outcomes, the GEBA scale was evaluated from standard photographs by two blinded dermatologists as subjective parameter in every visit.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The GEBA assessments by two blinded dermatologists were reliable and consistent.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Minoxidil 1% lotion tolerance and effectiveness in eyebrow hypotrichosis was confirmed by a randomized, double-blind, placebo-controlled, split-face comparative study.

    “This was confirmed by a randomized, double-blind, placebo-controlled, split-face comparative that demonstrated tolerance and effectiveness of minoxidil 1% lotion in eyebrow hypotrichosis when compared to placebo [24].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] Worapunpong N, Tanglertsampan C (2017) Treatment of eyebrow hypotrichosis with 1% minoxidil lotion: a prospective, randomized, double-blind, placebo-controlled trial. J Med Assoc Thai 100:573–577

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Suchonwanit et al. compared bimatoprost 0.03% versus 0.01% in 30 patients with eyebrow hypotrichosis; both concentrations significantly improved eyebrow density and diameter (P < 0.05) with non-significant superiority of 0.03% to 0.01%.

    “In their recent randomized double-blinded split face trial, Suchonwanit et al. [22] compared application of bimatoprost 0.03% versus bimatoprost 0.01% in 30 patients with eyebrow hypotichosis. Both 0.01% and 0.03% bimatoprost significantly improved eyebrow density and diameter (P < 0.05) with non-significant superiority of the 0.03% to the 0.01% concentration.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] Suchonwanit P, Harnchoowong S, Chanasumon N, Sriphojanart T (2020) Comparison of the efficacy and safety of using 0.01% versus 0.03% bimatoprost for the treatment of eyebrow hypotrichosis: a randomized, double-blind, split-face, comparative study. J Cosmet Dermatol. 19(3):714–719 source

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The GEBA instrument is a validated 4-point scale used to grade fullness of the eyebrows.

    “The GEBA instrument is a validated 4-point scale used to grade fullness of the eyebrows (1 = very sparse, 2 = sparse, 3 = full, and 4 = very full).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Animal studies revealed that bimatoprost can prolong the anagen duration and prolong the telogen-to-anagen transition phase, resulting in increased hair growth and length.

    “Animal studies revealed that bimatoprost can prolong the anagen duration and further prolongs telogen to anegen transition phase. This results in increased hair growth and length.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [11] Sasaki S, Hozumi Y, Kondo S (2005) Influence of prostaglandin F2alpha and its analogues on hair regrowth and follicular melanogenesis in a murine model. Exp Dermatol 14:323–328 source
    • cites [12] Uno H, Zimbric ML, Albert DM, Stjernschantz J (2002) Effect of latanoprost on hair growth in the bald scalp of the stump-tailed macacque: a pilot study. Acta Derm Venereol 82:7–12 source

  • May combine two claims.

    Premisecitation

    Two randomized trials compared bimatoprost 0.03% to either minoxidil 3% or a vehicle solution for 4 and 9 months, respectively, and reported an equipotent response of bimatoprost to minoxidil and a superior response of bimatoprost to vehicle.

    “Two randomized trials compared the efficacy of bimatoprost 0.03% to either minoxidil 3% or a vehicle solution for 4 months and 9 months, respectively, and reported an equipotent response of bimatoprost to minoxidil while a superior response of bimatoprost to vehicle was demonstrated [7, 19].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [7] Beer KR, Julius H, Dunn M, Wilson F (2013) Treatment of eyebrow hypotrichosis using bimatoprost: a randomized, double-blind, vehiclecontrolled pilot study. Dermatol Surg 39:1079–1087 source
    • cites [19] Suwanchatchai W, Tanglertsampan C, Pengsalae N, Makornwattana M (2012) Efficacy and safety of bimatoprost 0.03% versus minoxidil 3% in enhancement of eyebrows: a randomized, double-blind, split-face comparative study. J Dermatol 39:865–866 source

  • May combine two claims.

    Premisecitation

    Topical minoxidil has been shown to enhance eyebrows and has a favorable safety effect in eyebrow hypotrichosis.

    “A few number of reports and studies proved an eyebrow enhancement and favorable safety effect of topical minoxidil use in eyebrow hyptrichosis [5].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [5] Gajbhiye V, Lamture Y (2020) Minoxidil a youth elixir for eyebrow hypotrichosis. J Clin Diagn Res 14(2):PC01–PC031 source
21 of 21

  • The paper relies on this without support.

    The observed improvements from baseline in all three groups are attributable to the active treatments rather than to placebo effect, natural course, or measurement variability.

    “A significant improvement in GEBA score was reported in all the three groups after treatment (P ≤ 0.001);”

  • The paper relies on this without support.

    The GEBA assessments by two blinded dermatologists were reliable and consistent.

    “For outcomes, the GEBA scale was evaluated from standard photographs by two blinded dermatologists as subjective parameter in every visit.”
2 of 2

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • The stated carbopol concentration does not match the preparation

    Minor

    Both gel-preparation sections call for 1% carbopol but specify 2 g per 100 ml, which is 2% (weight/volume).

    Reported 1 · recomputed 2

  • Satisfaction scale has two stated lower bounds

    Minor

    The results describe the satisfaction scale as running from 1 to 10, whereas the Table 4 note says it runs from 0 to 10.

  • Baseline P3 differs from the result for identical distributions

    Minor

    The 0.01% bimatoprost and minoxidil groups have identical counts in both baseline GEBA categories. Their reported between-group P3 of 0.06 is inconsistent with those identical distributions.

  • Baseline P1 and P2 differ for identical comparisons

    Minor

    Before treatment, the 0.01% bimatoprost and minoxidil groups have identical GEBA distributions. Comparing either with the 0.03% group should therefore give the same result, but P1 is 0.057 and P2 is 1.0.

4 of 4

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Worapunpong N, Tanglertsampan C (2017) Treatment of eyebrow hypotrichosis with 1% minoxidil lotion: a prospective, randomized, double-blind, placebo-controlled trial. J Med Assoc Thai 100:573–577

Cited by

Still being checked.

Related

Authors
Zaky, M. S., Hashem, O. A., Mahfouz, S. M., & Elsaie, M. L.
Affiliations
  • Al-Azhar University (EG)
  • National Research Centre (EG)
Corresponding author
Elsaie, Mohamed L.
ORCID
Elsaie, Mohamed L.
Venue
Archives of Dermatological Research
Publisher
Springer Science and Business Media LLC
Published
2023-07-30
Volume
315
Issue
9
Pages
2635-2641
ISSN
  • 0003-9187 (ISSN-L)
  • 1432-069X
DOI
10.1007/s00403-023-02679-2
PMC
PMC10514173
OpenAlex
W4385392539
Semantic Scholar
866d6396a44d135ca5b21e835bc28f947cc3e7af
Cited by
6
References
24
Citations by year
2026: 2 · 2025: 1 · 2024: 3
FWCI
1.60
Type
journal article
Language
en
Open access
Licence
Locations
  • Archives of Dermatological Research (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by)
Funders
National Research Centre Egypt
Topics
  • Health Sciences › Medicine › Urology › Hair Growth and Disorders
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › melanin and skin pigmentation
  • Health Sciences › Medicine › Dermatology › Chemotherapy-related skin toxicity
Keywords
bimatoprost, minoxidil, topical treatment, treatment efficacy, treatment safety, concentration comparison
MeSH terms
Bimatoprost, Administration, Topical, Double-Blind Method, Eyebrows, Female, Humans, Hypotrichosis, Male, Minoxidil, Treatment Outcome

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