Encyclopedia · drug with hair side effects
EGFR inhibitors (erlotinib, cetuximab)
Cancer drugs that block the EGF receptor can make eyelashes grow abnormally long and curly, and scalp hair curly or brittle, all reversing after the drug stops.
What it is
EGFR inhibitors (tablets such as erlotinib and gefitinib, antibodies such as cetuximab) treat lung, colorectal and head and neck cancers. They are prescription-only cancer drugs.
How it works
The EGF receptor helps regulate follicle growth and the shift into regression, so blocking it changes the hair cycle. We did not verify finer mechanism details.
What the studies show
- In a case series of 6 patients on erlotinib, eyelashes became curly, irregular, long and brittle; scalp hair turned curly or straight, brittle, fine or rigid with slower growth and less volume. All gradually resolved after the drug was withdrawn. Zheng 2016
- Single case reports describe acquired lash overgrowth with erlotinib Jazayeri 2009 Lane 2007 and with cetuximab Crespo-Carballes 2020 (we read only the titles).
- A meta-analysis of 8,052 patients on targeted cancer drugs found pigmentary changes of skin or hair, with EGFR and BCR-ABL inhibitors among the most common culprits in case reports. Dai 2017
- Erlotinib is also listed among drugs reported to repigment gray hair, as incidental findings in low-quality reports. Yale 2020
How it's used in studies
Standard oncology doses; not studied for hair.
Side effects and safety
The hair effects are usually minor compared with the rash, diarrhoea and lung toxicity of these drugs. Long lashes can irritate the eye.
Bottom line
A real, reversible class effect known mainly from case reports and small series. It shows that EGFR signalling clearly controls shaft length and shape, but these are serious cancer drugs and not a lash strategy. Discuss with a doctor.
Fun facts
- Lashes that grow abnormally long and curly on cancer pills are a recognised side effect, and the same drugs can curl scalp hair.
Studies 6
Zheng H et al. Trichomegaly and scalp hair changes following treatment with erlotinib. Exp Ther Med. 2016
Result: Curly, long, brittle eyelashes and altered scalp hair; all gradually resolved after the drug was withdrawn.
Read the study ↗Jazayeri F et al. A case of acquired trichomegaly following treatment with erlotinib. BMJ Case Rep. 2009
Result: Acquired eyelash overgrowth with erlotinib (title only read).
Read the study ↗Lane K et al. Erlotinib-associated trichomegaly. Ophthalmic Plast Reconstr Surg. 2007
Result: Erlotinib-associated eyelash overgrowth (title only read).
Read the study ↗Crespo-Carballes MJ et al. Trichomegaly induced by cetuximab. J Fr Ophtalmol. 2020
Result: Eyelash overgrowth induced by cetuximab (title only read).
Read the study ↗Dai J et al. Pigmentary changes in patients treated with targeted anticancer agents: a systematic review and meta-analysis. J Am Acad Dermatol. 2017
Result: Pigmentary changes occurred in 21.5% overall (RR 20.1); EGFR and BCR-ABL inhibitors were common culprits in case reports.
Read the study ↗Yale K et al. Medication-induced repigmentation of gray hair: a systematic review. Skin Appendage Disord. 2020
Result: Many drugs and some B vitamins were reported to repigment gray hair, mostly as incidental, low-quality reports.
Read the study ↗Related
- Drug-induced hair changesMedicines can thin hair, regrow it curly, darken or whiten it, or lengthen lashes; this table sorts the best-known links by how strong the evidence is.
- ImatinibA leukaemia drug that blocks the receptor pigment cells depend on can lighten or whiten hair reversibly, and oddly has also been listed among drugs that darkened gray hair.
- Immune checkpoint inhibitors (nivolumab, pembrolizumab)Anti-PD-1 cancer immunotherapy darkened white hair in 13 of 14 lung cancer patients in one series, and in a single case left a persistent curly-hair look.
- Chemotherapy hair changes ("chemo curls")Hair often regrows curlier, softer or a different colour after chemotherapy, but nobody has measured how often; what is better documented is that permanent thin regrowth is more common than once believed.